Removable prosthetic treatment in oral pemphigus vulgaris: Report of three cases

Abstract

Pemphigus vulgaris (PV) is the most common clinical phenotype affecting the oral mucosa. Although rare, this vesicular disease may represent a severe complication in the management of edentulous or partially dentate patients because of the priority of care in handling the oral tissues. Analysis of the dental literature indicated a lack of evidence about the possibility of rehabilitating PV patients with removable prosthesis. Our study aimed to evaluate and describe the possibility of rehabilitating three patients who suffered from oral PV with removable prosthesis, although the friction of the prosthesis on oral soft tissues is one of the causes of the development of vesicular lesions which could break, causing oral mucosal pain and erosion. Three patients, referred to the Oral Pathology and Medicine section of the Dental School in Bari University, underwent biopsy, direct and indirect immunofluorescence tests, and enzyme-linked immunosorbent assay to confirm the diagnosis of oral PV. For each patient, a systemic corticosteroid therapy was planned. After the clinical remission of the PV signs, the patients were planned for an oral rehabilitation with removable prosthesis. As long as certain precautions are followed, patients with PV in a phase of clinical remission, induced by treatment, can be treated successfully with removable prosthesis. Although some authors have previously cautioned about the use of removable prosthesis for the treatment of patients with oral pemphigus, it is our view that, if patients follow the rigorous and periodic follow-up as discussed above, along with a corticosteroid immunosuppressive therapy, they may not show any deterioration of their clinical symptoms.