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Stunning Pemphigoid Case

Dr. John R. Bush, Pittsburgh, PA.

Dr. John R. Bush, Pittsburgh, PA.

Desquamative gingivitis like mucous membrane pemphigoid is a rare, chronic autoimmune blistering disorder of the mucous membranes. Symptoms include fluid-filled blisters that can be friable, causing itchy, burning or painful sensations. While Pemphigoid can develop in any age group, it most frequently affects elderly patients. It can affect mucous membranes in any area of the body, but is most frequently found in the oral cavity and eyes. Early detection and multidisciplinary treatment to manage the condition is important to decrease future complications.

Dr. John Bush received an Orkos Award for excellence in case study for his treatment of a patient with pemphigoid. The patient presented to his office with painful, fluid-filled blisters that made oral hygiene almost impossible to complete. She had previously tried to administer clobetasol propionate, a steroid commonly used to treat swelling, itching, and irritation, but it did not have a positive effect. Dr. Bush searched for another option and followed a protocol pioneered by Dr. Robin Henderson, the Division Head of Periodontics at Oklahoma University. That protocol involves sequential Perio Tray™ delivery of lidocaine gel to numb tissues for treatment comfort, followed by Perio Gel™ with 1.7% hydrogen peroxide to manage biofilm, and finishing with lidex gel, a steroid to treat the blistered tissue.

Treatment started on December 9, 2021 with the most painful ulceration distal and apical to tooth 27. An interproximal papilla was also very painful. Two weeks after Perio Tray™ administration of Lidocaine (5%), Perio Gel™, and Lidex, the ulceration around 27 healed, the interproximal papilla was still present but less inflamed and much more comfortable. Due to this increased comfort level, the patient was more thorough with her oral hygiene.

Pemphigoid Case

After another two weeks of treatment, the patient continued to show improvement and was increasingly more comfortable, even able to drop the lidocaine treatment. Dr. Bush noted Interdental papilla as more coral pink and less bulbous and inflamed. The patients was instructed to continue Perio Tray™ delivery of Perio Gel™ in 15 minute daily increments and to only use the Lidex during flareups. Weeks later, Dr. Bush reported that the patient “is having wonderful results with the program. She is pain free, eating and brushing normally.”

Perio Protect celebrates these results with Dr. Bush and is proud to partner with him for patient care. “It’s this kind of dedication to patient care illustrated by Dr. Bush,” explains Tanya Dunlap, Managing Director at Perio Protect, “that matters in the treatment of these rare and painful disorders. He didn’t give up but sought a treatment that would provide relief and positive results for his patient.”

To schedule an appointment with Dr. Bush, please contact his office directly. The address is 2400 Ardmore Blvd., Suite 402, Pittsburgh, PA, 15221. The phone number is 412-351-3757.

Pemphigoid Protocol with Rx Perio Tray™ Carriers for this Orkos Award Case Study

Perio Tray™ sequential administration of

· Lidocaine gel (5%) for 10 minutes

· Perio Gel for 15 minutes

· Lidex gel for 30 minutes

At this frequency:

· 3x/day for 2 weeks with all 3 meds in sequential treatment

· 2x/day for 4 weeks with 2 meds (this patient no longer needed lidocaine)

· 1x/day continuous with Perio Gel and using Lidex for flair ups

Patients may need to continue longer with the topical steroid or change to another steroid. Lidex does not uniformly work for all patients. Contact for Dr. Henderson’ s White Paper A Novel Approach for the Treatment of Desquamative Gingivitis.

For more information on mucous membrane pemphigoid see Hasan, Shamimul. “Desquamative gingivitis - A clinical sign in mucous membrane pemphigoid: Report of a case and review of literature.” Journal of pharmacy & bioallied sciences vol. 6,2 (2014): 122-6. doi:10.4103/0975-7406.129177


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