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Fast Facts: Perio Edition – Non-Dental Biofilm Induced Gingivitis – Mucocutaneous Disorders

Fast Facts: Perio Edition Episode 43

[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello and welcome to Fast Facts: Perio Edition. On this week’s episode, we continue the conversation about patients that can present with an oral inflammatory condition not associated with dental biofilm. Last week, we looked at patients that present with some type of an inflammatory condition in their oral cavity associated with fungus, and this week, we’re going to continue that convo by looking at patients that present with Mucocutaneous disorders. I want to put a warning before we even get started, this is going to be a lot of pathology talk. For those of you who hated pathology in hygiene school, buckle up because we’re doing it.
When we talk about these types of Mucocutaneous disorders, what we’re talking about is some type of an autoimmune disease of the skin or mucosal membrane, and there are a few specifically that we look at. The first is Pemphigus Vulgaris. Pemphigus Vulgaris is an autoimmune disease of the skin and mucosal membranes. This is where we begin to see oral mucosal lesions or gingival lesions that may precede skin involvement.
So the opportunity for us, if we begin to see desquamative gingivitis or some type of a vesicle or lesion in the free or attached gingiva that is not resolved by our periodontal therapy, by our debriding therapy, that sending this patient in for testing could help diagnose this autoimmune disorder before it begins to involve the skin. We can also see Pemphigoid. Pemphigoid is a mucocutaneous disorder in which autoantibodies begin to target the basement membrane. We begin to see a separation or a detachment of that basement membrane.
That is what we call a positive nikolsky sign. You guys remember that. And so this is where we begin to see, again, desquamative lesions of the gingiva. There are intense areas easily ruptured. This separation of the basement membrane oftentimes tells us that this patient has an autoimmune disorder. We also are starting to see many patients presenting with various forms of Lichen Planus. Lichen Planus is an incredibly common mucocutaneous disease in which we begin to see skin lesions in tandem with oral lesions. There are two major flavors of Lichen Planus. Most specifically, we’re looking at either a wickham striae where we begin to see kind of a transient lace like lesion, or we begin to see in some cases a desquamative or ulcerative lichen planus. These are going to be situations in which the patient may present with some type of a painful inderation or lesion. Finally, looking at patients that present with lupus erythematosus. Lupus erythematosus is a massive group of disorders, autoimmune wise, that are characterized by a presence of autoantibodies. These patients can either present with discoid or systemic lupus erythematosus in which we’re not just looking at the gingiva becoming involved, but also a range of organ systems that patients that present with these types of challenges can present not only with ulcerations in the gingiva, but also remember that very iconic butterfly skin lesion across the face in patients that present with some type of photosensitivity as well. Patients that present with these types of lesions can also experience additional challenges with scaley or euthymic macules located on the nose and the cheeks.
That concludes today’s discussion about patients that present with dental biofilm induced gingivitis associated with mucocutaneous disorders. Stay tuned, as next week we continue the conversation and conclude it by discussing traumatic lesions associated with non dental biofilm induced gingivitis. Have a wonderful week.
This has been another episode of Fast Facts – Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website www.KatrinaSanders.com Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts – Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We’ll see you next week for another Fast Fact!

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