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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 865-867  

Idiopathic desquamative gingivitis


1 Department of Pediatric Dentistry and Orthodontics, King Khalid University, College of Dentistry, Abha, Saudi Arabia
2 Department of Periodontics, Faculty of Dentistry, AIMST University, Bedong, India
3 School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
4 Department of Periodontics, JKK Nattraja Dental College, Komarapalayam, Tamil Nadu, India
5 Krishna Dental Clinic, Erode, Tamil Nadu, India

Date of Submission29-Sep-2020
Date of Decision30-Sep-2020
Date of Acceptance01-Oct-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Rajeev Arunachalam
Department of Periodontics, Faculty of Dentistry, AIMST University, Bedong
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_622_20

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   Abstract 


Desquamative gingivitis is described as an erythematous, desquamated gingival lesion. There are many etiologic factors for the appearance of such lesions. The aim of this case report is to diagnose the cause of the lesion by analyzing the complete medical, dental, and personal histories. An elaborated differential diagnosis is done, and the lesion is successfully treated accordingly. The gold standard treatment is usually provided by systemic or topical corticosteroids. Another treatment option is antioxidant therapy which provides rapid healing of the tissue

Keywords: Corticosteroids, desquamative gingivitis, differential diagnosis, systemic antioxidants


How to cite this article:
Alkahtani ZM, Arunachalam R, Bapat RA, Thangavelu A, Jegatheeswaran AG. Idiopathic desquamative gingivitis. J Pharm Bioall Sci 2021;13, Suppl S1:865-7

How to cite this URL:
Alkahtani ZM, Arunachalam R, Bapat RA, Thangavelu A, Jegatheeswaran AG. Idiopathic desquamative gingivitis. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Oct 26];13, Suppl S1:865-7. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/865/317589




   Introduction Top


In our clinical practice, unusual gingival manifestations put us in confusion about the diagnosis. The term “desquamation” is derived from the Latin word “Desquamare” which means scraping fish flakes.[1] Desquamative gingivitis is a clinical sign which manifests as desquamation, erosions, ulceration, vesicles, and bullas involving both free and attached gingivae.[2] It is associated with autoimmune and systemic diseases such as pemphigus vulgaris, pemphigoid, and bullous form of oral lichen planus. This condition was first described by Tomes in 1894. Desquamative gingivitis was then coined by Prinz in 1932. In 1960, McCarthy suggested that desquamative gingivitis was a gingival response associated with vesiculobullous lesions and adverse reactions to chemicals or allergens.[3] According to Glickman, in 1953, chronic desquamative gingivitis may represent a manifestation of several disease processes.[4] This involves the erythema, desquamation, and ulceration of the free and attached gingivae. The initial cause of this desquamation was unclear.[5] The disease is more prevalent in women and in the fourth to fifth decades of life. There is a very strong correlation between dermatologic mucocutaneous disorders and desquamative gingivitis.[6] The presented case report of desquamative gingivitis showed the typical signs of erythematous patches.

[TAG:2]Case Report [/TAG:2]

A 52-year-old male with the chief complaint of burning sensation in the mouth reported to Krishna Dental Clinic, Erode, Tamil Nadu. The patient experienced a burning sensation mainly in the upper palatal region for the past 6 months. The patient's history revealed that he had redness of gums and also had a burning sensation while taking hot and spicy foods. The burning sensation was also accompanied by pain in the back tooth regions for the past 2 months. The patient had warm salt water gargling to relieve his symptoms. The complete medical history was taken, which showed that the patient did not have any skin diseases or autoimmune disease. There were no associated ocular, cutaneous, and genital lesions. The routine laboratory investigations revealed that the patient is not anemic and his blood counts were normal. His dental history depicted that he had undergone extraction before 6 years and no other dental problems were reported. No habit of smoking, tobacco chewing, and alcohol was reported.

The clinical examination revealed bright, red, erythematous gingiva in the upper and lower anteriors, as shown in [Figure 1]. The upper palatal region showed reddish desquamated patches which peeled on probing, as shown in [Figure 2]. The desquamation was more on the attached gingival areas and in palatal mucosa. The patches were seen in 31, 32, 41, 42, 43, and 44 labial mucosal and 17, 16, 26, 27, and 25 palatal mucosal regions. The etiology for the appearance of desquamated gingivitis in this patient was unknown. The oral hygiene was poor and exhibited a band of subgingival calculus and recession in 16 and 17. Based on clinical findings, this patient was diagnosed provisionally as desquamative gingivitis.
Figure 1: Reddish lesions in labial gingiva of 42, 43, and 44 regions

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Figure 2: Reddish ulcerated palatal mucosa in 15, 16, 17, 26, and 27 areas

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Full mouth scaling and root planing was done in lower anteriors, premolars, and upper posteriors. The patient was advised with 0.2% chlorhexidine mouth rinse. Oral hygiene instructions were also given. Topical application of triamcinolone acetonide twice daily for 3 weeks was prescribed. After 3 weeks, the systemic antioxidant therapy twice daily for 2 months was advised. The patient was recalled after 6 months, clinical examination showed healed pale gingiva, and the burning sensation was cured.


