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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, 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 (reddening) and œdema (swelling) of the marginal and attached
attached
gingiva (gum).

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

Dental Update 2017.  Desquamative Gingivitis − Aetiology, Diagnosis & Management
Photo showing Desquamative Gingivitis in Oral Lichen Planus
Photo showing Desquamative Gingivitis in Cicatrial Pemphigoid
Photo showing Desquamative Gingivitis in Benign Mucous Membrane Pemphigoid
Last Updated 28th June 2017