**3. Results**

**Table 4** summarizes the gingival symptoms in the 39 patients. Clinical symptoms described were soreness (31 patients, 79.5%), bleeding (21 patients, 53.8%), and swelling (18 patients, 46.2%). The results summarizing the gingival site involvement are shown in **Table 5**. The sites where DG lesions were most frequently found were the anterior areas (35 patients, 89.7%). In contrast, only four patients (10.3%) had DG lesions confined to the molar areas. Most of the gingival involvement was observed in the labial/buccal area (37 patients, 94.7%). In 22 patients (56.4%), gingival involvement was also observed in the palatal/lingual area. A positive Nikolsky's sign was demonstrated in 38 of the 39 patients (97.4%) at the first visit (**Table 6**). In 16 of the 38 patients (42.1%) in association with positive

**63**

**4. Discussion**

*Gingival Nikolsky's Sign: A Valuable Tool in Identifying Oral Manifestations of Mucous…*

Soreness 17 14 31 (79.5%) Bleeding 16 5 21 (53.8%) Swelling 14 4 18 (46.2%)

Anterior gingiva 22 13 35 (89.7%) Restricted to the molar gingiva 3 1 4 (10.3%) Labial/buccal gingiva 24 13 37 (94.9%) Palatal/lingual gingiva 14 8 22 (56.4%)

Positive 24 14 38 (97.4%) Negative 1 0 1 (2.6%)

**MMP (n = 25) PV (n = 14) Total (n = 39)**

**MMP (n = 25) PV (n = 14) Total (n = 39)**

**MMP (n = 25) PV (n = 14) Total (n = 39)**

**MMP (n = 24) PV (n = 14) Total (n = 38)**

Nikolsky's sign, gingival bleeding was induced by gentle pressure (**Table 7**). All 16

With gingival bleeding 16 0 16 (42.1%) Without gingival bleeding 8 14 22 (57.9%)

In this study, 39 DG patients with autoimmune bullous diseases diagnosed as MMP or PV participated. All the patients complained of gingival soreness, bleeding, and/or swelling (**Table 4**). A positive reaction showing Nikolsky's sign was confirmed in 38 patients (97.4%) at their first visit (**Table 6**). This result indicates that it is important to evaluate the presence of gingival Nikolsky's sign in DG patients. Patients showing positive Nikolsky's sign should have MMP or PV included in the differential diagnosis when DG is identified. However, it should be noted that it is critical to conduct DIF biopsy testing in addition to histopathological examination. By doing this, the oral healthcare providers can contribute to the early diagnosis and treatment for MMP or PV lesions in the oral cavity. It is

patients were subsequently diagnosed as having MMP (**Table 7**).

*DOI: http://dx.doi.org/10.5772/intechopen.82582*

**Table 4.** *Gingival symptoms.*

**Table 5.**

**Table 6.**

**Table 7.**

*Gingival site involvement.*

*Gingival Nikolsky's sign at the first visit.*

*Positive Nikolsky's sign with or without gingival bleeding.*

*Gingival Nikolsky's Sign: A Valuable Tool in Identifying Oral Manifestations of Mucous… DOI: http://dx.doi.org/10.5772/intechopen.82582*


#### **Table 4.**

*Gingival Disease - A Professional Approach for Treatment and Prevention*

individual which provided information on each patient's gingival symptoms, gingival site involvement, and the presence of gingival epithelial desquamation based on a test for Nikolsky's sign. At the initial dental appointment, a test for Nikolsky's sign was performed in all 39 patients by a single examiner (HE) using the "marginal" method and the "direct" method (**Figures 5** and **6**) [32, 33]. Briefly, a positive gingival Nikolsky's sign described the extension of the erosion on the surrounding normal-appearing tissue by rubbing the edge of the affected area with a periodontal probe (the "marginal" method), or the ease of inducing erosion by rubbing apparently unaffected the gingiva distant from the lesions (the "direct" method). All 39 patients were evaluated using the "marginal" method. In addition, in some patients we also used the "direct" method. When a positive Nikolsky's sign was identified, the

*Nikolsky's sign with bleeding in mucous membrane pemphigoid. Gingival bleeding can occur in some patients* 

*Nikolsky's sign in pemphigus vulgaris. The epithelium is dislodged by the application of a firm sliding force.*

**Table 4** summarizes the gingival symptoms in the 39 patients. Clinical symptoms described were soreness (31 patients, 79.5%), bleeding (21 patients, 53.8%), and swelling (18 patients, 46.2%). The results summarizing the gingival site

involvement are shown in **Table 5**. The sites where DG lesions were most frequently found were the anterior areas (35 patients, 89.7%). In contrast, only four patients (10.3%) had DG lesions confined to the molar areas. Most of the gingival involvement was observed in the labial/buccal area (37 patients, 94.7%). In 22 patients (56.4%), gingival involvement was also observed in the palatal/lingual area. A positive Nikolsky's sign was demonstrated in 38 of the 39 patients (97.4%) at the first visit (**Table 6**). In 16 of the 38 patients (42.1%) in association with positive

presence of gingival bleeding was also evaluated (**Figure 6**).

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**3. Results**

**Figure 5.**

**Figure 6.**

*characterized by subepithelial blister formation.*

*Gingival symptoms.*


#### **Table 5.**

*Gingival site involvement.*


#### **Table 6.**

*Gingival Nikolsky's sign at the first visit.*


**Table 7.**

*Positive Nikolsky's sign with or without gingival bleeding.*

Nikolsky's sign, gingival bleeding was induced by gentle pressure (**Table 7**). All 16 patients were subsequently diagnosed as having MMP (**Table 7**).
