Abstract
Desquamative Gingivitis (DG) comprises heterogeneous clinical manifestations of numerous immune-mediated muco-cutaneous diseases. Optical Coherence Tomography (OCT) has been proposed as a valuable diagnostic support even if, to date, there are no standardized OCT-diagnostic patterns applicable to DGs. A systematic review was performed to detect existing data on in vivo OCT diagnostic patterns of the most common immune-mediated DGs (i.e., pemphigus vulgaris, mucous membrane pemphigoid and oral lichen planus). It has been found that OCT exhibits specific patterns that address the diagnosis of DG by pemphigus vulgaris (i.e., intraepithelial unilocular blister, reduced epithelial thickness, presence of acantholytic cells in the blister) and by mucous membrane pemphigoid (i.e., subepithelial multilocular blister, presence of inflammatory infiltrate), but not by oral lichen planus. These patterns could offer an attractive diagnostic OCT framework to support the clinical preliminary assessment and monitoring of these complex pathological conditions.
Highlights
Desquamative gingivitis (DG) denotes a clinical sign of a very large spectrum of diseases with different pathogenesis [1]
Five subjects from the three selected papers had average age of 62.6 ± 3.65 years; 60% were diagnosed with Membrane Pemphigoid (MMP) and the remaining 40% with Pemphigus Vulgaris (PV)
All cases (100%) of PV patients had intraepithelial blisters, with a unilocular morphology reported in one case of two (50%) investigating this parameter
Summary
Desquamative gingivitis (DG) denotes a clinical sign of a very large spectrum of diseases with different pathogenesis [1]. Pemphigus Vulgaris (PV), Mucous Membrane Pemphigoid (MMP) and Oral Lichen Planus (OLP) represent about 80% of cases of DG [1,2]. These immune-mediated diseases could be characterized by mucocutaneous involvement and chronic course. Almost one-third of the patients presented primarily with only gingival involvement in the form of DG which remains underdiagnosed for a longer time than in cases of multisystem involvement [3] The reason for this evidence is not known, but it could be attributed to the non-specific features of immune-mediated DG compared to many conditions that present as gingival inflammation, especially those that are plaque-related. DIF is an expensive technique, available only in advanced research laboratories [8]; the practice of biopsy in gingiva affected by DG is difficult because the tissues are fragile and thin, and so are difficult to manipulate [5]
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