COMMENTARY

The Clinical Challenge of Immune-Mediated Oral Diseases

Eric T. Stoopler, DMD

Disclosures

March 06, 2014

Clinical and Demographic Overlaps Among Immunologically Mediated Oral Diseases: A Challenge for Clinicians

do Carmo MA, Gleber-Netto FO, Romano ML, Caldeira PC, Aguiar MC
Gen Dent. 2014:62:67-72

Study Summary

Dental professionals are expected to evaluate and manage a wide variety of conditions affecting the oral and maxillofacial region.[1] The dentition and its supporting structures are only one component of this anatomical region, and it is imperative that oral healthcare providers have the ability to diagnose diseases that can affect any part of the oral cavity and its associated structures. Immune-mediated conditions can initially present in the oral cavity or may be indicative of widespread disease.[1]

The most common immune-mediated diseases that affect the oral cavity are lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Depending on disease severity, this can have a significant impact on a patient's quality of life.[2]

These 3 conditions often have a similar clinical presentation, including ulceration and erythema of the gingiva and mucosal tissues, and disease diagnosis can be challenging.[3] do Carmo and colleagues retrospectively assessed and compared the demographic data and clinical manifestations in patients with oral lichen planus (OLP), oral pemphigus vulgaris (OPV), and oral mucous membrane pemphigoid (OMMP). Their goal was to provide relevant information about the similarities and differences among these diseases for dentists to improve their ability to recognize clinical presentations of each disorder.

These investigators reviewed 25,435 cases from a 55-year period at the Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Brazil. Only histologically confirmed cases of OLP, OPV, or OMMP were included in the study. Demographic data, including sex, age, and skin color (white or nonwhite), were recorded, along with the clinical features of the oral lesions (site and symptoms). The clinician's ability to recognize clinical presentation of OLP, OPV, or OMMP was compared with the final histopathologic diagnosis.

The main results of the study were the following:

Overall

  • Autoimmune diseases accounted for 301 (1.18%) of the total cases; and

  • Of the 301 cases identified, OLP accounted for most cases of disease (250 cases; 83.1%).

Oral lichen planus

  • OLP affected mostly white women, with highest prevalence between 40 and 60 years of age;

  • OLP affected the buccal mucosa most often, followed by the tongue and then the gingiva;

  • Common clinical features of OLP were white and gray lines affecting the mucosa and desquamative gingivitis;

  • Symptoms, such as pain, burning, and itching, were reported in 37 of 250 cases (14.8%), and tissue ulceration was reported in 37 of 250 cases (14.8%); and

  • OLP was the primary clinical diagnostic hypothesis in 213 cases (85.2%) of histologically confirmed disease.

Oral pemphigus vulgaris

  • OPV affected mostly white women, with the highest prevalence between 40 and 60 years of age;

  • OPV primarily affected the buccal mucosa;

  • The most common clinical feature of OPV was an erythematous ulcer;

  • Symptoms, such as pain, burning, and itching, were reported in 21 of 27 cases (77.7%); and

  • OPV was the primary clinical diagnostic hypothesis in 22 of 27 cases (81.5%) of histologically confirmed disease.

Oral mucous membrane pemphigoid

  • OMMP affected mostly white women between 20 and 76 years of age;

  • OMMP primarily affected the gingiva;

  • The most common clinical features of OMMP were erythematous ulcers and blisters;

  • Symptoms, such as pain, burning, or itching, were recorded in 16 of 24 cases (66.7%); and

  • OMMP was the primary clinical diagnostic hypothesis in 16 of 24 cases (66.7%) of histologically confirmed disease.

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