Long-term periodontal stability following palliative management of pemphigus vulgaris: A 5-year case report.

Abstract

Background: Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous disorder that may cause painful oral erosions, mucosal fragility, and impaired oral hygiene, complicating periodontal treatment. This case report describes a staged, minimally traumatic approach to periodontal management in a patient with active PV.

Methods: A 49-year-old female with active PV and persistent oral and cutaneous lesions despite systemic therapy presented with severe oral pain, gingival bleeding, and difficulty performing oral hygiene. Initial management consisted of a 2-month palliative botanical oral care regimen, gentle plaque-control instructions, and avoidance of mechanical trauma. Pain was assessed using a 10-point Numerical Rating Scale. Following improvement in oral comfort, scaling and root planing were performed, followed by periodontal re-evaluation and maintenance at 3-month intervals. Periodontal parameters were assessed at baseline and 5 years.

Results: Pain decreased from 7/10 at baseline to 2/10 after 1 week and 1/10 following initial therapy. Improved oral comfort facilitated oral hygiene and non-surgical periodontal therapy. Periodontal re-evaluation demonstrated reduced probing depths and gingival bleeding. At 5 years, clinically healthy gingival tissues, minimal bleeding on probing, and stable alveolar bone levels were observed.

Conclusion: A staged, minimally traumatic approach facilitated periodontal treatment and long-term periodontal stability in this patient with active PV.

Key points: A staged, minimally traumatic approach can enable safe periodontal therapy in patients with poorly controlled pemphigus vulgaris. Palliative topical therapy may provide palliative symptom relief, improving patient comfort and tolerance to oral hygiene and periodontal treatment. Long-term periodontal stability can be achieved with careful treatment sequencing and regular maintenance, even in patients with persistent mucocutaneous disease.

Plain language summary: Pemphigus vulgaris is a condition that causes fragile, painful sores in the mouth, making it difficult for patients to eat, brush their teeth, and maintain good oral health. In this case, a patient with poorly controlled disease experienced severe pain and bleeding gums despite medical treatment. A cautious, step-by-step dental approach was used to manage her condition. First, a soothing, non-irritating mouth rinse was prescribed to reduce discomfort and allow the patient to tolerate oral hygiene. After symptoms improved, careful deep cleaning of the teeth and gums was performed, followed by regular maintenance visits every 3 months. The patient showed rapid improvement in comfort within 1 week and was able to eat normally again. Over 5 years, her gums remained stable and healthy with minimal bleeding. This case suggests that a cautious, staged approach can help safely manage gum disease in patients with sensitive oral conditions.