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Introduction
Chronic disease characterized by erythematous, erosive, vesiculobullous or desquamative lesions of the free and attached gingiva.
History
First recognized & reported in 1894 Prinz(1932)-chronic diffuse desquamative gingivitis Merritt(1984)-milder cases of this condition. McCarthy et al(1960)- Desquamative gingivitis was not a
specific disease entity, but a gingival response associated with a variety of conditions.
Clinical Features-
May involve whole gingiva uniformly or single or multiple, discrete or irregular patches.
Patients may be free of symptoms or complain of a burning sensation with or without intense pain.
III. Aging IV. Abnormal response to bacterial plaque V .Idiopathic VI. Chronic infections
Tuberculosis Chronic candiadiasis Histoplasmosis
CLINICAL EXAMINATION
(Recognition of the pattern of distribution of lesion)
DESCRIPTION OF STAINING REACTION WITH PERIODIC ACID-LEIUCOFUCHSIN METHOD OF CERTAIN TISSUE COMPONENTS IN NORMAL GINGIVA AND IN DESQUAMATIVE GINGIVITIS
Normal gingiva
Basement membrane Sharply defined undulating lines
Intense red
Diffuse pink
Lichen planus
Inflammatory mucocutaneous disorder that may involve mucosal surfaces (oral cavity, genital tract) & skin (scalp & nails) first described by Wilson(1869)
Gingival lesions
Keratotic- raised, white lesions are present.
Erosive-extensive, erythematous area Vesicular-raised ,fluid filled area Atrophy-epithelial thinning take place.
HISTOPATHOLOGY Hyperkeratosis Hydropic degeneration of basal layer Dense infiltrate of lymphocytes. Civatte bodies are seen. Max-joseph spaces are seen
IMMUNOPATHOLOGY
Fluorescence along the basement membrane zone with numerous extension into lamina propia.
Daniel and Quadra-White(1980)
Bullous pemphigoid
Bullous pemphigoid is a chronic, autoimmune, subepidermal bullous disease with tense bullae that rupture and become flaccid in the skin.
Oral lesions
Oral lesions are smaller and form more slowly. Gingival lesions consist of generalized edema, Inflammation, desquamation and localized area of vesicle formation.
Histopathology
Sub epithelial clefting with epithelial separation from underlying lamina propria, leaving intact basal layer
Immunofluorescence
IgG deposits along epithelial basement membrane. Basement membrane antibodies in 40-70% cases with indirect immunofluorescence
Cicatricial Pemphigoid
chronic, vesiculo-bullous autoimmune disorder of unknown cause that predominantly affects women in the fifth decade of life.
Oral lesions
areas of erythema, desquamation, ulceration, and vesiculation, of the attached gingiva The bullae tend to have a relatively thick roof and rupture in 2 to 3 days, leaving irregularly shaped areas of ulceration
Pemphigus Vulgaris
Autoimmune blistering disease of the skin and mucous membrane Characterized by vesicles and bullae in which fluid filled blisters are formed.
Oral lesions
Bullae rupture easily and tender on palpitation. Show Nikolsky phenomenon Difffuse erythematous involvement of gingiva.