Immune-Mediated Desquamative Gingivitis and Optical Coherence Tomography Diagnostic Patterns: Clinical Implication from a Systematic Review

Abstract

Desquamative Gingivitis (DG) comprises heterogeneous clinical manifestations of numerous immune-mediated muco-cutaneous diseases. Optical Coherence Tomography (OCT) has been proposed as a valuable diagnostic support even if, to date, there are no standardized OCT-diagnostic patterns applicable to DGs. A systematic review was performed to detect existing data on in vivo OCT diagnostic patterns of the most common immune-mediated DGs (i.e., pemphigus vulgaris, mucous membrane pemphigoid and oral lichen planus). It has been found that OCT exhibits specific patterns that address the diagnosis of DG by pemphigus vulgaris (i.e., intraepithelial unilocular blister, reduced epithelial thickness, presence of acantholytic cells in the blister) and by mucous membrane pemphigoid (i.e., subepithelial multilocular blister, presence of inflammatory infiltrate), but not by oral lichen planus. These patterns could offer an attractive diagnostic OCT framework to support the clinical preliminary assessment and monitoring of these complex pathological conditions.

Diagnostic Concordance between Optical Coherence Tomography and Histological Investigations for Immune-Mediated Desquamative Gingivitis: Observational Study

“…To overcome these complexities, the effectiveness of the OCT technique was tested, and some studies supported the OCT ability to preliminarily discriminate in vivo DGs [18]. The application of this device on gingival mucosa was facilitated by the non-elasticity of the tissue, reducing one of the main problems related to use of OCT in the oral cavity, and typically represented by altered optical properties induced by the mechanical compression of the oral soft tissue [14].…”

“…From these, the best frames were finally selected for the OCT diagnoses, based on pre-determined patterns considered mainly discriminative for DGs related to OLP (erosive and bullous), PV and MMP [15,18], and after comparison with OCT archive image of gingival healthy mucosa (Figure 2). These patterns were summarized below.…”

“…A very recent systematic review of the literature, investigating the feasibility of OCT for the preliminary evaluation of DG, allowed to identify potential diagnostic OCT patterns for immune-mediated DGs (i.e., MMP and PV) [18].…”

Personalized Medicine in Oral Oncology: Imaging Methods and Biological Markers to Support Diagnosis of Oral Squamous Cell Carcinoma (OSCC): A Narrative Literature Review

“…Briefly, confocal microscopy (CM) and optical coherence tomography (OCT) are based on an incident harmless laser source penetrating the epithelial layers. Then, an associated detector collects the backscattered co-planar or coherent light, respectively, thus allowing the digital rebuilding of virtual horizontal (in CM) or transversal (in OCT) sections of the tissue at a microscopic resolution [ 82 , 84 , 85 , 86 ].…”

Desquamative Gingivitis in the Context of Autoimmune Bullous Dermatoses and Lichen Planus—Challenges in the Diagnosis and Treatment

“…This diagnostic tool has been observed to display particular patterns in the case of DG-mediated pemphigus vulgaris (such as diminished epithelial thickness, intraepithelial unilocular blister and acantholytic cells present in the blister) and in the case of mucous membrane pemphigoid (for example existence of inflammatory infiltrate and multilocular subepithelial blister). Furthermore, OCT offers the possibility to deposit and examine images at any time, facilitating treatment surveillance and the identification of disease recurrence prior to clinical manifestations [ 39 , 40 ]. Even though research is ongoing, OCT could pose an intriguing non-invasive alternative for clinical preliminary evaluation and surveillance of such intricate pathological conditions.…”