Is this more than periodontal disease?

I read the information in the post which perhaps you may have missed. This patient has significant systemic inflammation from here periodontal, arthritis and asthma. Start with what you know clear the oral inflammation, the Nd-Yad laser wavelength targets inflamed tissue very well. The desquamative portion will be be helped by controlling the inflammation. The periodontal inflammation and any systemic inflammation such as arthritis, heart disease, diabetes are linked. Her physician will be able to better manage the medical issues and the dentist will be able to control the dental issues. It is all linked. The medical diagnosis is made by working in tandem with the physician. Inflammation affects the entire body it is all linked. So hopefully now you understand how LANAP will help this problem by controlling the inflammation. There is probably some mouth breathing going on. That's my initial diagnosis and treatment. That's what I think is going on to answer the posters question. I have treated similar cases with good results. Giving the patient hormonal therapy or a mouthwash is ignoring the inflammation, treat the cause.

I'd be concerned about your approach CRS. While temporarily the Laser might create a surface healing the underlying cause would still create an environment on a cellular level to make the signs of the patients autoimmune disease return. Personally I'd try the following 1. Biopsy - r/o pemphigoid, pemphigus 2. Treat topically as needed lidex, dexamethsone rinse(in concert w/MD's tmt) 3. Treat Peri-implantitis lesions locally (LANAP) keeping in mind it's the combination of the stepped abutment and open contact causing the bone loss and food impaction in the #30 area. The desquamative lesions can be from a variety of issues, everything from meds the patient takes to environmental local issues (toothpaste allergy etc). Going ahead with surgery seems a little risky from a medico-legal standpoint without a little background homework first.

I don't feel that cleaning up the mouth is risky vs how long do you want to wait to treat this. You do know that periodontal disease is managed not cured. The bacteria load can be monitored with salivary testing and observing the tissue response, the important part is no bleeding on probing. Treating a patient with topical steroids is risky. If I still did not get a tissue response then biopsy. This clinically based on the photos does not appear to be autoimmune but coordination with the MD as I stated before is a good approach. Autoimmune disease is aggravated by periodontal inflammation I would start treating the perio. If the patient is placed on systemic steroids or immune suppressive meds it will complicate the picture since the immune system is altered so eliminate the dental factior and help the MD.Decrease the bacteria many ways including LANAP to do this as a teamed approach with the MD. If you don't have the right laser, start with oral hygiene, salivary baseline testing, supra gingival scaling to leave some attachment for the LANAP to work. It is about re-establishing the attachment to provide a healthy barrier to oral bacteremia. The systemic issues will be treated by the MD not the dentist putting Lidex on the area. Also figure out why the patient might be mouth breathing. Part of medicine is formulating a differential diagnosis and starting treatment informing the patient what you hope to achieve. Start with what you know and have a differential diagnosis.

Possible lichen plannus or errosive desquamative gingivitis.

The diode just burns the tissue, treat the inflamed tissue with the optimal wavelength to get the pigmented bacteria. The perio protect is good for long term after LANAP. Look at the bone loss on the X-rays . Unfortunately scaling and root planing will just remove the tissue which could be disenfected and regenerated. .

there is research that supports Perio Protects claims on perioxide gel in biofilm elimination and maintenance. having just completed an article on peroxide use in perio I was able to find 35 lit references to support its use. How do you define "qualified clinicians?"

The patient is a mouth breather, which could contribute to her problem. I have referred her to the oral medicine department at the nearest dental school.

Treating the periodontal disease in tandem with the physician treating the medical issues is a win-win. The bacteria fuels the fire of systemic or autoimmune inflammation. The mouth matters and this inflammation allows oral bacteria to seed the bloodstream and promote any systemic inflammation. This is very simple and what dentists know best. Sure do a biopsy if that makes you comfortable it most likely come back with inflammatory cells. I'm not sure what this has to do with dental implants but happy to give the info.