Desquamative Gingivitis

• Parakeratinised tissues?

  • gingiva
  • hard palate
• Orthnokeratinised?

  • gingiva
  • hard palate
• Non keratinised tissue?

  • lining mucosa
  • buccal mucosa
  • alveolar mucosa
  • soft palate
  • FOM
  • underside of tongue
• examples of hyperkeratosis?

  • buccal mucosa irritated by chewing tobacco
  • hard palate irritated by smoke
• How quick is the turnover of surface cells

  2.7 hours
• What is the differentiation of cells

  how quick the cell changes and matures
• what is the proliferation of cells

  how quickly they divide and provide new cells
• Turnover What is cell turnover

  how quickly cells divides and passes through entire epithelium
• turnover rates of cells

  buccal mucosa = 14 days

  FOM = 20 days

  Hard palate = 24 days

  skin = 27 days
• desosomes

  attachments between epithelial cells
• Hemi desmosomes

  attachment between epithelial calls and extracellular matrix of the basal lamina
• Rete pegs

  epithelial projections extending into underlying connective tissue
• autoimmune diseases

  antibodies work against the connection between cells and the connection between tissue layer. immunofluorescence can be used to id the site of attack
• What is desquamation

  shedding of the outermost layer of a tissue and is a natural controlled turnover process
• What is ulceration

  discontinuity or break in a bodily membrane with loss of surface tissue, disintegration and necrosis of epithelial tissue
• desquamative gingivitis can be ...

  an initial sign/symptom of an underlying disorder
• plaque induced gingival inflammation can ?

  exacerbate the condition and mask histological features of the underlying disorder (desquamative gingivitis)
• What is the clinical appearance of desquamative gingivitis ?

  • red and glazed gingivae
  • loss of stippling
  • areas of superficial epithelial desquamation and ulceration
  • vesicles, white striate and flecks can be seen
• Causes of desquamative gingivitis ?

  • lichen planus
  • mucous membrane pemphigoid
  • pemphigus vulgaris
  • local hypersensitivity reactions
  • plasma cel gingivitis
  • orofacial granulomatosis
  • epidermolysis bullosa
• lichen planus overview?

  • a chronic inflammatory mucocutaneous disorder
  • affects 1.5-2% worldwide
  • mostly middle aged but has been reported in kids and YA
  • female : male 3:2
• where does lichen planus affect orally

  mucosa = 90%

  tongue = 30%

  gingiva = 13%

  palate and lips = rarely
• Lichen planus commonly affects what other parts of the body ?

  • wrists
  • ankles
  • shins
  • lower back
• what types of lichen planus are there?

  • papular
  • plaque like
  • reticular aka. wickhams striae which is caused by hyperplasia of the stratum ganulosum
  • bullous
  • atrophic
  • errosive which has 1-5% chance for malignant transformation
• Histology of lichen planus

  • hyperkeratosis
  • acanthosis (a thickening of stratum spinosum)
  • liquefaction degeneration of basal cell layers (civatte bodies)
  • A densure subepithelial band of T lymphocytes
  • elongated, widened and flattened rete pegs
  • immunofluorescence of basement membrane IGM
• Lichenoid reactions cause:

  dental materials :

  • antigen fixation in epithelial cells
  • remove and replace material to resolve

  drug erosions:

  • history of taking the drug
  • unilateral lesions in atypical sites like lips/palate
  • erosive lesions (esp. NSAIDS)
• Lichenoid reaction histopathology (how it differs from lichen planus)?

  • +++ mixed diffuse subepithelial inflmmatory infiltrate
  • perivascular inflmmatory infiltrate
  • parakeratosis (nuclei in keratinocytes at the surface of tissues)
  • civatte bodies in epithelial laywe
  • circulating basal cell cytoplasmic autoantibodies
• What are civatte bodies

  degenerating cells
• drugs which can cause lichenoid reactions

  • antihypertensives - ca channel blockers, ace inhibitors, beta blcokers
  • oral hypoglycaemics - tolbutamide
  • NSAIDS - ibuprofen, naproxen
  • second line anti arthritics - gold, penicilamin
  • Xanthine oxidase inhibitors - allopurinol
  • psychoactive drugs - lorazapem, lithium
  • antiparasitics - antimalarials
  • antimicrobials - tetracylcines, dapsone
  • others - idodides
• plasma cell gingivitis qualities?

  • rapid onset
  • sharply demarcated
  • affects entire extent/band of attached gingiva
  • may be marked gingival enlargements
  • may extend to palate
• Plasma cell gingivitis can be cause by hypersens allergic reactions to


  Foods allergens:

  • nuts
  • fruits
  • milk
  • eggs

  Flavouring agents in chewing gum and TP:

  • mints
  • menthol
  • cinammon

  Spices:

  • chilli
  • cardamom
• What is hyperkeratosis ?

  a chance in keratin quantity due to irritation and the protective response of the tissue
• PCG hisopathology?

  • Plasma cells undergoing excessive synthesis of Ig

  • Vessel dilatation

  • Plasma cell Russell Bodies (contain Ig)
• What does PCG mimic?

  • leukaemia
  • myeloma
  • dicoid lupus erythamatosus
  • atrophic lichen planus
  • pemphigoid
• Phemiphus qualities?

  • 1:1 ratio m:f
  • mostly 50+
  • Fragile intra-epithelial bullae
  • Nikolsky sign = blisters appear on pressure/friction
• What is a bulla

  bulla = large thin walled fluid filled blister
• Phemphigoid qualities?

  • 2:1 f:m
  • 50+
  • sub epithelial bullae at BM level
  • mostly affects OM and conjunctiva
  • scarring of eyes (ie. lid to globe and entropion)
  • 25% skin affected
• Pemphigoid diagnosis ?

  • Identify immunoglobulin against Basement membrane
  • Biopsy - Direct immunofluoresence IgG and C3 (less commonly IgA)
• Pemphigus histopathology?

  • cell adhesion mediated by desmoglein 3 PV antigen) transmembrane glycoprotein in desmosomes
  • IgG autoantibodies against PV antigen degrades cell adhesion
  • Identifying IgG against PV antigen
  • Bloodtest = identifies circulating IgG by indirect immunofluoresence
  • Biopsy = of peri-lesional tissue identifies IgG around individual cells of epithelium by direct immunofluoresence
• Epidermolysis bullosa?

  • 50 in 1 mil births (EB simplex and EB junctional)
  • a collagen protein defect which affects connection of epidermis to underlying dermis causes cells to: rupture easily, separate from eachother, blisters form with minor injury
  • +++ scarring affecting dexterity and oral access
• Orofacial granulomatosis

  an inflammatory non caseating granulomatous disease

  cause unknown, could be:

  • infection
  • genetic
  • allergy (cell med hypersens w activated T helper lymphoctes present)
  • food intolerance (carnosin, cocoa, carbane, cinammaldehyde)