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Background and objectives: Desquamative gingivitis (DG) is a clinical term used to describe gingival conditions marked by erythema (unrelated to dental plaque), epithelial desquamation, and various intraoral lesions, with occasional extraoral involvement. It is typically linked to a range of underlying diseases. Materials and methods: A narrative literature review was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, searching with keywords like “oral dysplasia”, “oral mucosa lesions”, or “desquamative gingivitis”. In addition to the literature review, a case report of a patient with DG is included to illustrate the diagnostic challenges and treatment considerations in a clinical setting, and to design and test simplified diagnosis and treatment-planning algorithms. Results: Diagnosis can be supported by a standard punch biopsy to obtain tissue samples for histopathological evaluation. The complex clinical case presented illustrates the clinical features of DG and highlights the challenges associated with its diagnosis and management. The mainstay of treatment, as resulted from 96 studies included in our review, involves topical and systemic corticosteroids, with topical calcineurin inhibitors serving as adjunctive therapy. Conclusions: A universally accepted treatment protocol is still lacking for DG, so this report outlines an effective, experience-based therapeutic approach. Additionally, it offers a simplified framework for diagnosis, treatment planning, and therapeutic management, contributing to the growing knowledge base needed for a decision-support algorithm development.

Abstract ObjectivesTo evaluate the efficacy of a gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to professional plaque removal on desquamative gingivitis (DG).Materials and methodsA randomized clinical trial was conducted on patients suffering DG due to mucocutaneous diseases. Patients received professional supragingival prophylaxis with oral hygiene instructions and were randomly assigned to use test or control gels as toothpaste and to apply it on DG lesions 3 times/day for 4 weeks. DG clinical score (DGCS), clinical periodontal variables, and visual analog scale (VAS) for pain and oral health impact profile (OHIP-14) were collected at baseline, 2 and 4 weeks.ResultsTwenty-two patients were randomly assigned to test (n = 11) or control group (n = 11). Eighteen had diagnosis of oral lichen planus and four of mucous membrane pemphigoid. DGCS statistically decreased in both groups after treatment with no significant differences between groups. Clinical periodontal outcomes decreased in both groups, but no significant differences were observed. Periodontal variables statistically improved only in test group after treatment. VAS and OHIP-14 scores decreased in test and control groups without significant differences. However, only one test group showed a statistically significant decrease in VAS and OHIP-14 scores after treatment. No adverse effects were reported.ConclusionsTest gel may alleviate DG and improve quality of life without side effects.Clinical relevanceA gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to mechanical debridement may improve both clinical and patient related outcomes in DG patients without side effects.Clinical trial registration.The study protocol was registered at clinicaltrials.gov with the following number: NCT05124366 on October 16, 2021.

Background Desquamative gingivitis is a clinical condition characterized by erythema, blisters, and erosions within the gingiva. It may be a manifestation of oral lichen planus or autoimmune bullous diseases, such as pemphigus vulgaris and mucous membrane pemphigoid. The identification of the cause of desquamative gingivitis typically involves the analysis of clinical manifestations, histopathology, and immunopathology evaluation. This article reviews available data on the application of noninvasive imaging techniques (reflectance confocal microscopy, optical coherence tomography, and line‐field confocal optical coherence tomography) in identifying the cause of desquamative gingivitis. Materials and Methods The review of the literature for desquamative gingivitis was performed by searching the PubMed, Scopus, and Wiley databases up to January 2025. Results This study aimed to evaluate the applicability of noninvasive imaging techniques, including RCM, OCT, and LC‐OCT, in the differential diagnosis of desquamative gingivitis. Findings suggest these modalities offer characteristic diagnostic patterns across underlying diseases. In oral lichen planus, RCM typically shows disrupted connective tissue papillae, obscured basement membranes, and inflammatory cell infiltrates. In pemphigus vulgaris, the key findings are acantholytic keratinocytes and intraepithelial clefts, while mucous membrane pemphigoid displays subepithelial clefts and signs of hemorrhage. OCT findings in desquamative gingivitis associated with oral lichen planus include maintained epithelial thickness in the erosive forms and multilocular blisters in the bullous variants of the disease. In pemphigus vulgaris, OCT reveals intraepithelial clefts and thinning of the epithelium, while mucous membrane pemphigoid is marked by subepithelial blister formation and fluid accumulation. Conclusion New noninvasive imaging techniques, such as reflectance confocal microscopy and optical coherence tomography, may support clinical decision‐making, improve biopsy targeting, and enhance long‐term monitoring of desquamative gingivitis.

