# Desquamative Gingivitis, Oral Hygiene, and Autoimmune Oral Diseases: A Scoping Review
## 4 Discussion
[PERSON] et al., in a 2013 publication, demonstrated that the reduction of dental plaque had the strongest correlation with enhancements in both the clinical presentation and symptom relief in a cohort of 20 patients suffering from OLP, specifically within the gingival tissues affected by the lesions [49]. Unlike prior research, indeed, despite the occurrence of an immune-inflammatory response associated with a chronic disease, they showed that the key to maintaining gingival health and improving painful symptomatology and gingival lesion severity is imperative to achieve adequate plaque control through the setting of proper supportive periodontal therapy. In 2015, [PERSON] et al. were the first with their study to offer compelling proof of the significance of maintaining plaque control when treating patients with OLP gingival lesions. The randomized controlled trial involved a total of 82 patients, divided into two groups: the first received home oral hygiene instruction with sonic-type electric toothbrushes and interdental brushes; the second, on the other hand, was instructed to continue with their usual oral hygiene maneuvers. Both groups underwent follow-up visits at 4 and 20 weeks, and it was shown that the intervention group, compared with the control group, had statistically significant (\(p<0.05\)) reductions in perceived pain, functional limitation, psychological discomfort, and plaque indices [50]. Subsequently, in 2018, [PERSON] et al. published a randomized controlled trial of a total sample of 32 patients diagnosed with desquamative gingivitis, in which the efficacy of intensive plaque control programs with a sonic toothbrush and with a manual toothbrush were compared: patients were divided into two separate groups, with the first receiving oral hygiene instruction with a sonic toothbrush and the second, on the other hand, receiving instruction with a manual one, and both clinical outcomes and matrix metalloproteinase (MMP) levels within the gingival crevicular fluid (GCF) were assessed. While there were no statistically significant variances observed between the utilization of a sonic toothbrush and a manual toothbrush, the group that employed the sonic toothbrush exhibited a statistically notable decrease in MMP-1 and MMP-9 levels [51]. [PERSON] et al. in 2019 conducted a study of 60 patients--divided into an intervention group and a control group--with OLP with gingival lesions. This study was very similar in setting and results to the study by [PERSON] et al. but with the difference that the intervention group was provided with manual soft brushes. The rationale for this choice was that this type of toothbrush appears to be more widespread in Italy to date [52]. Although there are--albeit few--findings in the literature inherent in the relationship between desquamative gingivitis and plaque control, to date there are still few published studies that have directed their focus on the role that periodontal pathogenic bacteria, and thus overt periodontal disease, have in influencing the course of gingival lesions ascribable to the term desquamative gingivitis. In 2017, a study conducted by [PERSON] et al. examined 11 bacterial species found in lesions associated with desquamative gingivitis related to oral lichen planus (OLP) and in cases of plaque-induced gingivitis. The research revealed a higher occurrence of bacterial species like Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and Eikenella corrodens in specimens from OLP patients compared to those without OLP [53]. Further insights into the bacterial role in the pathogenesis of OLP were provided by [PERSON] et al. who, in patients with OLP lesions, found that resident oral cavity bacteria can (1) compromise the epithelial physical barrier, (2) be internalized into epithelial cells or T cells, and (3) promote T-cell chemokine release.