any medications and she had no known drug allergies.
Review of Systems
Vital signsBlood pressure: 120/70 mmHgPulse rate: 78 beats/minuteRespiratory rate: 15 breaths/minute
Dental History
The patient had received sporadic general dental care and orthodontics in Brazil and was unsure if the city water she had consumed in her childhood was fluoridated. She had received dental care more regularly since moving to the United States 13 years ago. She had her teeth cleaned twice yearly. She reported that her teeth and gums were very sensitive and that local anesthesia was often needed during her cleanings.
Social History
The patient had been born and raised in Brazil and had moved to the United States when she was 28 years old. She was married and had two daughters. She worked as a housecleaner. The patient consumed one to three alcohol drinks per week and denied the use of tobacco products.
Family History
Both of the patient’s parents resided in Brazil and were in good health. She had one brother who lived in the United States and was also in good health. The patient was unaware of any dental problems in the members of her immediate family.
Extraoral Examination
The patient had no detectable lesions, masses, or swelling. The temporomandibular joint was within normal limits.
Intraoral Examination
The buccal mucosa adjacent to the mandibular third molars demonstrated diffuse white reticulation.
Generalized gingival erythema was present with desquamation of the maxillary and mandibular anterior gingiva (Figure 1.3.1).
Figure 1.3.1 Frontal view.
Hard Tissue Examination
The patient had several restorations in her posterior dentition. All of the restorations appeared clinically and radiographically sound.
No carious lesions were detected.
Periodontal Examination
The periodontal examination revealed probing depths of 1–4 mm with generalized bleeding on probing.
There was diffuse gingival erythema with varying degrees of mucosal sloughing and erosion.
There was generalized mild to moderate gingival recession on the facial and lingual/palatal surfaces of her teeth.
The patient had mild plaque accumulations on her posterior teeth.
Occlusion
The patient had class III occlusion with an open bite on the posterior left side.
Radiographic Examination
A full‐mouth set of radiographs was taken.
No carious lesions were detected.
There was generalized mild horizontal bone loss.
There were no other pathologic findings noted.
Diagnosis
Following review of the history and clinical evaluation, a clinical diagnosis of desquamative gingivitis was rendered.
Treatment Plan
The patient received a dental scaling with oral hygiene instructions. The treatment of her desquamative gingivitis will be determined after a definitive diagnosis is established.
Discussion
Desquamative gingivitis is not a definitive diagnosis but a clinical term referring to the manifestation of a variety of underlying conditions. To arrive at a definitive diagnosis, a tissue biopsy is required. In this case, punch biopsies of the gingiva and buccal mucosa were performed and submitted for pathologic evaluation. One sample was placed in 10% formalin for hematoxylin and eosin staining and the second in Michel’s medium for direct immunofluorescence studies. The pathology report was signed out as oral lichen planus (LP).
After the diagnosis was established, the patient was prescribed a topical corticosteroid (fluocinonide gel 0.05%) and instructed to apply it two to three times daily. The patient returned after two weeks of treatment with improvement of gingival erythema. The patient was informed that because there is no cure for her condition, the medication would need to be reapplied whenever she became symptomatic.
Self‐Study Questions
1 How are non‐plaque‐induced gingival lesions classified?
2 What is desquamative gingivitis, and how does it differ from plaque‐induced gingivitis?
3 What is the differential diagnosis for desquamative gingivitis?
4 How is desquamative diagnosis managed?
5 What is the presentation and prevalence of oral LP?
6 How is a diagnosis of oral LP rendered?
7 What is the etiology of oral LP?
8 What are the histopathologic features of oral LP?
9 How is oral LP managed?
10 What is the long‐term prognosis for oral LP?
Answers located at the end of the chapter.
References
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2 2. American Academy of Periodontology Position Paper. Oral features of mucocutaneous disorders. J Periodontol 2003; 74:1545–1556.
3 3. Lo Russo L, Fierro G, Guiglia R, et al. Epidemiology of desquamative gingivitis: evaluation of 125 patients and review of the literature. Int J Dermatol 2009; 48:1049–1052.
4 4. Leao JC, Ingafou M, Khan A, et al. Desquamative gingivitis: retrospective analysis of disease associations of a large cohort. Oral Dis 2008; 14(6):556–560.
5 5. Guiglia R, Di Liberto C, Pizzo G, et al. A combined treatment regimen for desquamative gingivitis in patients with oral lichen planus. J Oral Pathol Med 2007; 36(2):110–116.
6 6. Chams‐Davatchi D, Valikhani M, Daneshpazhooh M, et al. Pemphigus: analysis of 1209 cases. Int J Dermatol 2005; 44:470–476.
7 7. Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88(4):431–436.
8 8. Scully C, Almeida OPD, Welbury R. Oral lichen planus in childhood. Br J Dermatol 1994; 130:131–133.
9 9.