Mucocutaneous Diseases Affecting the Periodontium (MacNeil likes to ask about these topics Flashcards
● Desquamative Gingivitis (apparently Dr. Tao likes to ask about this one??)
o Characterized by intense erythema, desquamation, and ulceration of the free and attached gingiva
o A gingival response associated with a variety of conditions
o This is a clinical term NOT a DIAGNOSIS
This is a clinical term NOT a Dx
Desquamative Gingivitis
Diseases presneting as desquam Gingivitits
Lichun planus
pemphigoid
Permphagus vulguras
Lupus Erythematosus
Erythema multiforme
Necrotizing stomatitis
● Lichen Planus
o Immunologically-mediated mucocutaneous disorder
▪ T-lymphocytes play a central role
o Prevalent in middle aged and older females
o 5 Subtypes:
▪ Reticular, erosive, patch, atrophic, bullous
● Oral lesion: more than gingiva is involved
● Gingival lesion: restricted in gingiva
▪ Reticular lesion shows Wickham’s striae (“fishnet”)
▪ Use of corticosteroids
o Histologic features
▪ Hyperkeratosis, hypergranulosis
▪ A band-like lymphocyte infiltrate against undersurface connective tissue
▪ Saw tooth appearance of rete pegs
▪ DIF shows shaggy deposits of fibrinogen at DEJ
● Pemphigoid
o Cutaneous, immune-mediated, subepithelial disease
▪ Separation of the basement membrane zone
o Nikolsky’s Sign/Test: blow air on the tissue
▪ If surface epithelial peels off it is positive sign
o 3 Conditions:
▪ Pemphigoid gestationi
▪ Bullous pemphigoid
● Predominant skin lesion
▪ Mucous membrane pemphigoid
● Characteristic ocular lesion – symblepharon
● Oral lesion: Nikolsky’s sign, Attached gingiva
o Bulla ruptures in 2-3 days Healing takes up to 3 weeks
o Histology
▪ Separated epithelium from intact basal cell layer
▪ DIF: smooth linear deposits of IgG and C3 at basement membrane zone
● Pemphigus Vulgaris
o A group of autoimmune disorders
▪ Produces cutaneous and mucous membrane blisters
o Pemphigus vulgaris is the most common of all
▪ Lethal chronic condition (10%) mortality rate
▪ Predilection in women (after 4th decade of life)
o Also has a positive Nikolsky’s sign
o Locations
▪ Soft palate – 80%
▪ Buccal mucosa – 46%
▪ Tongue – 20%
o Histology
▪ Tombstone appearance – not “clean cut”
▪ Tzanck cell is characteristic
▪ Basal cells remain attached to subjacent basement membrane and connective tissue
▪ DIF: intercellular deposits of IgG in epithelium = fishnet appearance
● Lupus Erythematosus
o Autoimmune disease with 3 clinical presentations
▪ Systemic/Chronic cutaneous/Subacute cutaneous
● Cutaneous lesion
o Butterfly pattern
o Discoid lesion
o Scar and atrophy production
● Oral lesion: ulcerative or lichen planus-like
● Erythema Multiforme
o Reactive acute vesiculobullous disease
o Mucocutaneous inflammatory disease
o Broad spectrum from self-limiting to severe progression
o Predominant in young individuals
● Necrotizing Stomatitis
o An inflammatory destructive gingival condition
o Young adults, HIV-infected individuals
o Characteristics of gingival lesion
▪ Punched-out appearance
▪ Pseudomembrane – composed of leukocytes, fibrin, and necrotic tissues (and masses of bacteria)
o May develop fever and malaise
Metronidazole
Metronidazole for NUG/NUP: Antabuse (no alcohol or alcohol mouthwash)
-induced by stress, smoking and poor oral hygiene
-more Aa and fusobacterium
- Main periodontal manifestations with:
a. Pregnancy/diabetes/leukemia/HIV/AIDS/transplant pts/epilepsy/hypertension
9. Genetic diseases affecting the periodontium
10. Immunologic effects for periodontal disease? How?
