Desquamative gingivitis is one of the very common and stubborn non plaque induced gingival diseases affecting middle aged population.

1. DESQUAMATIVE GINGIVITIS
Dr. Monali Shah
Professor, KMSDCH

2. Contents
• Introduction
• Diagnosis of desquamative gingivitis
• Conditions associated with desquamative gingivitis
• Conclusion
• References

3. INTRODUCTION
1st Recognized by Tomes 1894
Chronic Desquamative gingivitis 1932 by
Prinz
Later in 1960, McCarthy et al. - was not a
specific disease entity but a gingival response
associated with a variety of conditions.

4. What is Desquamative gingivitis?

5. What is DG? Contd…..
• Desquamative gingivitis describes a painful, non-
plaque induced, sloughing of the gingiva.
• The lesions of can occur at any gingival site but
are most common on the labial aspect of anterior
teeth. Sometimes involving other part of oral
mucosa.
• It is considered to be a manifestation of a number
of diseases, most peaking in the fourth to sixth
decades of life.
• More prevalent in female.

6. What is DG? Contd……
• Desquamative gingivitis is a long standing
condition of indefinite duration with periods of
remission and exacerbation, which may or may
not terminate spontaneously.
• The term desquamative gingivitis (DG) describes
a clinical condition in which the gingival tissues
are erythematous, blistering, and eroding.
• It is not a diagnosis but is a term applied to the
manifestation of a multitude of mucocutaneous,
systemic, allergic, and immunologic diseases.

7. Diagnosis of desquamative gingivitis
Clinical
features
Constant burning pain or sometimes painless
Intolerance to thermal change as well as food
Tooth brushing becomes difficult-more plaque accumulation-aggravate
gingival condition
Episodic in nature and recurrence is high
Irregularly distributed bright red or grey Lesions may be present on
other part of oral cavity along with gingiva
Patches of denuded epithelium
Nikolsky’s sign present

8. • Direct- Anti Ig G, Ig A,
Ig M, anti-fibrin, anti-C3
Clinical history
Biopsy
Immunofluorescence
Microscopic
examination
Clinical
examination
•Symptoms & historical aspects
•Information regarding previous
therapy
•Recognition of pattern of
distribution of lesions
•Presence of Nikolsky’s sign
•Incisional biopsy- Best
•Perilesional biopsy - Avoid
at ulceration area•Approx 5 µm sections of
formalin fixed, paraffin
embedded tissue

9. Diseases clinically
presenting as
Desquamatie
gingivitis
Lichen
planus
Pemphigus
vulgaris
Pemphigoid
Dermatitis
herpetiformis
Erythema
multiforme
Lupus
erythematosus
Linear IgA
disease
Chronic
ulcerative
gingivitis

10. Lichen planus
• White striations and plaques with occasional blisters and
bullae of the gingiva. It is most common in middle-aged.
3:2 predilection for women – 25-45% DG can be high up to
75%
Pemphigus vulgaris
• Rare, usually seen in middle aged. Death can occur if
untreated. Presented as fluid-filled blisters that rupture,
leaving behind irregularly-shaped, erythematous, painful
ulcerations. A positive Nikolsky sign. – 3-15% DG can be
associated.

11. Mucous membrane pemphigoid
• The average age of onset 50 to 60 Women are affected
twice as often as men. Can affect extra oral sites with
conjunctival involvement leading to blindness and
laryngeal involvement causing airway obstruction. - 8-
14% to be cause of DG
Erythema multiforme
• EM is a mucocutaneous blistering and ulcerative
condition that has an acute onset and is self-limiting
but may be chronic and episodic as well. Patients are
usually in their third or fourth decades of life and men
are affected more often than women - responsible for
2% of cases of DG

12. Disease and histological differentiation
diseases Microscopic feature
Lichen
planus
 Sub-epithelial band-like infiltrate of predominantly T-
lymphocytes with liquefaction of the basal cell layer .
 The epitheliu is atrophi with saw-toothed rete ridges
Pemphigus
vulgaris
 Intraepithelial separation above the basal cell layer leaving
ehi d a hara teristi to sto e patter .
 Acantholysis
 Rou ded ells alled Tzanck
 ells i cytologic smears.
Erythema
multiforme
 Perilesional biopsy shows subepithelial or intraepithelial
vesiculation with mixed inflammatory infiltrate and
sometimes basal cell and keratinocyte necrosis.
Mucous
membrane
pemphigoid
 Split between the surface epithelium and underlying connective
tissue below the basement membrane

13. Treatment
Systemic therapy
Prednisone Dapsone Cyclosporin
Intra-lesion
Triamcinolone
Topical
Triamcinolone Betamethasone Retinoids Flucinomide
 But if its associated with ERYTHEMA
MULTIFORME……….no corticosteroids….That a
detrimental
 Emphasis should be on hydration and topical
analgesics.
 The best treatment is yet to be determined, but
patients usually require in-patient treatment.

15. References
• Carranza’s clinical periodontology – Newman ,Takei
Klokkevold Carranza - 10th edition
• Clinical periodontology and implant dentistry- Jan
lindhe Thorkild karring iklaus p. lang - 5th edition
• Textbook of Oral Pathology, 5th edition-Shafers
• Perio 2000- Vol 18