RESUMEN
OBJECTIVE: To evaluate the usefulness of exfoliative cytology as a diagnostic tool for patients with clinical symptoms of desquamative gingivitis. METHOD AND MATERIALS: Fifteen patients clinically diagnosed with desquamative gingivitis were evaluated. At their first visit, a cytologic smear was performed on the gingival lesion. On their second visit, a gingival biopsy was obtained from the perilesional site. Control smears were taken from 15 patients who had no oral lesions. RESULTS: The cytologic findings showed diffuse or collective Tzanck cells in 3 of the 15 cases. The findings of the other 12 cases were nonspecific inflammatory changes compared to the control. The definitive diagnosis for each case was made according to histopathologic and direct immunofluorescence (DIF) findings. The 3 cases in which Tzanck cells were recognized in the cytologic smear were subsequently diagnosed as pemphigus vulgaris. The cases in which only nonspecific cytologic findings were obtained were later diagnosed by biopsy and DIF as mucous membrane pemphigoid or lichen planus. CONCLUSION: All the cytologic findings of the 15 patients, except for 3 cases in which Tzanck cells were found, were nondiagnostic. Therefore, the use of exfoliative cytology does not appear to be appropriate as a diagnostic tool for patients showing the clinical symptoms of desquamative gingivitis, because this technique adds to the cost and delays the definitive diagnosis. However, using the cytologic technique may occasionally be of some value as a minimally invasive screening tool when pemphigus vulgaris is suspected.
Asunto(s)
Citodiagnóstico/estadística & datos numéricos , Gingivitis/patología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Diagnóstico Diferencial , Femenino , Técnica del Anticuerpo Fluorescente Directa , Humanos , Liquen Plano Oral/diagnóstico , Masculino , Persona de Mediana Edad , Penfigoide Benigno de la Membrana Mucosa/diagnóstico , Pénfigo/diagnóstico , Proyectos PilotoRESUMEN
Gingival involvement in erosive lichen planus (ELP) is classified as nonplaque-induced gingival lesions. Occlusive steroid therapy (OST) using a plastic stent is administered to enhance the effect of corticosteroids by maximizing the contact between the corticosteroids applied on the gingiva and the gingival lesions. Clinical efficacy may be enhanced with OST even when low-potency topical corticosteroids are used. The treatment of 2 cases of gingival ELP with symptoms of intraoral pain and a long-term burning sensation is presented. In both cases, severe erythema was found in the attached gingiva. Plastic stents were constructed to provide OST. The patient was instructed to apply topical corticosteroid (0.1% triamcinolone acetonide) to the inner surface of the stent and wear the stent continuously between meals and at night. The condition of the gingiva dramatically improved by providing OST for 10 weeks (case 1) and 3 weeks (case 2). The improvement in the gingival condition has been controlled for a long period (7 to 10 months) even after OST was completed. The treatment methods shown in this report are encouraging and worthy of further study.
Asunto(s)
Antiinflamatorios/administración & dosificación , Enfermedades de las Encías/tratamiento farmacológico , Liquen Plano Oral/tratamiento farmacológico , Triamcinolona Acetonida/administración & dosificación , Administración Tópica , Anciano , Femenino , Enfermedades de las Encías/patología , Humanos , Liquen Plano Oral/patología , Persona de Mediana Edad , StentsRESUMEN
BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune disease characterized by acantholysis in the epithelium. PV is often difficult to diagnose in the early stages, since the oral lesions are relatively nonspecific. We report on a case with a favorable outcome due to early diagnosis and effective treatment of oral lesions. METHODS: A 53-year-old Japanese woman presented with a month-long history of painful gingiva. PV was diagnosed using clinical, histopathological, and direct immunofluorescence criteria 1 month after the first visit. Evaluation of the circulating autoantibody titers to desmoglein (Dsg)1 and Dsg3 was conducted by enzyme-linked immunosorbent assay (ELISA). Occlusive steroid therapy (OST) using a topical corticosteroid (0.1% triamcinolone acetonide) was provided for 8 weeks. After OST was completed, a buccal frenectomy was performed to eliminate localized toothbrushing trauma. RESULTS: There were no adverse effects on wound healing after the procedure. No oral PV lesions were detectable at the 9-month reevaluation, and the patient remains in complete remission. The Dsg1 ELISA was negative while the Dsg3 ELISA was indeterminate at the first visit. The Dsg1 ELISA was also negative at reevaluation, but Dsg3 ELISA reactivity had increased 9 months after completion of treatment. CONCLUSION: Large scale clinical trials will be required to validate the clinical benefits of the OST treatment regimen, and further research is necessary to determine the importance of ELISA antibody examination in long-term management of oral PV.