Classification of Gingival Diseases
Gingival Manifestations of Systemic Conditions

Gingival Manifestations of Systemic Conditions

Systemic conditions can be reflected in the gingival and oral conditions. These include mucocutaneous disorders, allergic reactions to dental restorative materials and reactions to oral hygiene products or foods/additives.

Mucocutaneous Disorders

Lichen Planus – This is a chronic disease thought to be caused by a cell-mediated immune reaction. There are 3 forms of the disease: the common reticular form and the more rare erosive and bullous forms. Wickham’s striae (lacy white lines) and a bumpy appearance are characteristic of the asymptomatic reticular form. In the erosive form, alternating patches of white lesions and raw red areas may be present and tender for the patient. This form may transform to squamous cell carcinoma and so these lesions should be carefully and periodically examined. With the bullous form, smaller fluid-filled lesions (vesicles) or larger vesicles (bullae) may be present.

Image: Lichen planus
Lichen planus

Pemphigoid – Similar to Lichen Planus in that this is also thought to be an autoimmune reaction, it is different in that it is more common in older adults and women. Symptoms include blistering and sloughing of the surface of the gingival epithelium (Nikolsky’s sign) exposing the underlying connective tissue. These areas can be quite painful. Lesions can appear on the buccal mucosa and inner surface of the lips.

Image: Pemphigoid

Pemphigus vulgaris – This is an autoimmune disorder that involves blistering and erosions of the scalp, trunk and other skin surfaces in addition to oral lesions. In approximately 50% of the cases, painful blisters occur orally as the first sign of the disease. Severe cases may require hospitalization for wound management similar to burn patients.

Image: Pemphigus vulgaris
Pemphigus vulgaris

Erythema multiforme –This condition may be a hypersensitivity reaction. It involves both skin and mucous membranes. Skin lesions are large red blotches with a target-like appearance. Oral lesions occur in up to 60% of cases and may be the only site involved. Oral manifestations include swollen lips, often with extensive crust formation, and gingival lesions that involve bullae that rupture and leave ulcers.

Image: Erythema Multiforme
Erythema Multiforme

Lupus erythematosus – This is a chronic autoimmune disorder that has 2 main forms: discoid (DLE) and systemic (SLE). SLE is what is commonly referred to as simply “Lupus” and involves many organ systems. In DLE, only the skin is involved. Oral lesions are more common in SLE (up to 45% of cases vs. 25% for DLE) and are characterized by a well-defined central red area surrounded by a raised white radiating border.

Image: Lupus erythematosus
Lupus erythematosus

Drug Induced

Because a systemically induced drug acts as an allergen, it can sensitize tissues and cause an allergic reaction. When a drug, such as aspirin, is placed locally, it can irritate the area ("aspirin burn"). Reactions can be seen in the oral cavity and present in many different forms including: vesicular and bullous lesions (most common), pigmented/non-pigmented macular lesions, erosions and deep ulcerations. The most common area affected is the gingiva.

Image: Aspirin burn
Aspirin burn

Allergic Reactions

Allergic reactions to dental restorative materials, components of oral hygiene products and foods or additives occur and are most common in patients with a history of allergic conditions such as allergic skin rashes, hay fever or asthma.

Dental Restorative Materials

Mercury, nickel and acrylic. Gingival lesions as the result of a contact allergy to various dental materials do occur. Allergies to precious alloys are extremely rare.

Image: Acrylic allergy
Acrylic allergy

Reactions Attributable To Toothpastes, Mouth Rinses, Chewing Gum Additives and Food Additives

Desquamative gingivitis may occur with the use of tartar control toothpastes or mouth rinses. The pyrophosphates and the flavoring agents used to mask their flavor have been identified as the main causative agents. Products or foods that use a carvone (main ingredient in spearmint oil) - or cinnamon- based flavoring system have been associated with an intense erythema of the attached gingiva, sometimes with ulcerations.

Image: Cinnamon contact allergy
Cinnamon contact allergy