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Introduction Diagnosis of underlying causes for desquamative gingivitis (DG) is often delayed in clinical settings, but little is known about factors influencing its delayed diagnosis. We investigated the diagnostic patterns and associated factors in a cohort of patients presenting primarily with DG.Materials and methods A total of 41 patients presenting primarily with DG were interviewed to evaluate professional and patient diagnostic delays. Severity of DG was evaluated using the desquamative gingivitis clinical score (DGCS) proposed by Arduino et al. (2017).Results The study sample was composed of 29 females and 12 males. On average, patients waited 10.8 ± 10 months (range 4-20 months) before seeking their first professional consultation (that is, patient delay). Less severe disease and female gender were significantly associated with longer patient delay. Patients consulted an average of 4.1 ± 2 healthcare professionals (range two to six) before a definitive diagnosis was reached, with an average professional delay of 7.3 ± 5 months (range 2-11 months). Professional delay was positively correlated with the number of professional consultations (r = 0.69) and absence of other oral mucosal lesions or extraoral involvement.Conclusions Considerable diagnostic delay is a feature of the natural history of DG. Increased patient knowledge and professional awareness regarding DG symptoms and diagnostic measures is needed to reduce diagnostic delay and improve patients' experience with this disease.

Heroin addiction is associated with poor oral health. Oral and dental care in heroin addiction might be complicated by altered mental status, negative attitude towards oral health, dental anxiety and fear, drug interaction, and associated medical co-morbidity. We present the oral findings and discuss the dental, behavioural, and anaesthetic management considerations in a 46-year-old man who had dental anxiety and had been an intravenous heroin user for the past 23 years.

Subcutaneous emphysema is rarely encountered in endodontic practice and consequently there is a dearth of information in the dental literature about this complication. The following report presents an interesting case of periorbital emphysema encountered during endodontic therapy. Attention is drawn to the presentation and management of this mostly preventable complication.