Providing Adapted Care for Patients with Immune-mediated Mucous Membrane Conditions.

Abstract

Background: Immune-mediated diseases frequently manifest in the oral mucosa, which may be the first clinical sign for many patients. Some of these diseases present in ways that are pathognomonic (specific) for the condition; however, others have signs and symptoms that may appear very similar to systemic conditions unrelated to immune-mediated diseases. Thus, differential diagnosis can prove difficult. This case study examines a 50-year-old African-American female with co-diagnoses of Lichen Planus and Mucous Membrane Pemphigoid. These immune-mediated diseases affect the oral mucosa, causing the patient pain and burning sensations within the mouth. The symptoms associated with these conditions make maintenance of good oral hygiene difficult for the patient. Objectives: The objective of this case study was to explore Mucous Membrane Pemphigoid and Lichen Planus: the clinical and histological presentations, the implications for dental treatment, and the best proven therapies for management. Methods utilized during treatment will be presented. Methods: The patient presented to the IU School of Dentistry Dental Hygiene Clinic for routine periodontal maintenance and examination. The sensitive nature of the patient’s oral mucosa due to Lichen Planus and Mucous Membrane Pemphigoid required employment of alternative methods to routine dental care. Modifications to the patient’s diet and home oral care routines were suggested. Conclusion: Oral health providers should be conscious of the clinical manifestations of Lichen Planus and Mucous Membrane Pemphigoid, in addition to and differentiated from other oral conditions. Likewise, providers should be adept at altering routine dental care methods to accommodate patients with these and other immune-mediated conditions. If clinical treatment and oral care are administered properly, the patient should experience alleviated symptoms and suffer less discomfort and sensitivity on a day-to-day basis and during dental assessment and treatment.