Desquamative Gingivitis

• Is the term Desquamative Gingivitis a description or diagnosis?

  description
• area of mouth orthokeratinised:

  • gingiva
  • hard palate
• area of mouth parakeratinised?

  • gingiva
  • hard palate
• areas of mouth non-keratinised?

  • lining mucosa
  • buccal mucosa
  • alveolar mucosa
  • soft palate
  • floor of mouth
  • underside of tongue
• when might hyperkeratosis occur?

  when buccal mucosa irritatated by smokeless tobacco or smoking
• how fast do surface layer cells shed?

  2.7 hours
• what is the differentiation of cells?

  how quickly they change and mature
• what is proliferation of cells?

  how quickly they divide and provide new cells
• what is cellular turnover?

  how quickly cells divide and passes through entire epithelium

  • buccal mucosa 14 days
  • floor of mouth 20 days
  • hard palate 24 days
  • skin 27 days
• desmosomes?

  attachments between epithelial cells
• rete pegs?

  epithelial projections extending into underlying connective tissue
• hemi-desmosomes?

  attachments between epithelial cells and extracellular matrix of basal lamina
• with autoimmune diseases antibodies work against:

  • connection between cells
  • connections between tissue layers
• what is desquamation?

  shedding of the outermost layer of a tissue, natural controlled turnover process
• ulceration: discontinuity or break in bodily membrane with loss of surface tissue, disintegration and necrosis of epithelial tissue
• desquamative gingivitis

  • initial signs/symptoms of underlying disorder
  • plaque induced gingival inflammationmay exacabate condition and mask histological features
• clinical appearance of desquamative gingivitis:

  • red glazed gingivae
  • loss of stippling
  • area of superficial epithelium desquamation/ulceration
  • vesicles, white striate, flecks may be seen
• how do we obtain a diagnosis for desquamous gingivitis?

  biopsy and histopathology
• what might cause desquamative gingivitis?

  • Lichen Planus
  • Mucous membrane pemphigoid
  • Pemphigus Vulgaris
  • Local hypersensitivity reactions
  • Plasma cell gingivitis
  • Orofacial granulomatosis
  • Epidermolysis Bullosa (Rare)
• Lichen Planus:

  • chronic inflammatory mucocutaneous disorder
  • 1.5-2% of population
  • middle age - has been reported in younger
  • present on skin and orally on mucosa, tongue, gingiva, palate/lips (in prevelance order)
• Reticular hyperplasia of stratum granulosum

  
• Plaque like lichen planus

  
• Papular Lichen Planus

  
• Bullous Lichen Planus

  
• Atrophic lichen planus

  
• Erosive lichen planus - 1-5% potentially malignant

  
• Histopathology of Lichen Planus:

  • hyperkeratosis
  • acanthosis - thickening of statum spinosum
  • liquefaction degerneation of basal cell layer (civatte bodies)
  • dense subepithelial band of T lymphocytes
  • elongates, wide, flat rete pegs
• Epithelium with Lichen Planus

  
• Lichenoid Reactions:

  • dental material - antigen fixation, lesions resolve if material removed/replaced
  • drug erosion - history of drug taking, unilateral, atypical sites, erosive lesion?
• Histopathology of Lichenoid reactions:

  • mixed, diffused subepithelial inflammatory infiltrate
  • perivascular inflammatory infiltrate
  • parakeratosis - nuclei in keratinocytes at surface
  • civatte bodies (degenerating)
  • circulating basal cell cytoplasmic antibodies

  
• What drugs can cause lichenoid drug erosions?

  • antihypertensives
  • oral hypoglycaemics
  • non-steriodal anti-inflammatory drugs
  • seconds line anti-arthritics
  • xanthines oxidase inhibitors
  • psychoactive
  • antiparasitic
  • antimicrobial
• Plasma cell gingivitis

  
• plasma cell gingivitis:

  • rapid onset
  • sharply demarcates
  • affects entire band off attached gingiva and may extend to palate
  • hypersensitive allergic reaction - food, flavourings, spices
• Histopathology plasma cell gingivitis:

  • plasma cell undergoing excessive synthesis of Ig
  • plasma cell Russel Bodies - contain Ig
  • vessel dialation
  • may mimic: leukaemia, myeloma, pemphigoi
• plasma cell gingivitis

  
• Pemphigus:

  ages 50+, fragile intra-epithelial bullae (blisters), nikolsky sign - appear on pressure/friction

  
• histopathology Pemphigus:

  • IgG autoantibodies against PV antigen degrades cell adhesion
  • identify by blood test or biopsy
• Pemphigoid:

  ages 50+, more common in females, sub-epithelial bullae - at basement membrane level, mainly affects oral mucosa, conjunctiva, scarring occurs

  
• How do we identify Pemphigoid?

  look at basement membrane, IgG and C3 immunofluorescence

  
• Epidermolysis Bullosa:

  • collagen protein defects so cells rupture easily, separate, blisters form
  • 50 in 1 million births
  • significant and debilitating scarring affects - oral access and dexterity