Exodontia.Info
Desquamative Gingivitis
The term 'desquamative gingivitis' is a clinical
description, not a diagnosis.

It is used for conditions in which the
gingivæ (gums)
appear red or raw.  Usually the whole of the attached
gingiva of varying numbers of teeth is affected.

This is a clinical descriptive term used for non-specific
gingival (gum) manifestation of several chronic muco-
cutaneous
(effecting the skin and ‘wet’ surfaces of the
body) diseases.

With rare exceptions, an
auto-immune mechanism is
responsible.  
Cicatricial Pemphigoid and Lichen Planus
are the most common
auto-immune diseases that manifest
Desquamative Gingivitis.

Less commonly are
Bullous Pemphigoid, Pemphigus,
Linear IgA Disease, Epidermolysis Bullosa Acquisita
(weblink),
Chronic Ulcerative Stomatitis (weblink), Discoid
Lupus Erythematosus and Psoriasis.

Desquamative Gingivitis has also been associated with:

  • Chemical damage, such as reactions to sodium lauryl
    sulphate in toothpastes.
  • Allergic responses.
  • Drugs.
  • Pyostomatitis vegetans.
Desquamative Gingivitis presents as erythema
The ‘facial’ (that is, the surfaces facing out towards the lips
and cheeks) surface is more frequently affected than the
lingual / palatal gingivæ.  Spontaneous desquamation of
the
epithelia, blister formation and areas of superficial
erosions are common.

Some patients make no complaint, but the main complaint
is of persistent soreness of the
gingivæ; worse when
eating acerbic or spicy foods such as tomatoes, citrus
fruits and others.

The
desquamation may vary from mild, almost insignificant
small patches to widespread redness a ‘glazed’
appearance.

In addition to a full history and examination, biopsy
examination and appropriate
histo-pathological and
immunological investigations are frequently indicated.


Some other conditions can present with redness or ulcers
rather than the
atrophy or erosions typical of
Desquamative Gingivitis and should be excluded.

Such appearances may be seen in:

  • reactions to various mouthwashes, chewing gum,
    medications and dental materials
  • candidiasis (Thrush)
  • lupus erythematosus
  • plasma cell gingivitis
  • Crohn’s disease, sarcoidosis and oro-facial
    granulomatosis
  • leukæmias
  • factitial (self-induced) lesions.


The treatment of
desquamative gingivitis consists of:

  • improving the oral hygiene
  • minimising irritation of the lesions
  • specific therapies for the underlying disease where
    available
  • often local / systemic immuno-suppressive or dapsone
    therapy, notably cortico-steroids.  Cortico-steroid
    creams used overnight in a soft polythene splint, may
    help.


Useful Articles:

Oral Features of Mucocutaneous Disorders.  Committee on
Research, Science and Therapy.  American Academy of
Periodontology 1994.

Dental Update 1999.  Orofacial Disease - Update for the
Dental Clinical Team 7. Complaints Affecting Particularly
the Palate or Gingivae

Australian Dental Journal 2003.  Desquamative Gingivitis.  
A Sign of Mucocutaneous Disorders

Journal of IMAB - Annual Proceeding (Scientific Papers)
2007.  Desquamative Gingivitis as a Symptom of Different
Mucocutaneous Disorders
Photo showing Desquamative Gingivitis in Oral Lichen
Planus
Photo showing Desquamative Gingivitis in Cicatrial
Pemphigoid
Photo showing Desquamative Gingivitis in Benign Mucous
Membrane Pemphigoid