Chapter 22 - Desquamative Gingivitis

Abstract

The term desquamative gingivitis (DG) describes a peculiar clinical presentation of the free and attached gingivae, characterized by intense erythema, desquamation, and ulceration. Approximately 50% of patients with DG have additional intraoral sites affected. DG is not a specific disease entity; rather, it is a gingival response associated with a number of conditions, most of them with a dermatologic genesis. Although a wide spectrum of disorders may be associated with DG, the etiology of most cases is lichen planus, cicatricial pemphigoid, or pemphigus vulgaris. It is essential to obtain a precise diagnosis to appropriately manage the disease responsible for DG. A thorough clinical history, clinical examination, biopsy for hematoxylin and eosin and direct immunofluorescence studies are necessary. Treatment of DG is based on a rigorous plaque control regimen and topical steroids. Dentists play a key role in the precise diagnosis and management of DG. The importance of recognizing, diagnosing, and properly managing this condition is highlighted by the significant morbidity associated with undiagnosed DG. Furthermore, serious and life-threatening conditions, such as squamous cell carcinoma, can mimic DG. Therefore clinicians should be alert to the possibility of a malignancy initially manifesting as DG.