Dr. P. Srujan Kumar MDS Reader

2. Presented by
Dr. P. Srujan Kumar
MDS Reader

3. INTRODUCTION
The term chronic desquamative gingivitis was
coined in 1932 by prinz
Characterized by intense redness, desquamation,
and ulceration of the free and attached gingiva

4. ETIOLOGY
HARMONAL IMBALANCE

5. CLINICAL FEATURES
MILD
MODERATE
SEVERE

6. MILD FORM
diffuse erythema of the marginal, interdental,
and attached gingiva
painless and comes to the attention of the
patient because of discoloration
most frequently in females between 17-23yrs

7. MODERATE FORM
Presents as patchy distribution of bright red
and gray areas involving the marginal and
attached gingiva
The surface is smooth and shiny, and
normally resilient gingiva becomes soft

8. there is slight pitting on pressure, and the
epithelium is not firmly adherent to the
underlying tissues
massaging the gingiva with the finger result
in peeling of the epithelium and exposure of
underlying bleeding connective tissue surface

9. The oral mucosa in the remainder of mouth
is extremely smooth and shiny
Patients complains of burning sensation and
sensitivity to thermal changes and inhalation of
air is painful

10. The patients cannot tolerate condiments,
and tooth brushing causes painful denudation
of the gingival surfaces
occurs most frequently between 30 - 40 yrs

11. SEVERE FORM
characterized by scattered, irregularly shaped
areas in which the gingiva is denuded and
strikingly red
The surface epithelium seems shredded and
friable and can be peeled-off in small patches

12. occasionally there are surface vessels that
rupture, releasing a thin, aqueous fluid and
exposing an underlying surface that is red and raw
a blast of air directed at the gingiva causes
elevation of the epithelium and the consequent
formation of a bubble

13. the mucous membrane other than the gingiva
is smooth and shiny and is extreamly painful
the patient cannot tolerate coarse foods,
condiments, or temperature changes
constant dry, burning sensation -- oral cavity
occurs mostly after menopause

14. HISTOPATHOLOGY
DESQUAMATIVE GINGIVITIS APPEARS AS ONE
OF THE TWO TYPES:
bullous lesions, resembling the histopathologic
features of mucous membrane pemphigoid
or
lichenplanus

15. occasionally there will be a thin atrophic
epithelium with little or no keratin at the
surface and dense, diffuse infiltration of
chronic inflamatory cells in the underlying tissue

16. MANAGEMENT
LOCAL TREATMENT
The patient is carefully instructed in
plaque control using a soft brush, because the
gingival surface is easily abraded with hard rush

17. oxidizing mouth washes [ hydrogen peroxide 3% diluted to
one part peroxide and two parts warm water] should be
used twice daily
gingival tissue is gently dried with a sterile sponge,
and a cortecosteroid ointment such as triamcinolone
[kenalog, aristocort ] 0.1% is gently rubbed into the gingiva
several times daily

18. SYSTEMIC THERAPY
prednisone can be used in a daily dose or
every-other-day dose of 30-40mg and gradually
reduced to a daily maintenance dose of 5-10mg
or every-other-day maintenance dose of 10-20mg

19. CONCLUSION
Local therapy will eventually improve the condition
Particular care and patience is required in the
atropic gingivitis of aging,because no systemic therapy
has been found to be useful other than nutritional
supplement such as vitamin B complex