Objective This systematic review synthesizes existing empirical evidence on the efficacy and safety of pharmacological treatment options for desquamative gingivitis (DG), in order to establish evidence-based clinical recommendations on DG clinical management. Methods A comprehensive literature search was conducted across seven databases to retrieve literature records published from 1990 to 2023, followed by manual searches of reference lists of the included articles. Studies assessing pharmacological interventions for DG with relevant clinical outcomes were included. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Relevant data, including those on clinical improvement and adverse events, were extracted and synthesised to determine the efficacy and safety of the pharmacological agents used in the included articles. Results Out of the yielded 624 records and the manual search, 15 studies met the inclusion criteria, comprising randomized controlled trials (RCTs), non-randomized trials and cohort studies. MMAT scores ranged from 5 to 7, with a mean score of 5.57. Clobetasol (53.33%) and tacrolimus (26.67%) were the most frequently studied agents, both demonstrating significant reductions in pain and lesion severity. Emerging therapies, such as platelet-rich plasma and bio-adhesive gels containing propolis and nano-vitamin formulations, showed promising results, particularly as adjunctive treatments. Quality of life (QoL) assessments was limited, with only one study employing a validated tool (OHIP-14). Recurrence rates were inconsistently reported with no reported relapses in clobetasol-treated groups during short-term follow-up. Safety profiles differed across pharmacological agents with topical treatments exhibiting mild and transient adverse effects. Systemic agents exhibited a higher risk profile, including candidiasis and haemolysis. Conclusions Clobetasol and tacrolimus remain first-line therapies for DG, supported by their efficacy and manageable safety profiles. Platelet-rich plasma and nano-vitamin-based therapies offer potential alternatives but require further validation. Given the variability in treatment protocols, standardized guidelines and long-term studies are needed to optimize the clinical management. Clinical trial number Not applicable.

Desquamative gingivitis (DG) denotes a heterogeneous immune-mediated disease for which early diagnosis represents a great challenge. The main aim of this study is to validate diagnostic concordance between specific Optical Coherence Tomography (OTC) patterns for DG related to oral Lichen Planus (OLP), Pemphigus Vulgaris (PV), and Mucous Membrane Pemphigoid (MMP) and definitive histological diagnosis. Forty-three patients with suspected immune-mediated DGs, were progressively recruited. Before biopsy, an OCT preliminary evaluation was performed using specific pre-determined OCT diagnostic patterns (i.e., morphology and localization of blisters, status of the basal membrane, epithelial thickness, presence/absence of acantholytic cells into blister and/or inflammatory infiltrate) related to OLP, PV and MMP. After histological confirmation, OCT and histological diagnoses were compared. Using pre-determined patterns, OCT diagnoses of DGs were: 22 (51%) OLP, of which 11 (26%) were with the bullous variant, 4 (9%) PV and 6 (14%) MMP. The same diagnoses were found by histological investigations (with the main OCT discriminatory potential for the bullous variant of OLP). The concordance between the two diagnostic methods was confirmed by the Fisher exact test (p-value < 0.01). These specific OCT patterns show a diagnostic reliability in 100% of the cases investigated, suggesting their accuracy to support the complex diagnosis and management of immune-mediated DGs.

Mucous membrane pemphigoid (MMP) is a heterogeneous group of autoimmune chronic inflammatory, subepithelial blistering disorder, predominantly involving the mucous membranes. It has a female predilection and commonly occurring after the fifth decade of life. The oral mucosa is affected in more than 90% of cases. Dentists could be the first health personnel to identify and diagnose this rare mucocutaneous lesion. Two unique cases of oral MMP with varied clinical presentation, the diagnostic modality, treatment and follow-up are presented.

