Complicated clinical variants of mucoperiodontal lesions: desquamative gingivitis

Abstract

Objective. To study the frequency, clinical and topographic features, risk factors for development, quality of primary diagnosis and treatment of desquamative gingivitis in patients with chronic pathology of the oral mucosa. Materials and methods. A cohort cross-sectional clinical study with elements of sociological analysis of patients (n = 314; 99 males and 215 females aged 18 to 62 years), who visited the medical advisory center for oral mucosal diseases (OMD) was conducted. According to the results of clinical and laboratory studies, the diagnosis of the main oral mucosal disease was formulated, and patients with desquamative gingivitis were isolated into a separate group. Hygienic (OHI-S) and periodontal (PMA, BoP, PBI, CPITN) indices were evaluated, and impact of oral pathology on the patients quality of life using OHIP-49-RU index was assessed for objectification of periodontal status. Results. High (17.8 %) incidence of desquamative gingivitis was found in patients with chronic oral mucosal diseases of predominantly autoimmune origin (lichen planus, pemphigus vulgaris, erythema multiforme, psoriasis). Desquamative gingivitis develops significantly more often (60.7 %) in women and affects the vestibular surfaces of the anterior-upper dentogingival segment, manifests clinically apparent edema, pain, hemorrhagic and sensory-paresthetic symptoms, which limit the functionality of the patient (chewing, speech, oral hygiene, social communication and professional realization), that significantly reduces the key parameters of patients quality of life. Conclusions. The main reasons for chronization of desquamative gingivitis and low effectiveness of its treatment are the following: low level of polyclinic diagnostics, problems of differential diagnosis, the predominant use of irrational, pathogenetically unjustified means and methods of treatment, as well as the lack of interdisciplinary approaches to the planning of complex therapy.