Desquamative gingivitis (DG) is a manifestation of a number of mucocutanenous disorders, one of it being oral lichen planus (OLP). OLP is an autoimmune disease. The aetiology for this condition is unknown, but there are few factors associated with its occurrence, for example alcohol drinking, smoking, allergic reaction to certain medications or restorative material. DG lesions increase the long-term risk for plaque-induced periodontal disease. At the same time, dental plaque and calculus cause gingival OLP resulting in the erosive disease. This report presents the management of a case of oral lichen planus associated with desquamative gingivitis with periodontitis. The expertise involved are from the oral medicine, periodontic and prosthodontic clinics. The uniqueness of the case management was the introduction of single tufted brush, Tepe® compact tuft toothbrush, to perform “solo brushing technique”. It was able to remove plaque effectively and did not cause irritation to the gingivae. Patients presenting with mucocutaneous disorders which exarcebates other oral conditions requires multidisciplinary management. Proper treatment planning will significantly improve their oral health related quality of life.

Methods: In total, 185 lesions were identified on bone and SPECT-CT scans from 32 patients. Lesions were classified as metastatic (109 sclerotic lesions) and benign (76 lesions) morphologically on low-dose CT. Semiquantitative analysis using SUVmax and mean HU was performed on the lesions and compared. To discriminate benign and metastatic lesions, the correlation between SUVmax and mean HU was determined using the intraclass correlation coefficients. Results: The SUVmax was higher in metastatic lesions (20.66±14.36) but lower in benign lesions (10.18±12.79) (p<0.001). The mean HU was lower in metastatic lesions (166.62±202.02) but higher in benign lesions (517.65±192.8) (p<0.001). A weak negative correlation was found between the SUVmax and the mean HU for benign lesions, and a weak positive correlation was noted between the SUVmax and the mean HU on malignant lesions with no statistical significance (p=0.394 and 0.312, respectively). The cutoff values obtained were 10.8 for SUVmax (82.6% sensitivity and 84.2% specificity) and 240.86 for the mean HU (98.7% sensitivity and 88.1% specificity) in differentiating benign from malignant bone lesions. Conclusions Semiquantitative assessment using SUVmax and HU can complement qualitative analysis. Metastatic lesions had higher SUVmax but lower mean HU than benign lesions, whereas benign lesions demonstrated higher mean HU but lower SUVmax. A weak correlation was found between the SUVmax and the mean HU on malignant and benign lesions. Cutoff values of 10.8 for the SUVmax and 240.86 for the mean HU may differentiate bone metastases from benign lesions.