In the oral cavity, gingiva lesions may occur that are not associated with bacterial plaque, which require adequate diagnosis and treatment. Desquamative gingivitis is usually related to mucocutaneous disorders, such as pemphigus vulgaris (PV), where oral lesions, including gingival lesions, may precede skin lesions. Management is multidisciplinary and treatment includes topical and systemic pharmacological therapy, require adequate control of dental plaque by the patient and strict supervision over time by the professional for the maintenance and stability of the gingival tissues. Two clinical cases of patients with a diagnosis of PV are presented, which were managed in a timely and integral way to control and stabilize the systemic and local factor. En la cavidad oral se pueden presentar lesiones en gíngiva que no están asociadas a placa bacteriana, las cuales requieren de un adecuado diagnóstico y tratamiento. La gingivitis descamativa está usualmente relacionada con desórdenes mucocutáneos, como el pénfigo vulgar (PV), donde las lesiones orales incluyendo las lesiones gingivales, pueden preceder las lesiones cutáneas. El manejo es multidisciplinario y el tratamiento incluye terapia farmacológica tópica y sistémica, se requiere un adecuado control de la placa bacteriana por parte del paciente y una estricta supervisión en el tiempo por parte del profesional para el mantenimiento y estabilidad de los tejidos gingivales. Se presentan dos casos clínicos de pacientes con diagnóstico de PV los cuales fueron manejados de manera oportuna e integral para controlar y estabilizar el factor sistémico y local.

Background We present a case report on desquamative gingivitis diagnosed as linear IgA disease (LAD), which is a rare autoimmune bullous disease exclusively affecting the oral gingiva. The oral mucosa can be impacted by various autoimmune bullous diseases, and our report focuses on this particular manifestation of LAD. Case presentation This patient presented with atypical symptoms, as frequent blister formation on the gingiva was the primary clinical manifestation. A combination of systemic and local treatment was administered to the patient. Following the treatment, there was a significant improvement observed in both the erythema and the bullous lesions on the gingiva. Conclusions A more suitable local treatment strategy should be formulated for patients presenting with oral topical lesions, which clinicians can employ effectively.

Background: Desquamative gingivitis is a clinical manifestation often associated with various mucocutaneous disorders, characterized by red, painful, and friable gingiva. It is predominantly seen in middle-aged to elderly females and is typically linked to autoimmune conditions such as lichen planus, pemphigoid, and pemphigus, among others. Due to the chronic pain and difficulty in maintaining personal oral hygiene, professional care becomes crucial. Methods: This article explores the application of guided biofilm therapy as a novel, gentle approach for managing desquamative gingivitis, focusing on three clinical cases. This therapy employs erythritol-based powders for biofilm removal, offering a less abrasive and more comfortable alternative to traditional mechanical plaque removal techniques. Results: The cases demonstrate the effectiveness of guided biofilm therapy in reducing discomfort and improving clinical outcomes in desquamative gingivitis patients, particularly those suffering from mucous membrane pemphigoid, pemphigus vulgaris, and oral lichen planus. Conclusions: The guided biofilm approach underscores the importance of tailored periodontal therapy in managing nonplaque-induced gingival lesions, improving patient compliance and oral health outcomes.

Abstract Introduction: Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disorder with unknown etiology. Numerous treatment options have been reported, with topical corticosteroids being very often used as the first-line therapy for gingival lesions. However, a relatively novel therapeutic option is provided by tacrolimus. Aim: To compare the clinical effectiveness of topical tacrolimus 0.1% and clobetasol propionate 0.05% in the management of desquamative gingivitis, a distinct clinical manifestation of OLP. Materials and methods: This comparative study included 20 patients with histologically proven symptomatic OLP with gingival manifestation. The participants were divided into 2 groups: group A (clobetasol propionate 0.05% cream) and group B (topical tacrolimus 0.1% ointment). They were instructed to apply topical medications twice daily for three consecutive weeks. Custom trays have been used for better drug delivery. The patients were recalled at 1, 2, and 3 months after cessation of therapy for a follow-up control of any relapse. Results: The subjects in both groups showed a significant reduction in the burning sensation/pain and discomfort according to the visual analog scale (VAS). Similarly, both groups showed reduction in the efficiency index, and moderate improvement especially was seen in the tacrolimus 0.1% group (53%) and the clobetasol propionate group 0.05% (47%). Patients treated with clobetasol propionate 0.05% didn’t have a relapse at 2 and 3 months after cessation of treatment. In contrast, 30% of the patients treated with tacrolimus 0.1% had a relapse of the condition at 2 and 3 months. Conclusions: Tacrolimus can be considered as a good alternative topical medication in the treatment of OLP, especially in those patients that do not respond to topical corticosteroids.