Role of Periodontal Therapy Plus Sodium Doxycycline in the Management of Desquamative Gingivitis: A Pilot Study ^†

1. Aim

Desquamative gingivitis (DG) is a clinical representation of many autoimmune diseases, presenting with erythema, shedding and ulceration of free and attached gingiva. In the last decade, evidence suggested that DG could play a role in increasing the long-term risk for periodontal tissue breakdown, leading to the inclusion of periodontal therapies as additional treatment for DG patients [1]. Topical doxycycline gel has been tested successfully as additional option to scaling and root planing (SRP), triggering the reduction of periodontal pathogens [2]. Aim of the present work was to assess the role of 14% doxycycline gel (Ligosan^®, Dental Trey, Turin, Italy) as an additional tool to non-surgical periodontal treatment on patients affected by Oral Lichen Planus (OLP)-related DG, and active periodontitis.

2. Methods

Patients referred to the Department of Oral Medicine, CIR Dental School, Turin, were enrolled. Inclusion criteria were: symptomatic DG, caused by histologically confirmed OLP, and active periodontitis, with at least three periodontal intraosseous defects of 5 mm or more. The eligible patients were randomly assigned either to “cases”, where Ligosan^® was administered with SRP, or to “controls”, undergoing SRP alone. Severity of DG and periodontitis were evaluated through the following parameters: visual analogue scale (VAS), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and desquamative gingivitis clinical score (DGCS) [3]. Statistical analysis was performed through Wilcoxon and signed rank test.

Table 1. Treatment designed for Cases and Controls.

Timing	Cases	Controls
T0	Anamnesis; oral examination and orthopantomography (OPT); photographic documentation; fulfilment of periodontal chart; evaluation of VAS, FMBS, FMPS, DGCS	Anamnesis; oral examination and orthopantomography (OPT); photographic documentation; fulfilment of periodontal chart; evaluation of VAS, FMBS, FMPS, DGCS
T1 (one week after T0)	Ultrasonic scaling; instructions for domiciliary oral hygiene; Chlorexidine 0.20% mouthrinse three times daily for one month	Ultrasonic scaling; instructions for domiciliary oral hygiene; Chlorexidine 0.20% mouthrinse three times daily for one month
T2 (one week after T1)	Root planing of maxillary teeth; reinforcement of motivation for oral hygiene	Root planing of maxillary teeth; reinforcement of motivation for oral hygiene
T3 (one week after T2)	Root planing of mandibular teeth; application of Ligosan® in the maxillary intraosseous pockets; no flossing and sole occlusal brushing for 7 days; soft diet for 3 days	Root planing of mandibular teeth; reinforcement of motivation for oral hygiene
T4 (one week after T3)	Application of Ligosan® in the mandibular intraosseous pockets; no flossing and sole occlusal brushing for 7 days; soft diet for 3 days	Conventional oral and radiographic (OPT) examination; photographic documentation; fulfilment of periodontal chart; re-evaluation of VAS, FMBS, FMPS, DGCS
T5 (eight weeks after T4)	conventional oral and radiographic (OPT) examination; photographic documentation; fulfilment of periodontal chart; re-evaluation of VAS, FMBS, FMPS, DGCS	/

shows the main characteristics of each therapeutic protocol.

3. Results

Ten patients were recruited: six cases (4 M; 2 F; mean age: 54 years old; range 48–84), and four controls (1 M; 3 F; mean age: 72 years old; range 64–74). Among cases, statistical analysis revealed a significant decrease of FMPS and FMBS (p < 0.05), a quasi-significant decrease of DGCS (p = 0.07), with no significant variations of VAS (p > 0.05), after treatment. Controls experienced no significant fluctuations for either of the aforesaid parameters (p > 0.05). When compared, only FMPS was significantly decreased in cases rather than controls (p < 0.05).

4. Conclusions

To our knowledge, this is the first attempt of experimenting the reliability of topical doxycycline in patients with DG and active periodontitis. The main limitation of this work relies in the very small sample of patients recruited. Ligosan^® showed encouraging results in the reduction of DG severity, and improvement of the periodontal status. Further studies on larger samples could be useful to establish the consistency of these preliminary results.