Desquamative Gingivitis: A Narrative Review of Practical Diagnostic Approach for General Dental Practitioners

Desquamative gingivitis (DG) is a clinical sign characterized by gingival erythema, epithelial desquamation, and erosion rather than a discrete diagnosis. It most commonly reflects underlying oral lichen planus, mucous membrane pemphigoid, or pemphigus vulgaris. As affected patients typically present to general dental practitioners, timely recognition and structured triage are essential for effective management. However, diagnostic delays remain common and can extend the management period by several months. This narrative review synthesizes the current evidence on the clinical presentation, epidemiology, etiology, differential diagnosis, diagnostic workup, and management pathways relevant to general dentistry for this condition. Key findings indicate that a staged clinical history and examination can substantially narrow the differential diagnosis prior to biopsy, that histopathology combined with direct immunofluorescence offers superior diagnostic yield compared with histopathology alone, and that biopsy technique and site selection, favoring perilesional or uninvolved tissue and atraumatic sampling methods, meaningfully affect the diagnostic accuracy. Chronic ulcerative stomatitis and lichen planus pemphigoides are important but frequently overlooked mimics of more common causes. While disease-specific pharmacotherapy generally requires specialist oversight, professional oral hygiene reinforcement and gentle periodontal care delivered by general dental practitioners produce consistent, evidence-supported improvements in pain and lesion activity across all underlying diagnoses. A structured, practical approach to recognition, biopsy planning, and prompt referral can shorten the diagnostic pathway and improve long-term outcomes in patients with this challenging clinical condition.