Velinda, Yelena, Elle and Elina

Non-Plaque induced gingival lesions
Mucocutaneous lesions



Lichen planus
1. What this type of gingival disease would look like clinically- there are several forms of lichen planus: reticular, patch, atrophic, erosive and bullous. the most common is reticular form. Reticular lesions are asymptomatic ,bilateral and consist of interlacing white lines on the posterior aspect of buccal mucosa. It also may affect lateral borders and dorsum of the tongue, hard palate, and gingiva. erythema may surround the lesion - feature that are associated with coexisting candidiasis.
2. What this type of gingival disease would look like radiographically- no changes would be noted radiographically.
3. Specific organism associated with the gingival disease- none, it is immunologically mediated mucocutaneous disorder.
4. How would you diagnosis this- what would your differential diagnosis be? Clinical examination, immunopathology, histopathology. Differential diagnosis - if erosive component is present lupus erythematous and chronic ulcerative stomatitis should be included in differential diagnosis. if white striation is absent, the differential diagnosis should include erosive lichen planus, pemphigus vulgaris, cicatrisial pemphigoid.

Pemphgoid
1. What this type of gingival disease would look like clinically- include bullous pemphigoid, and cicatricial pemphigoid. Bullous pemphigoid affect skin and is not scarring.; characterised by formation of bullae that rapture and become flaccid in the skin..oral lesions aocures secondarily- erosive or descuamative gingivitis or bullous lesions. Cicatrisial pemphigoid involves oral cavity conjunctiva and mucosa of the nose, vagina, rectum, esophagus, and urethra. Ocular lesions is characterised by unilateral conjunctivitis, that become bilateral withing 2 weeks, formation of vesicular lesion which eventually produce scarring and blindness. orally - descuamotive geingivitis with erythema, vesiculation, desquamation and ulceration of attached gingiva.
2. What this type of gingival disease would look like radiographically- no changes radiographically
3. Specific organism associated with the gingival disease- none, immune mediated disorder.
4. How would you diagnosis this- what would your differential diagnosis be? Histopathology, Immunofluorescence. Differential diagnosis- bullous pemphigoid, erythema maltiforme, erosive lichen planus, dermatitis herpetiformes.



Pemphigus vulgaris
1. What this type of gingival disease would look like clinically- small vesicles or large bullae. Bullae can rapture and leave extensive area of ulcerations. More commonly involved areas-soft palate, buccal mucosa, ventral surface and dorsum of the tongue. Less often the lesions confined to gingival tissue- causing erosive gingivitis or desquamative gingivitis.
2. What this type of gingival disease would look like radiographically- no changes radiographically.
3. Specific organism assoicated with the gingival disease- none, autoimmune disorder.
4. How would you diagnosis this- what would your differential diagnosis be? Histopathology, cytology, clinical examination, immunofluorescence. Differential diagnosis- erythema multiforme, pemphigoid, bullous lichen planus.



Erythema multiforme
1. What this type of gingival disease would look like clinically- multiple shallow painful ulcers with erythematous border. Buccal mucosa and the tongue are most frequently affected. The skin may have target lesions specific for erythema maltiforme.
2. What this type of gingival disease would look like radiographically - no changes radiographically.
3. Specific organism assoicated with the gingival disease- none, autoimmune disease.
4. How would you diagnosis this- what would your differential diagnosis be? Clinical examination, immunofluorescence. Differential diagnosis - erosive lichen planus, desquamotive gingivitis, pemphigus vulgaris.

Lupus erythematosus
1. What this type of gingival disease would look like clinically – the oral lesions are usually ulcerative or similar to lichen planus on buccal mucosa and palate. In chronic cutaneous lupus erythematous lesions can show scarring.
2. What this type of gingival disease would look like radiographically- no changes radiographically.
3. Specific organism associated with the gingival disease none, autoimmune disorder.
4. How would you diagnosis this- what would your differential diagnosis be? Clinical examination, histopathology, immunofluorescence. Differential diagnosis- erythema maltiforme, erosive lichen planus, and pemphigus vulgaris.

Drug induced
1. What this type of gingival disease would look like clinically – vesicular and bullous lesions, pigmented or non-pigmented macular lesion, erosion that are followed by deep ulcerations. The lesions can be seen in different areas of oral cavity with gingiva mostly affected.
2. What this type of gingival disease would look like radiographically – no changes radiographically.
3. Specific organism associated with the gingival disease- none, drugs acts as an allergen either alone or in combination, sensitizing the tissue and causing allergic reaction.
4. How would you diagnosis this- what would your differential diagnosis be? Thorough medical history evaluation aids in diagnosing the condition and removing of causative agent. Biopsy and patch testing may be indicated.

Allergic reactions to dental restoratives:


Mercury:

- What it might look like clinically: gingival pigmentation in linear form, ulceration of gingival and adjacent mucosa.

- What it might look like radiographically: Destruction of underlying bone.

- How would you diagnose it: Acts as an irritant and can accentuate pre-existing inflammation and mercurial pigmentation.


Nickel and Acrylic:

- What it might look like clinically: inflammation

- What it might look like radiographically: If irritant is not removed, may cause destruction of underlying bone.

- How would you diagnose it: extensive medical history must be done and elimination process of possible agents.


Reactions attributable totoothpastes or dentifrices, mouth rinses or mouthwash and chewing gum additives

- What they might look like clinically: Reaction attributable to toothpastes, mouth rinses and chewing gum additives may appear as desquamative lesions, ulcerations of the gingiva, or both.

- What they might look like radiographically: Cannot be seen radiographically

- How would you diagnose it: An extensive medial history must be done and an elimination process of possible agents.