Pathology · patient case question
During hygiene therapy, which of the following should be avoided in this patient?
Patient case: Gums That Peel
Patient: 61-year-old female
Chief Complaint: “My gums peel away and I keep getting blisters that pop and leave raw spots.”
Background: Symptoms present for 5 months and worsening. Difficulty eating due to pain. She also reports persistent dry mouth. No known autoimmune disease.
Medications: Sertraline · Oxybutynin · Loratadine
Vital Signs: BP 130/80 mmHg · HR 76 bpm · RR 16 · T 98.6°F
Findings: Diffuse erythematous, desquamating attached gingiva in all quadrants. Flaccid bullae on the buccal mucosa that rupture readily, leaving ragged, painful ulcers. Firm lateral pressure on clinically uninvolved mucosa induces epithelial sloughing. Reduced salivary pooling; multiple new cervical carious lesions since her last visit.
Show answer and explanation
Correct answer: C. Air-powder abrasive polishing
- A. Incorrect. Gentle hand instrumentation is appropriate and necessary. Plaque control substantially reduces gingival inflammation and lessens the severity of desquamative gingivitis.
- B. Incorrect. A soft brush, or an ultra-soft brush, is precisely what should be recommended. Meticulous gentle hygiene is a cornerstone of managing desquamative gingivitis.
- C. Correct. The high-velocity abrasive stream will strip fragile epithelium from the already compromised mucosa and induce extensive painful sloughing. It is contraindicated in any active vesiculobullous condition.
- D. Incorrect. Chlorhexidine is beneficial here. It controls plaque when mechanical hygiene is too painful to perform effectively, though an alcohol-free formulation is better tolerated on ulcerated tissue.