Pemphigus is a group of potentially life-threatening autoimmune diseases characterized by cutaneous and/or mucosal blistering. Pemphigus vulgaris (PV), the most common variant, is characterized by circulating IgG antibodies directed against desmoglein 3 (Dsg3), with about half the patients also having Dsg1 autoantibodies. There is a fairly strong genetic background to pemphigus with linkage to HLA class II alleles and ethnic groups such as Ashkenazi Jews and those of Mediterranean and Indian origin, are especially liable. Oral lesions are initially vesiculobullous but readily rupture, new bullae developing as the older ones rupture and ulcerate. Biopsy of perilesional tissue, with histological and immunostaining examination are essential to the diagnosis. Serum autoantibodies to either Dsg1 or Dsg3 are best detected using both normal human skin and monkey oesophagus or by enzyme-linked immunosorbent assay. Before the introduction of corticosteroids, PV was typically fatal mainly from dehydration or secondary systemic infections. Current treatment is largely based on systemic immunosuppression using corticosteroids, with azathioprine or other adjuvants or alternatives but newer therapies with potentially fewer adverse effects, also appear promising.

The literature analysis revealed that in immunocompetent patients, the oral mucosa is the second most frequently affected site of the head and neck region. In the oral cavity, the tongue is the most affected site. Diagnosis of oral leishmaniasis represents a challenge but must be considered in any differential diagnosis of exophytic lesions of oral mucosa.

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Objectives:The role of dental professionals in screening for oral cancer has been limited. The purpose of this study was to investigate and compare the educational priorities of oral medicine specialists, general dental practitioners, and doctors of dental surgery with regards to the diagnosis and management of oral cancers and potential malignant disorders.Study Design:This was a longitudinal survey.Materials and Methods:A Delphi survey was directed to a panel of 25 oral medicine specialists asking them to identify the major difficulties in diagnosing and managing patients with oral cancer or suspected malignancy. In a second phase, two groups of generalists were asked to express their ratings on the issues identified by experts.Results:The response rate of the experts to the survey was 84%, while only 44% of the generalists participated. Although the three groups agreed on most of the issues, there were significant differences of opinions on 10 of the items proposed by specialists (P < 0.05 from the Kruskal–Wallis test), which were observed mainly between experts and general dental practitioners (P < 0.017 from the Mann–Whitney U test). The opinion of the participants about future investments in the field of education resulted in similar results (P > 0.05 from the Chi-square test), with the specialists ranking highest on mandatory annual thematic courses, while the generalists prioritizing more interactive and extensive pre-graduation courses on oral cancer detection.Conclusion:This study confirms a clear need to improve the educational foundation on oral cancer by a didactic process starting with pre-graduation courses that should involve National Health Care Services, National Dental Associations, and academia.