Delayed
Diagnosis of
Desquamative
Gingivitis
Authors
Seena Patel, DMD, MPH*
Assistant Professor, Associate Director of Oral Medicine, Arizona School
of Dentistry & Oral Health, A.T. Still University, Mesa, Arizona
Satish Kumar, DMD, MDSc, MS
Assistant Professor, Department of Periodontics and Preventive Dentistry,
University of Pittsburgh, Pittsburgh, Pennsylvania
ABSTRACT
Purpose:
Mucous membrane pemphigoid (MMP) is a rare,
autoimmune, subepithelial blistering disorder
that often affects the oral mucosa. The hallmark
clinical sign is an oral blister, which then ruptures
into an ulceration. Unfortunately, symptoms can
initially present non-specifically, which can
mislead the clinician regarding diagnosis and
result in a considerable delay in definitive
diagnosis, multiple specialist consultations,
and ineffective treatments. The purpose of this
case report is to review the diagnostic process
involved for a gingival ulceration resulting from
MMP, its pathogenesis, clinical features, and
management and to highlight the factors
resulting in delayed definitive diagnosis.
Methods:
This case highlights a 70-year-old woman with
recurrent and persistent gingival ulcerations who
consulted her primary care physician, a general
dentist, periodontist, and a dermatologist, prior
to obtaining a correct diagnosis.
Results:
The patient was seen in a university-based oral
medicine clinic, where she was diagnosed with
mucous membrane pemphigoid limited to
the oral mucosa. She had undergone several
unsuccessful treatments before she was
appropriately treated for oral mucous
membrane pemphigoid.
Conclusions:
An awareness of autoimmune-mediated
mucocutaneous disorders that affect the oral
cavity is critical for achieving a timely diagnosis
and appropriate management.
Keywords:
benign mucous membrane pemphigoid;
desquamative gingivitis; mucocutaneous
disorder; oral ulcer
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MAY/JU NE 2017 | P EN N S YLVA N IA D EN TA L J O UR N A L