For the patient above with desquamative gingivitis and a positive Nikolsky sign, which should be AVOIDED?

Correct answer: B. Abrasive air-polishing (prophy jet)

• A. Incorrect. Gentle scaling is necessary since plaque control markedly improves desquamative gingivitis.
• B. Correct. Air polishing directs abrasive powder at high pressure onto fragile mucosa, which will strip the epithelium and provoke extensive painful desquamation in a Nikolsky-positive patient.
• C. Incorrect. A mirror is used with gentle handling; care is needed at the commissures but it is not contraindicated.
• D. Incorrect. Alcohol-free rinse is specifically the preferred choice — alcohol-containing rinses cause burning and further tissue irritation.