Periodontics · patient case question
What should NOT be used in this patient?
Patient case: Desquamative gingivitis with positive Nikolsky sign
Scenario: Buccal mucosa PEELS on slight manipulation and the patient has a burning mouth after eating spicy food. There is GENERALISED DESQUAMATIVE GINGIVITIS on the facial gingiva (photo showed swollen, reddish gingiva). The description is effectively a POSITIVE NIKOLSKY SIGN.
Show answer and explanation
Correct answer: A. An abrasive prophy jet / air-polishing unit
- A. Correct. The epithelium separates under minimal force, so any abrasive or high-pressure instrumentation — air polishing, prophy paste under pressure, forceful retraction — will strip the mucosa and create iatrogenic erosions. Care is atraumatic.
- B. ALCOHOL-FREE mouthwash is specifically what you WANT: alcohol-containing rinses burn denuded mucosa and worsen symptoms.
- C. A mouth mirror is unavoidable and acceptable; it is used gently with minimal tissue retraction.
- D. Scaling is still required to control plaque, which markedly worsens desquamative gingivitis — it is performed gently rather than avoided.