# Desquamative Gingivitis, Oral Hygiene, and Autoimmune Oral Diseases: A Scoping Review
###### Abstract  
Desquamative gingivitis is a clinical condition with a chronic course, not specific to a particular disease, characterized by intense erythema, scaling, vesicles, and/or blisters that may involve both the marginal free gingiva (MG) and the neighboring adherent gingiva (AG). This scoping review aimed to investigate whether there is a correlation between oral hygiene and gingival lesions induced by autoimmune diseases of the oral cavity and whether periodontal disease can negatively influence a clinical picture of desquamative gingivitis due to an immune disorder of the oral cavity. Case series studies and randomized controlled trials were considered for this scoping review; studies that did not comply with the inclusion criteria were excluded. A total of seven studies were selected for this review. The PRISMA-ScR (preferred reporting items for scoping reviews) consensus has been followed. Based on the included studies, it is possible to state that improvement in disease and patient-reported outcomes may be the result of appropriate oral hygiene education when patients are found to have autoimmune diseases with gingival manifestations. autoimmune disease; benign mucous membrane pemphigoid; dentistry; oral hygiene; oral lichen planus; oral medicine; pemphigus vulgaris; periodontal disease 2023  
Deptamative gingivitis; Oral Hygiene, and Autoimmune Oral Diseases: A Scoping Review  
and symmetrical lesions [7; 8; 9]. OLP lesions are characterized by altered immune regulation mediated by CD8+ T lymphocytes, resulting in damage at the level of the keratinocytes, with a specific target of the pathology being basement membrane keratinocytes. At the histopathological level, different degrees of hyper-, ortho-, and parakaratosis, liquefaction of basal cells, basal membrane thickening, and atrophy of the epithelial ridges can be observed in such lesions; at the level of the lamina propria, however, a banded infiltrate formed predominantly by T lymphocytes is observed [10; 11; 12]. The worldwide prevalence of LP lesions at the level of the oral cavity is estimated to be between 1% and 2%: almost half of these lesions see gingival tissue involved in an obvious manner, and about 10% of patients with OLP have only gingival manifestations in the form of an erythemat lesion, which is clinically referred to as \"desquamative gingivitis\" [13; 14; 15]. OLP occurring at the gum level can be identified in clinical terms by the existence of redness (atrophic lichen planus), erosions, and/or ulcerations (erosive lichen planus) of bullae/blisters (bullous lichen planus). In each of these gingival manifestations, OLP lesions vary in the clinical form, extent, and degree of gingival involvement [16; 17; 18]. Mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV) represent the main subtypes of autoimmune bullous diseases that most commonly and predominantly affect the oral mucosa; the former most frequently affects female subjects aged 50-70 years, electively in the oral mucosa (90% of cases) and conjunctiv mucosa (65% of cases); the latter, on the other hand, predominantly affects skin and oral mucosa, having precisely the latter as the site of first appearance in 50-70% of cases, without, however, presenting a clear predilection for either sex [19]. MMP localizes electively at the gingival tissue level, causing erythema, edema, scaling, blistering, and ulceration; this frequently leads it to be mistaken for periodontal disease. Other less frequent localizations are the buccal mucosa, tongue, and palate. MMP lesions are characterized by the linear deposition of IgG, IgA, or C3 along the epithelial basement membrane zone and the presence of autoantibodies directed against an antigen present at the basement membrane level, BPAG-2. This leads to a clear separation of the epithelial lamina from the underlying lamina propria, with the formation of a subepithelial blister [20; 21].