Chronic desquamative gingivitis

The characteristics in the concept, etiology pathogeny and clinic of the cronic descamative gingivitis are reviewed. The differential diagnostic with other similar processes are analyzed. The paper is finished with the therapeutics approach of this entity.     

Immunofluorescent studies in desquamative gingivitis

Twenty-seven patients (19 females and 8 males) with a clinically diagnosed desquamative gingivitis were used in this study. Twenty-seven additional patients with oral and skin diseases and with gingival involvement other than that of the de-squamative gingivitis type served as controls. Biopsy gingival specimens were sectioned and stained with H and E. The rest of the tissue specimen was cut with a cryostat and used for immunofluorescent assays of the tissue-bound antibodies (IgG, IgA, IgM, C3 and fibrin). Circulating antibodies were determined by using the indirect immunofluorescence method in serum samples. Normal human oral mucosa and several animal epithelial tissues were used as substrates. The immunopathologic findings suggest the diagnosis of lichen planus in the presence of linear or granular fibrin deposition at the basement membrane zone/mucosal submucosal interface with or without cytoid bodies and cicalricial pemphigoid, in the presence of circulating and/or tissue-bound immunoglobulins and C3 in a linear continuous pattern along the BMZ. It is suggested that an accurate diagnosis of the underlying disease of the desquamative gingivitis can be made on the basis of the clinical, histopalhologie, immunopathologic and follow-up findings.     

Frequency of desquamative gingivitis in skin diseases

In an attempt to determine the frequency of desquamative gingivitis (DG) in pemphigus vulgaris (PV), bullous pemphigoid (BP), cicatricial pemphigoid (CP), and lichen planus (LP), a large series of patients examined and classified in each group during the years 1972 to 1981 were included in this study. Analysis of the clinical data revealed that, of the four skin diseases, CP manifests as DG in 63.6 percent of the cases. Desquamative gingival lesions are less frequent in LP (25 percent) and in PV (18.4 percent). The great majority of DG patients were females (72.9 percent). Identification of the underlying causes of desquamative gingivitis is of utmost importance and is dependent upon clinical, histologic, and immunologic criteria.     

Expression of estrogen receptors in desquamative gingivitis

BACKGROUND: Most cases of chronic desquamative gingivitis (CDG) are shown by direct immunofluorescence (DIF) to be immune mediated diseases. Some patients present with similar clinical and microscopic findings as CDG but DIF staining is negative. It has been suggested that those cases of CDG may be hormone (estrogen) mediated and may be treated with estrogens with favorable results. METHODS: Gingival tissue from 24 cases of CDG and one case of ordinary gingivitis were studied for estrogen receptor (ER) expression using immunohistochemical techniques. Twenty-four of the 25 cases were female. Using standard DIF analysis, 11 of the CDG cases were diagnosed as benign mucous membrane pemphigoid, 10 as lichen planus or lichenoid mucositis (LP), and one as pemphigus. The remaining 3 cases were not diagnostic for a specific disorder (idiopathic). Five of the females had a history of estrogen substitute therapy. RESULTS: Twenty-two of 23 female CDG cases were positive for ER, although the degree of staining varied. A 32-year-old female with ordinary gingivitis, whose gingivitis varied with her menstrual cycle, did not stain for ER. A 50-year-old male and a 76-year-old female, both with gingival LP, also had negative staining for ER. CONCLUSIONS: There appears to be no correlation between diagnosed diseases (immunological versus idiopathic) and expression of ER in CDG gingiva. ER expression in the gingiva is probably not related to the presence or absence of estrogen supplementation. The results of this study do not support the use of estrogen in the treatment of idiopathic CDG.     

Labial veneers in the management of desquamative gingivitis

Desquamative gingivitis is an unsightly condition characterized by erythema and desquamation of the attached gingivae. The use of acrylic labial veneers as a vehicle for delivering medication and as a way to improve the esthetics is described.     

Periodontal clinical and microbiological data in desquamative gingivitis patients

Objectives

A series of patients affected by desquamative gingivitis (DG) was investigated in order to evaluate relation patterns among clinical parameters relevant to plaque-induced periodontitis, periodontal microbiological data and the presence of DG lesions.

Patients and methods

Eight oral lichen planus (OLP) and four mucous membrane pemphigoid (MMP) patients were examined. Periodontal measurements (performed at six sites per tooth on all teeth) included probing depth (PD), gingival recession (REC), clinical attachment loss (CAL) and full-mouth plaque (FMPS) and bleeding (FMBS) scores; the presence and the exact location (site by site) of DG lesions were carefully recorded. Sub-gingival plaque samples were collected and examined by means of real-time PCR for the quantitative determination of the six most important marker organisms of periodontitis. Statistically significant differences and correlation of studied variables between DG-positive and DG-negative sites were investigated in MMP and OLP cases using Mann–Whitney test (p?<?0.05) and the Spearman rank correlation coefficient, respectively.

Results

OLP gingival lesions do not significantly affect CAL, although the presence of such lesions may reduce REC and increase PD and FMPS. MMP gingival lesions significantly worsened CAL and increased REC and FMPS. In both OLP and MMP cases, no significant difference was found between DG-positive and DG-negative sites as regards the relative percentage of the investigated species on the total bacterial load. Correlations between the presence of DG lesions and clinical parameters (CAL, PD, REC) were not significant (p?<?0.05). Significant correlations were found for the presence of gingival OLP lesions and Aggregatibacter actinomycetemcomitans (AA) and for the absence of gingival MMP lesions and AA.

Conclusions

These findings are not definitive, but highlight the need for further investigations of periodontal clinical and microbiological aspects of disorders causing DG in order to clarify their potential interference with plaque-related periodontitis.     

Diagnostic pathways and clinical significance of desquamative gingivitis

The term desquamative gingivitis (DG) refers to a clinical manifestation that can be caused by several disorders. Many of them are immunologically mediated; in addition to the oral cavity, they can affect extraoral mucocutaneous sites, e.g., larynx, conjunctiva, esophagus, nasal and genital mucosa, and the skin. The degree of oral, periodontal, and systemic involvement determines the overall morbidity and, sometimes, the mortality of these disorders. We comprehensively review disorders commonly associated with DG and highlight diagnostic pathways, guidelines for differential diagnosis, and oral, periodontal, and systemic implications. More rare conditions are reviewed as well. Mucous membrane pemphigoid, oral lichen planus, and pemphigus vulgaris are responsible for the majority of cases of DG. In addition, other uncommon disorders should be considered. Accurate clinical, histologic, and serologic investigations are often required to differentiate among DG-associated disorders, provide adequate therapy, and improve the prognosis of patients.     

The management of intransigent desquamative gingivitis with Dapsone

Fifteen patients suffering from intransigent desquamative gingivitis due to lichen planus or benign mucous membrane pemphigoid were treated with dapsone (diphenylsulphapyridine) over a 3-month period. Twelve patients completed the trial. Therapeutic benefit was estimated clinically with the aid of 35mm color transparencies taken at 4-week intervals; and subjectively by the patients estimating their progress as worse, no change, some improvement or complete recovery. Taken as a whole, some 58% of patients had some benefit from therapy. Of the 7 patients with lichen planus, 1 showed complete recovery and 3 showed some improvement. In the 5 patients with desquamative gingivitis due to mucous membrane pemphigoid, 3 showed some improvement and 2 received no benefit. Three patients withdrew from the trial due to side effects of the dapsone such as headaches and nausea. It is concluded that dapsone therapy may be of some use in the management of desquamative gingivitis when traditional treatments have failed. Patients should be warned of the possibility of side effects.