Diseases Clinically Presenting As Desquamative Gingivitis

Lichen Planus

I ichen planus is a relatively common, chronic, dermatosis characterized by the presence of cutaneous violaceous papules that may coalesce to form plaques. I he current evidence suggests that lichen planus is an immunologically mediated mucocutaneous disorder where host I lymphocytes play a central role. ,s ;,> Although the oral cavity may present lichen planus lesions with a distinct clinical configuration and distribution, the clinical presentation sometimes may simulate other mucocutaneous disorders Therefore a clinical diagnosis of oral lichen planus should be accompanied by a broad differential diagnosis. Numerous epidemiologic studies have shown that oral lichen planus presents in (j.1% to 4% of the population. 10,1 The majority of patients with oral lichen planus are middle-aged and older females with a 2:1 ratio of fe males to males. Although possible, children are rarely affected. In a dental setting, cutaneous lichen planus is observed in about one third of the patients diagnosed with oral lichen planus." In contrast, two thirds of patients seen in dermatologic clinics exhibit oral lichen planus.102

Oral Lesions. Although there are several clinical forms of oral lichen planus (reticular, patch, atrophic, erosive and bullous), the most common are the reticular and erosive subtypes. I he typical reticular lesions are asymptomatic, bilateral, and consist of interlacing white lines on the posterior region of the buccal mucosa. The lateral border and dorsum ol the tongue, hard palate, alveolar ridge, and gingiva may also be affected. In addition, it is not unusual for the reticular lesions to have an erythematous background, a feature that is associated with the coexistence of candidiasis. Oral lichen planus lesions follow a chronic course and have alternating, unpredictable periods of quiescence and flares.

The erosive subtype of lichen planus is often assort-ated with pain and clinically manifests as atrophic, erythematous areas. Fine white radiating striations are observed bordering the atrophic zones. I hese areas maybe sensitive to heat, acid, and spicy foods (Color lig. 21-11.

Ciingival Lesions. Up to 10% of patients with oral lichen planus have lesions restricted to the gingival

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Lichen Planus Attached Gingiva

Color Fig. 17-1 Gingivitis: clinical features. A, Localized, diffuse, intensely red area facial of tooth H7 and dark pink marginal changes in the remaining anterior teeth B, Generalized papillary gingivitis. C, Generalized marginal inflammatory lesion D, Generalized diffuse inflammatory lesion. E, Papillary gingival enlargement. F, Different degrees of recession. Recession is slight in teeth #26 and 29 and marked in #27 and 28. Note the irregular contours of the gingiva in #28 and the lack of attached gingiva in #27. G, Insertion of a probe into the gingival sulcus. Note the lack of stippling, the slightly rolled margins, and the dark red color. H, Bleeding appears about 30 seconds after probing.

Desquamative Gingivitis

Color Fi.'i 18 : Gingival enlargements A, Chronic inflammatory gingival enlargement in a 27-year-old woman. Note the papillary enlargement and I he red, smoot h surfaces. B, Gingival enlargement associated with mouth breathing, typically localized to the marginal dnci papillary areas of teeth #6-11, in an 18-year-old man. C, Phenytoin-associated gingival enlargement in a 21-year-old man. In the maxilla, note the bulbous papillary enlargement, leaving a trough between enlarged papillae, and the pink, stippled surface. D, Occlusal view ol the same case shown in C. E, Cyclosporine-associated gingival enlargement in a 14-year-old boy. Note the enlarged papillae and margin, the deep red color, and the smooth surface. F, Gingival fibromatosis in a 16-year-old boy. Dense librotic enlargement partially covers the crowns of the teeth, and the pink, stippled surface shows minor marginal inflammatory changes.

Localized Gingival Margin Enlargement

C -tu Ficj. ' I A, Necrotizing ulcerative gingivitis: typical punched out interdental papilla between mandibular canine and lateral incisor. B, Necrotizing ulcerative gingivitis: typical lesions with progressive tissue destruction.

Continued

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Dealing With Back Pain

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