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| 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:
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:
The treatment of desquamative gingivitis consists of:
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
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 |