In the past, the term desquamative gingivitis was used as a diagnosis for an unusual condition affecting the gums characterized by painful, red, erosive lesions. Sometimes the gums appeared to be sloughing, with the formation of vesicles or bullae. 

The condition was noted to occur most often in elderly people, especially women, and was believed to be due to an imbalance in sex hormones. Today it is clear that desquamative gingivitis is caused by a number of vesiculobullous mucocutaneous  diseases. 

These types of diseases are often localized only to the oral tissues (i.e. the cheeks, tongue, and gingiva). However, they may also affect other tissues such as the skin, or internal organs.

Signs and Symptoms

How do you check to see if you might have one of these conditions? Ask yourself these questions:

1. Are your gums bright red?

2. Are they painful to the touch?

3. Are there white patches on your cheeks or gums?

4. Do your gums periodically seem to peel off, leaving a red, bleeding surface?

5. Do you have ulcers on your lips, cheeks, or gums (See figure below)?

6. Is your mouth or tongue ever dry or burning?

7. Do you have a thick, white coating on your tongue?

If you answered YES to any of these questions, you may have one of a group of diseases referred to as vesiculobullous mucocutaneous diseases. These conditions include lichen planus, cicatricial pemphigoid, pemphigus vulgaris, graft-versus-host disease (GVHD), and erythema multiforme, among others.

Most of these diseases are of unknown origin, affect mainly adult women over 50, affect females more than males, and are difficult to control.  

Since these conditions can affect not only the oral tissues but also other parts of the body, an accurate diagnosis is essential to controlling the symptoms and progression of the disease.

Diagnosis

In order to properly diagnose these conditions, a thorough medical history must be taken, including a review of all of your medications. 

Following a complete examination, certain laboratory tests may be required as well as a small tissue biopsy which can be examined under a microscope. Since many of these diseases look similar clinically, the biopsy is often the most critical factor in a proper diagnosis.

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