What is the FIRST-LINE treatment for desquamative gingivitis (caused by mucous membrane pemphigoid or erosive lichen planus)?

Correct answer: D. Topical corticosteroids (high-potency, e.g., clobetasol or fluocinonide)

• A. Systemic antibiotics do not address the autoimmune pathogenesis of desquamative gingivitis. They may be used adjunctively for secondary infections but are not first-line.
• B. Surgical gingival resection would traumatize already fragile tissue and could worsen the condition — not appropriate for autoimmune desquamative gingivitis.
• C. Antifungal agents treat candidiasis. Candida can secondarily colonize corticosteroid-treated gingival lesions, but antifungals are not the primary treatment for desquamative gingivitis.
• D. CORRECT. High-potency topical corticosteroids (clobetasol propionate 0.05% gel or fluocinonide 0.05% gel) applied with custom trays or directly to the affected gingiva are the first-line treatment for desquamative gingivitis secondary to MMP or erosive LP. They reduce autoimmune-mediated inflammation and promote healing.