Desquamative gingivitis

Desquamative gingivitis
Desquamative gingivitis
Other names	DG
Specialty	Periodontology

Desquamative gingivitis is an erythematous (red), desquamatous (shedding) and ulcerated appearance of the gums.^[1] It is a descriptive term and can be caused by several different disorders.^[2]

Signs and symptoms

Desquamative gingivitis involves lesions of the free and attached gingiva. Unlike plaque-induced inflammation of the gums (normal marginal gingivitis), desquamative gingivitis extends beyond the marginal gingiva, involving the full width of the gingiva and sometimes the alveolar mucosa.^[3] The term "full width gingivitis" usually refers to the oral lesions of orofacial granulomatosis however.^[4] The color is another dissimilarity between typical marginal gingivitis and desquamative gingivitis, in the latter it is dusky red.^[3] Plasma cell gingivitis is another form of gingivitis which affects both the attached and free gingiva.^[1]

Cause

Caused by various autoimmune diseases as well as allergies. Erosive lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, erythema exsudativum multiforme and lupus erythematosus.

Diagnosis

Differential diagnosis

Desquamative gingivitis is a descriptive clinical term, not a diagnosis.^[1] Dermatologic conditions cause about 75% of cases of desquamative gingivitis, and over 95% of the dermatologic cases are accounted for by either oral lichen planus or cicatricial pemphigoid.^[1] The exact cause of desquamative gingivitis cannot be determined about a third of cases.^[1]

Oral lichen planus^[1]
Cicatricial pemphigoid^[1] or less commonly bullous pemphigoid^[1]
Pemphigus vulgaris^[1]
Linear immunoglobulin A disease^[1]
Dermatitis herpetiformis^[1]
Lupus erythematosus^[1]
Chronic ulcerative stomatitis^[1]
Chronic bacterial, fungal, and viral infections^[1]
Reactions to medications, mouthwashes, and chewing gum^[1]

Rare causes include:

Crohn's disease^[1]
Sarcoidosis^[1]
Leukemia^[1]
factitious (self inflicted) lesions^[1]
Squamous cell carcinoma (can be mistaken for desquamative gingivitis)^[1]

Treatment

Improving oral hygiene
Minimising irritation of the lesions
Specific therapies for the underlying disease (where available)
Local or systemic immunosuppressive or dapsone therapy (notably not corticosteroids)

History

This condition was first recognized and reported in 1894, but the term desquamative gingivitis was not coined until 1932.^[1]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u Newman, Michael G.; Takei, Henry H.; Carranza, Fermín A., eds. (2012). Carranza's clinical periodontology (11th ed.). St. Louis, Mo: Elsevier/Saunders. pp. 111–126. ISBN 978-1-4377-0416-7.
^ Lo Russo, L; Fedele, S; Guiglia, R; Ciavarella, D; Lo Muzio, L; Gallo, P; Di Liberto, C; Campisi, G (January 2008). "Diagnostic pathways and clinical significance of desquamative gingivitis". Journal of Periodontology. 79 (1): 4–24. doi:10.1902/jop.2008.070231. PMID 18166088.
^ ^a ^b Odell, E. W., ed. (2010). Clinical problem solving in dentistry. Clinical problem solving in dentistry series (3rd ed.). Edinburgh ; New York: Churchill Livingstone. p. 192. ISBN 978-0-443-06784-6. OCLC 427608817.
^ Welbury R; Duggal M; Hosey MT (2012). Welbury, Richard; Duggal, Monty S.; Hosey, Marie Thérèse (eds.). Paediatric dentistry (4th ed.). Oxford: Oxford University Press. p. 319. ISBN 978-0-19-957491-9.