Desquamative gingivitis: retrospective analysis of disease associations of a large cohort.
ABSTRACT Desquamative gingivitis (DG) is usually a manifestation of immunologically mediated mucocutaneous disorders, although it was previously suggested to be hormonally related.
One hundred and eighty-seven Caucasian UK residents with clinical features of DG (126 female, median age of 51 years, range 23-93 years) were retrospectively evaluated.
It was established that, in this population, the largest cohort yet reported, oral lichen planus was most common (70.5%) while mucous membrane pemphigoid (14%), pemphigus vulgaris (13%), linear IgA disease (1.6%), dermatomyositis (0.5%) and mixed connective tissue disease (0.5%) were less common.
Oral lichen planus is the main disorder associated with DG. However, DG may be a feature of bullous disease and connective tissue disease.
- SourceAvailable from: Mariano Sanz
Article: Acute periodontal lesions.[Show abstract] [Hide abstract]
ABSTRACT: This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.Periodontology 2000 06/2014; 65(1):149-77. · 4.01 Impact Factor
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ABSTRACT: Background: Desquamative gingivitis (DG) is a clinical manifestation common to several diseases. It is known that most cases of DG are caused by mucous membrane pemphigoid (MMP), oral lichen planus (OLP), or pemphigus vulgaris (PV). Early recognition and treatment of these diseases can improve the prognosis, but diagnostic delays are common in DG patients because obtaining a diagnostic biopsy is technically challenging. We developed a biopsy technique designed to maintain the gingival epithelium for DG patients. The usefulness of this technique is discussed. Methods: This study was based on a retrospective review of 27 DG cases. A stab & roll technique was used to obtain gingival tissue. This technique is designed to reduce lateral forces on the epithelium during the procedure and to thereby prevent the inadvertent removal of the epithelium from the biopsy specimen. A total of 52 biopsies comprised of 27 for hematoxylin- and eosin- (H&E) stained samples and 25 for direct immunofluorescence (DIF) testing were reviewed. Results: Fifty-one of the 52 biopsies (98.1%) maintained the epithelium. Only 1 biopsy (1.9%) showed that the epithelium was totally absent. Therefore the H&E and DIF features of the remainder were defined. Definitive diagnoses of the diseases causing DG included MMP (13 cases), PV (8 cases), and OLP (6 cases). Conclusions: We were able to obtain a diagnostic biopsy from the gingiva of DG patients using the stab & roll technique. The gingival epithelium was well maintained, and the relationship with the underlying connective tissue was diagnostic. In the future, this stab & roll biopsy technique may facilitate early diagnosis and treatment of diseases causing DG.Journal of Periodontology 03/2014; · 2.40 Impact Factor