Desquamative gingivitis (DG) isn’t a specific disorder; it simply represents the gingival manifestation associated with some heterogeneous mucocutaneous disorders, such as oral lichen planus (OLP), mucous membrane pemphigoid (MMP), pemphigus vulgaris (PV), plasma cell gingivitis (PCG) and few others. [...]
Desquamative Gingivitis (DG) comprises heterogeneous clinical manifestations of numerous immune-mediated muco-cutaneous diseases. Optical Coherence Tomography (OCT) has been proposed as a valuable diagnostic support even if, to date, there are no standardized OCT-diagnostic patterns applicable to DGs. A systematic review was performed to detect existing data on in vivo OCT diagnostic patterns of the most common immune-mediated DGs (i.e., pemphigus vulgaris, mucous membrane pemphigoid and oral lichen planus). It has been found that OCT exhibits specific patterns that address the diagnosis of DG by pemphigus vulgaris (i.e., intraepithelial unilocular blister, reduced epithelial thickness, presence of acantholytic cells in the blister) and by mucous membrane pemphigoid (i.e., subepithelial multilocular blister, presence of inflammatory infiltrate), but not by oral lichen planus. These patterns could offer an attractive diagnostic OCT framework to support the clinical preliminary assessment and monitoring of these complex pathological conditions.
Background: Histopathological examination remains the gold standard for the diagnosis of oral mucosal lesions. To date little is known on the clinical–pathologic agreement for oral lesions diagnosed by oral medicine experts.
Objective: This retrospective study attempts to quantify the clinical–pathologic agreement for oral lesions diagnosed by oral medicine experts.
Methods: Data were collected retrospectively from the medical records of all new oral medicine consultations. The clinical diagnosis provided by an oral medicine expert was compared to the histopathological diagnosis. Clinical–pathologic agreement was estimated as the percentage agreement and was measured using weighted Kappa.
Results: The most common oral lesions were oral lichen planus (34.7%), traumatic fibroma (23.4%), squamous cell carcinoma (SCC) or severe dysplasia (6.7%), mucous membrane pemphigoid (MMP) (5.7%), leukoplakia (5.6%) and squamous papilloma (4.3%). The overall clinical–pathologic agreement for all lesions had a weighted kappa of 0.81 [95%CI 0.78% to 0.85%]. The concordance for the most common oral lesions in the study population was 90.2%, with a weighted kappa of 0.88 [95%CI 0.85% to 0.92%]. The clinical–pathologic agreement for SCC/severe dysplasia was 78.7%, for traumatic fibroma 91.4%, for leukoplakia 97.4%, for oral lichen planus 93.8%, for squamous papilloma 96.7% and for MMP 65%.
Conclusions: The overall concordance between clinical and histopathological diagnosis for oral lesions was excellent. Dentists have the unique opportunity to refer patients to oral medicine experts for diagnosis and management of oral diseases. Given their expertise patients may require fewer visits for diagnostic purposes.
Oral lichen planus (OLP) is a T cell-mediated inflammatory autoimmune disease. Autophagy has emerged as a fundamental trafficking event in mediating T cell response, which plays crucial roles in innate and adaptive immunity. The present study mainly investigated the mRNA expression of autophagy-associated genes in peripheral blood T cells of OLP patients and evaluated correlations between their expression and the clinical features of OLP. Five differentially expressed autophagy-associated genes were identified by autophagy array. Quantitative real-time RT-PCR results confirmed thatIGF1expression in the peripheral blood T cells of OLP patients was significantly higher than that in controls, especially in female and middle-aged (30–50 years old) OLP patients. In addition,ATG9BmRNA levels were significantly lower in nonerosive OLP patients. However, no significant differences were found in the expression ofHGS,ESR1, andSNCAbetween OLP patients and controls. Taken together, dysregulation of T cell autophagy may be involved in immune response of OLP and may be correlated with clinical patterns.
Desquamative Gingivitis: Protocols, Procedures and Critical Issues