   Discussion Top


Desquamative gingivitis is a descriptive clinical term for desquamation, erosions, ulcers, and bullas that most commonly involves both free and attached gingivae.[7],[8] The definitive diagnosis of desquamative gingivitis is always very difficult. Therefore, it is mandatory that dental practitioners must recognize and correctly diagnose desquamative gingivitis. A better diagnosis leads to a good prognosis and an improved life quality for those patients.[9]

Based on the etiology, desquamative gingivitis was classified as (1) dermatological diseases, (2) cicatricial pemphigoid, (3) lichen planus, (4) pemphigus, (5) Psoriasis, (6) Bullous pemphigoid, (7) epidermolysis bullosa acquisita, (8) contact stomatitis, (9) estrogen deficiencies following oophorectomy and in postmenopausal stages, (10) testosterone imbalance, (11) hypothyroidism, (12) aging, (13) idiopathic, (14) chronic infections, (15) tuberculosis, and (16) chronic candidiasis.[10] Based on the clinical findings and history of the patient, the present case was diagnosed as idiopathic desquamative gingivitis. The differential diagnosis of desquamative gingivitis includes factitious injuries, chemical and electrical burns, allergic reactions to mouthwashes, chewing gums, cosmetic products, drugs, cinnamon and dental abrasives, hormonal disorders, and mucocutaneous diseases.[11]

Thus, the success of therapeutic approach depends on the reinforcement of an appropriate final diagnosis. The desquamative gingivitis treatment includes complete removal of plaque and calculus. The control of local irritants such as rough restorations, ill-fitting dentures, traumatic oral hygiene procedures, and dysfunctional oral habits also should be done.[12] Treatments are available in the form of systemic or topical steroids, antimetabolites such as cyclophosphamide, azathioprine, and methotrexate, and low-level laser therapy. As the patient with desquamative gingivitis unable to maintain a proper oral hygiene due to unbearable pain, proper plaque control should be advised to the patient.[13]

In the present case, the free and attached gingivae showed reddish desquamative lesions in the lower anteriors and upper palatal region. The patient history had no significance related to allergies and habits. Hence, the case was finally diagnosed as idiopathic desquamative gingivitis. After thorough oral prophylaxis, topical steroids were prescribed and systemic antioxidants were also given in the review period. After 6 months healthy pale gingiva was seen and the burning sensation was completely eliminated.


   Conclusion Top


Thus, dentists would be the first health professionals to recognize these multimucosal involvement disorders. The management of desquamative gingivitis is always challenging because lesions may reoccur after it goes into remission. The present case was successfully treated using topical steroids and systemic antioxidant therapy along with good oral hygiene maintenance. The correct diagnosis of these types of lesions entails taking a detailed history, with a thorough intraoral and extraoral examination, along with histopathology studies.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Paul GT. Desquamative gingivitis: Does the gingiva tell you more than what meets the eye? A comprehensive review. J Adv Clin Res Insights 2019;6:48-52.  Back to cited text no. 1
    
2.
Newman MG, Takei H, Klokkevold PR, Carranza FA. Carranza's Clinical Periodontology. 10th ed. St. Louis: Saunders, Elsevier; 2006. p. 411-33.  Back to cited text no. 2
    
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Tofan EC, Părlătescu I, Ţovaru Ş, Nicolae C, Preda AS, Funieru C. Desquamative gingivitis-A clinicopathological review. Curr Health Sci J 2018;44:331-6.  Back to cited text no. 3
    
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Yajamanya SR, Jayaram P, Chatterjee A. Desquamative gingivitis mimicking mild gingivitis. J Indian Soc Periodontol 2016;20:565-8.  Back to cited text no. 4
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Al-Abeedi F, Aldahish Y, Almotawa Z, Kujan O. The differential diagnosis of desquamative gingivitis: Review of the literature and clinical guide for dental undergraduates. J Int Oral Health 2015;7:88-92.  Back to cited text no. 5
    
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Richards A. Desquamative gingivitis: Investigation, diagnosis and therapeutic management in practice. Periodontol 2005;2:183-90.  Back to cited text no. 6
    
7.
Karagoz G, Bektas-Kayhan K, Unur M. Desquamative gingivitis: A review. J Istanbul Univ Fac Dent 2016;50:54-60.  Back to cited text no. 7
    
8.
Deshpande Sathe R, Motwani R, Dwivedi P, Mahendra MS, Jain PG. Oral erosive lichen planus with desquamative gingivitis: A case report- Innovative approaches and review of treatment modalities. J Oral Med Oral Surg Oral Pathol Oral Radiol 2018;4:168-72.  Back to cited text no. 8
    
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Popova C, Doseva V, Kotsilkov K. Desquamative gingivitis as a symptom of different mucocutaneous disorders. J IMAB 2007;13:31-3.  Back to cited text no. 9
    
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Hasan S. Desquamative gingivitis-A clinical sign in mucous membrane pemphigoid: Report of a case and review of literature. J Pharm Bioallied Sci 2014;6:122-6.  Back to cited text no. 10
    
11.
Mhaske M, Thakur N, Bansode S, Kedar P. Desquamative Gingivitis treated by an antioxidant therapy- A case report. Int J Pharm Sci Invent 2016;5:18-22.  Back to cited text no. 11
    
12.
Suresh L, Neiders ME. Definitive and differential diagnosis of desquamative gingivitis through direct immunofluorescence studies. J Periodontol 2012;83:1270-8.  Back to cited text no. 12
    
13.
Lo Russo L, Fedele S, Guiglia R, Ciavarella D, Lo Muzio L, Gallo P, et al. Diagnostic pathways and clinical significance of desquamative gingivitis. J Periodontol 2008;79:4-24.  Back to cited text no. 13
    


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  [Figure 1], [Figure 2]



 

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