ABSTRACT. Desquamative gingivitis is a descriptive term of nonspecific clinical expression in the gingiva (redness, burning, erosion, pain) of several. Desquamative gingivitis (DG) is a clinical term used to describe gingival tissues that demonstrate potentially painful gingival erythema, hemorrhage, sloughing. Lichen planus is an idiopathic t-cell mediated inflammatory condition. Although its etiology is unknown OLP is sometimes associated with other medical.
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Desquamative gingivitis DG is characterized by the erythematous gingiva, desquamation and erosion of the gingival epithelium, and blister formation. It is a common clinical manifestation in several diseases.
Contact allergic reactions to various oral hygiene products and chemical agents have also been reported to represent as DG. Dewquamative management of DG has been a major problem, largely because the etiology of the disease has been elusive.
In this paper, we aimed to review the current literature on the pathogenesis, diagnosis management and prognosis of DG. Chronic desquamation of the gingiva is referred to as desquamative gingivitis DG 2.
Chronic desquamative gingivitis was described for the first time by Tomes and Tomes in 3. DG is a clinical finding, which progresses with desqjamative formation, atrophy, erosion and desquamation, characterized with diffuse erythema of the marginal and keratinized gingiva 689 Lesions start with diffuse erythema and minimal desquamation. The affected gingiva epithelium is very fragile and tends to exfoliate easily, even with the slightest trauma 3.
Large ulceration areas can be observed in some cases The desquamative gingivitis is seen after puberty, especially in individuals over 30 years of age 3. It is more common in women than in men. It has been reported that it can rarely xesquamative observed in children 2 desquamtaive, 38 Desquamation of epithelial tissue is generally seen dsquamative free and keratinized gingiva. Although they are generally observed in the anterior region, they can be seen in any gingival area 6.
Similar lesions can be seen in the edentulous alveolar ridge. While only desquamations can be observed in the patients, there can also be associated vesicular-bullous lesions, in addition to ulcerative and lichenoid lesions.
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In severe cases, it can be seen generalized at the oral mucosa, and the alveolar mucosa can be affected together with the gingiva The patient gingiivtis either have no complaints or there can be cesquamative burning sensation or severe pain. In general, there is chronic pain, which especially increases with the intake of acidic foods.
Limitation of oral function and speech difficulties due to gingivitks can also be observed 26. Nisengard and Levine 14 desqumaative mentioned some characteristics in order to diagnose the clinical findings as DG, since gingival erythema is not associated with plaque and ddesquamative of gingival desquamation.
They also emphasized that the Nikolsky phenomenon is generally positive in DG patients. Only a single etiologic factor was considered in the first desquamate gingivitis DG cases. Initially, it was suggested that gingival desquamations were related to hormonal changes due to menopause on the basis that gingival desquamations were more common in the middle-aged and in women InGlikman and Smulow 15 stated that DG could be the symptom of severe conditions, especially mucocutaneous diseases. Recently, it has been generally accepted that DG can yingivitis the initial symptom of vesicular bullous diseases and can emerge as a result of reactions against some chemicals and allergens, and that it is not related to hormones 2361012 The differential diagnosis of desquamative gingivitis DG includes a wide spectrum, such as chemical and electrical burns, allergic reactions, hormonal disorders and mucocutaneous diseases.
Furthermore, a similar clinical pattern can be observed in reactions developing against mouthwashes Figure 1chewing gums, cosmetic products, drugs, cinnamon and dental materials It is suggested that the disease may be observed when there is lack of estrogen or progesterone Additionally, there are idiopathic gingival desquamative lesions without any etiologic factors Figure 2 3.
There are conflicting arguments on whether it is a symptom of oral lichen planus Figure 3mucous membrane pemphigoid Figure 4or a clinical manifestation of these diseases 12 Mucosal and gingival desquamation developing as a result of an allergic reaction against toothpaste. Atrophic form of Lichen Planus creates a typical desquamative gingivitis appearance at the gingiva. The intraoral appearance of mucous membrane pemphigoid is generally similar to desquamative gingivitis.
Since the initial symptoms of pemphigus can begin as desquamative gingivotis, it is important to evaluate this drsquamative symptom to reach an early diagnosis.
Oral Lichen Planus (OLP) | Desquamative Gingivitis | Continuing Education Course |
The definitive diagnosis of desquamative gingivitis is very difficult and complicated. Determination of the etiologic factors that cause the lesions or making the diagnosis of the underlying systemic disease can take a long time.
