PV/MMP patients often require special care during maintenance appointments to manage sensitive areas of the mouth and prevent future blisters from forming. Open PV and MMP blisters can be very painful for patients, making it difficult to brush teeth and requiring a diet of soft foods. Consequently, patients may experience increased incidence of dental caries and periodontal disease.1 Presence of oral ulcerations may result in pain and bleeding during oral prophylaxis. However, this should not be a reason to delay or avoid prophylaxis, which should be done on a regular basis, even when lesions are present. Good oral hygiene is very important to positive treatment outcomes. Poor oral hygiene with dental plaque and gingival inflammation may reduce and delay treatment outcome.
Tips for dental professionals include:
- Conduct a complete oral mucosal examination. Evaluate for any abnormalities, including oral complications of PV/MMP treatment, such as candidiasis.
- Be gentle during maintenance appointments, and schedule more frequent appointments to control plaque build-up. 1,2
- Awareness of CAMBRA (Caries Management by Risk Assessment) protocols since the soft diet and difficulties in home care may increase risk for caries.
- Expect that the patient may experience pain and bleeding during the procedure. Plan for it by scheduling extra time and using local anesthetics, suction, and gauze as needed.
- Use simple hand scaling instruments to increase control and disrupt the tissue as little as possible. 1,2
- Polish teeth with a nonabrasive toothpaste, avoiding harsh abrasives and air polishers. 1
- Provide a list of rinses not containing flavoring agents, alcohol, or other harsh ingredients that might be irritating to oral tissues.
- Oral hygiene instructions for home care may need to be tailored based on the level of mucosal involvement. When significant oral disease is present, gentle home care including extra-soft toothbrushes, mildly flavored toothpastes, and mild mouth rinses may be all that the patient can tolerate. Some patients may not be able to floss due to bleeding and pain. During this time, frequent dental cleanings become more important. Once the oral ulcerations and associated pain decrease, the standard home care routine, including regular brushing and flossing, can be recommended.
- If patients are on a soft diet due to presence of oral ulceration and pain, suggest nutritious options such as vegetable soups, fruit smoothies, etc.
- If, after treatment and remission by a specialist, new lesions are observed, the general dentist should refer back to the specialist for re-evaluation and further treatment.
1. Burkhart N. Oral pemphigus vulgaris. Available at: www.rdhmag.com/articles/print/volume-27/issue-4/columns/oral-exams/oral-pemphigus-vulgaris.html.
2. Burkhart N. Mucous membrane pemphigoid. Available at: www.rdhmag.com/articles/print/volume-27/issue-3/columns/oral-exams/mucous-membrane-pemphigoid.html.