Desquamative And Transition Gingivitis Question And Answers

Desquamative Gingivitis

Question 1: Describe the etiology of desquamative gingival disease.
Answer:

Desquamative gingivitis is a descriptive term used to characterize a condition that exhibits intense erythema, desquamation (peeling of superficial epithelium), and ulceration.

• The predominant patient symptom is that of a burning sensation that does not occur in chronic gingival diseases.

Etiology

• Dermatologic/autoimmune conditions
• Cicatricial pemphigoid, lichen planus, bullous pemphigoid, pemphigus vulgaris (life-threatening), linear IgA disease, lupus erythematosus, chronic ulcerative stomatitis.
• Endocrine imbalance
• Postmenopausal estrogen deficiency

Read And Learn More: Periodontology Important Question And Answers

• Aging (senile atrophic gingivitis)
• Metabolic disorder—nutritional deficiency
• Abnormal response to local irritation
• Idiopathic
• Drugs: Toxic reaction, allergic reaction
• Chronic infections such as tuberculosis, chronic candidiases, and histoplasmoses.

Question 2: Discuss the clinical features of desquamative gingivitis.

This condition may manifest itself in mild, moderate, and severe forms.

• Mild form is characterized by different erythema of the attached gingiva which may or may not be painful.

Moderate Form

• Scattered areas of bright red, grey areas—marginal, attached gingiva
• Surface; smooth, shiny
• Soft consistency, pits with pressure
• Peeling of epithelium—pressure applied
• Burning sensation, sensitivity to thermal changes
• Labial—symptoms more severe
• Cannot tolerate condiments
• Age group—30–40 years.

Severe Form

• Scattered, irregularly shaped areas—gingiva denuded, red in appearance
• Speckled appearance
• A blast of air at gingiva—elevation of epithelium—bubble formation
• Rupture of a blood vessel—thin aqueous fluid released
• Very painful—burning sensation
• Cannot tolerate coarse food, temperature changes
• Dry mouth.

Diagnosis

The diagnosis is made based on clinical features and histologic investigation.

Treatment Plan

Treatment is instituted depending on the underlying condition. The most commonly occurring underlying problems are lichen planus, pemphigoid, pemphigus, and postmenopausal estrogen deficiency.

Transition From Gingivitis To Periodontitis

Global epidemiology of periodontal disease suggests that 90% of the population exhibits gingivitis. However, only 14%–18% of the population seemed to be affected by severe periodontitis. In other words, gingivitis does not always proceed to develop periodontitis.

• As periodontitis does not seem to develop without pre-existing gingivitis, defense mechanisms in the periodontium can limit the spread of inflammation.
• In spite of extensive efforts, the factors responsible for, the change from gingivitis to periodontitis have not yet been fully elucidated.
• The normally implicated reason relates to the microflora and the host response.
• An increase in the gram-negative bacilli has by and large been held responsible for the transition from gingivitis to periodontitis.
• The host response factors are, however, not yet fully elucidated. Conflicting reports about the role of TH1/TH2 cells and the role of B cells in immunoregulation have not helped matters.
• Whatever be the underlying reason, the shift from gingivitis to periodontitis is characterized by loss of attachment.
• This loss of attachment indicates a change from reversible gingivitis to an irreversible loss of tissue that characterizes periodontitis.
• Clinically, loss of attachment manifests itself as either pocket formation or gingival recession.
• Periodontal disease in its entirety encompasses both gingivitis and periodontitis.
• Till date, there are no reliable biochemical markers to indicate the change from gingivitis to periodontitis.
• Therefore, as of date, clinical parameters such as pocket formation or recession, are the most reliable numbers to identify the change.
• The clinical features and pathogenesis of pocket formation are described in succeeding chapters.