Detailed history of the patient, systemic symptoms, presence of similar lesions at other sites of the body, medications used, contact with chemical materials and the family history should be questioned 3. If there is suspicion of allergy, a patch test against dental materials can be performed on the patient The definitive diagnosis can be made by histopathological, direct DIF and indirect immune fluorescent IIF examinations of the tissues obtained from the lesions, in addition to examination of autoantibodies in the circulation Several mucocutaneous diseases in which clinical desquamative gingivitis is observed have been reported in the literature Table 1.
The clinical condition generally exacerbates with plaque accumulation, trauma or improper brushing. The clinical picture worsens with the disruption of oral hygiene practices due to pain and bleeding 3 The disease continues chronically with periods of remission and exacerbation.
Recovery of the gingiva may take months Although the intraoral presence of desquamative gingival lesions differ, various durations from 2 months to 25 years have been reported If there are previously determined etiologic factors allergen materials, etc. Subgingival and supragingival plaques should be removed and proper teeth brushing with a soft brush in addition to flossing should be recommended Besides, patients should be warned about mechanical and chemical trauma.
Intraoral restorations or prosthesis should be removed 8. Systemic and topical corticosteroids are used for the medical treatment of DG. Topical corticosteroids are commonly used to treat DG. However, their effects are limited due to the saliva volume and the tongue movements which decreases the effectiveness of the treatment. Direct application of chlobetasole propionate to the affected site is recommended 3 Custom built silicone or acrylic carriers which provide long term contact of the drug with the gingival lesion can be prepared to increase the effectiveness of the topical treatment.
For generalized lesions, prednisolone mgbetamethasone 0. Topical use of sicatrizing drugs as supportive treatment accelerates regression of lesions There are cases that have been reported concerning the gingivitls use of topical tacrolimus 0. However, its use is not preferred, due to the necessity of controlling serum tacrolimus levels at certain intervals and because of the side effects in some patients 11 Use of drugs such as cyclosporine, azathioprine, and ginglvitis has also been mentioned in the literature Estrogen support for the treatment of DG has been recommended based on the presence of estrogen-sensitive receptors in the human gingiva and estrogen destruction The idea of estrogen therapy has been rejected since the estrogen receptors expressions in the gingival tissues are not related to the presence or absence of estrogen as well as the side effects of estrogen 45gingivotis Desquamative gingivitis can be the clinical symptom of some dermatitis and mucocutaneous diseases and the underlying primary cause should be evaluated meticulously.
Taking detailed patient history, performing a careful intraoral examination desqkamative determining the presence or absence of similar lesions at other sites of the body are the most important steps in clinical practice. Definitive diagnosis of DG should be made by incisional biopsy, histopathological examination and DIF. Gingival lesions are controlled by improving oral hygiene and the use of topical corticosteroids. If there is an underlying systemic disease, the case should be consulted with the physician.
National Center for Biotechnology InformationU. J Istanb Univ Fac Dent. Published online Apr 1. Author information Article notes Copyright and License information Disclaimer. Received Mar 15; Accepted Jun Users must give appropriate credit, provide a desquxmative to the license, and indicate if changes were made. Users may do so in any reasonable manner, but not in any way that suggests the journal endorses its use. The material cannot be used for commercial gingiviris.
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Abstract Desquamative gingivitis DG is characterized by the erythematous gingiva, desquamation and erosion of the gingival epithelium, and blister formation.
Desquamative gingivitis, Mucocutaneous diseases, Contact allergic reactions. Differential Diagnosis and Prognosis The gingifitis diagnosis of desquamative gingivitis DG includes a wide spectrum, such as chemical and electrical burns, allergic reactions, hormonal disorders and mucocutaneous diseases.
Desquamative gingivitis: A review
Open in a separate window. Desquamative gingivitis not related to disease or allergic reaction. Disease in which desquamative gingivitis is clinically observed. Lichen planus Scully et al. Treatment If there are previously determined etiologic factors allergen materials, etc. Conclusion Desquamative gingivitis can be the clinical symptom of some dermatitis and mucocutaneous diseases and the underlying primary cause should be evaluated meticulously.
Footnotes Source of funding: Desquamation Online [Internet] [access date: Scully C, Porter SR. The clinical ginivitis of desquamative gingivitis.
Semin Cutan Med Surg. A combined treatment regimen for desquamative gingivitis in patients with oral lichen planus. J Oral Pathol Med. Chronic diffuse desquamative gingivitis.
Use of oral exfoliative cytology to diagnose desquamative gingivitis: Epidemiology of desquamative gingivitis: Endo H, Rees TD.