21/12/2024
chronic desquamative gingivitis
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Def:
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-A peculiar " مميزة"condition characterized by intense erythema , desquamation and ulceration of the free and attached gingival.
(described by By Prinz in 1932)
-It was not a specific disease entity, but a gingival response associated with a variety of conditions.
(Described by McCarthy & colleagues in 1960) , and this concept has been further supported by numerous immunopathologic studies.
ونحط تحت جملة " it is not a specific entity" مليون خط
-Many mucocutaneous conditions such as bullous pemphgoid , pemphigus vulgaris , linear
Immunoglobulin A disease , dermatitis herpetiformis , lupus erythematous , and chronic ulcerative Stomatitis can manifest as desquamative gingivitis.
يعني اما نلاقي قدامنا desquamative gingivitis اعمل diagnosis لل oral mucosa كلها كويس جدا عشان لو في any associated lesions
-Use of clinical and lab parameters have revealed that approximately 75% of desquamative gingivitis have a dermatologic genesis. (Cicatricial Pemphigoid & Lichen planus account for over 95% of dermatologic cases).
Differential diagnosis:
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1-Chronic bacterial , fungal and viral infections.
2-Reactions to medications, mouth washes and chewing gum.
Etiology:
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1-Endocrine imbalance:-
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-Usually occurs in females in the menopausal period due to hormonal imbalance.
2-Dermatosis:-
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-One of the main etiologic factors.
-E.x:-
Lichen planus (especially the erosive form) , leukoplakia , white spongy nevus , pemphigus vulgaris , mucous membrane pemphgoid , chronic ulcerative stomatitis , linear IgA disease , systemic lupus erthyematosis and dermatisis herpetiformis .
3-Chronic bacterial infections:-
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-Syphilis & T.B.
4-Mycotic disease:
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-Acute & chronic candidiasis.
-Actinomycosis. –Histoplasmosis.
6-Metabolic disturbances.
7-Vitamin C deficiency.
8-Aging.
9-Malignancy.
Clinical features:
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1-Mild form:-
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-Diffuse erythema of the marginal , interdental and attached gingiva.
-Painless.
–Common in females , between (17-23)years of age and in the child bearing period.
2-Moderate form:-
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-Patchy distribution of bright red and grey areas involving the marginal and attached gingiva.
-The surface is smooth and shiny.
-The gingival is soft, pitting on pressure due to edema and the epithelium is not firmly adherent to underlying tissues.
-Positive nikolisky's sign pressing on epithelium and pushing so it moves as in pemphigus vulgaris.
-Burning sensation and sensitivity to thermal changes.
-Age: 30-40 years of age.
-The labial surface is more severely involved as it is dehydrated because it is more exposed than the lingual surface.
3-Severe form:-
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-Scattered irregular areas of red and denuded gingiva.
–Extremely painful and burning sensation is accentuated in denuded areas.
-Surface epithelium is shredded, friable and peels off easily.
-Other areas of the oral mucosa may be affected as the cheek mucosa & the tongue.
Diagnosis:
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1-Clinical history to record the symptoms associated with this condition and to ask for old skin lesions.
2-Clinical examination to recognize the pattern of distribution of the lesion
(focal or multifocal , with or without confinement to gingival tissues).
3-Incisional biopsy to begin the microscopic and immunologic evaluation.
4-Microscopic examination.
5-Immunoflourescence.
Management:
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-The dentist must choose the optimum management for the patient according to:-
1-Practitioner's experience:
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-E.x: Erosive lichen planus can be treated by topical steroids. "dentist only"
2-Systemic impact of the disease:
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-E.x: Cicatricial pemphgoid is handled by both
the dentist and the ophthalmologist.
3-Systemic complications of the medications:
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-The patient is immediately referred to
a dermatologist for further evaluation and treatment.
-E.x: Pemphigus vulgaris once diagnosed by
the dentist , require immediate referral to the dermatologist.
-Treatment regimen:
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A)Plaque control.
B)Topical corticosteroids in moderate cases. "Kenacort A orabase"
C)Systemic corticosteroids in severe cases. "Predinsone"
Usually the result is obvious after 2 weeks of treatment
Frequent follow up is recommended every 3 months .
يمكن كده باختصار ده هو ملخص الكلام عن ال desquamative gingivitis عشان نعرف نميزه عن باقي انواع ال gingivitis زي
1-plaque-induced gingivitis.
2-1ry herpetic gingivostomatitis.
3-Necrotizing gingivitis (NUG).
4-Fungal gingivitis. " very rare"
