epidermolysis bullosa ( eb ) is a heterogeneous group of rare genetic disorders characterized by marked fragility of the skin and mucous membranes with blister formation occurring spontaneously or after mild trauma . eb has been divided into four broad categories based on the level of blistering within the dermal - epidermal junction , namely , eb simplex , junctional eb and dystrophic eb , which comprises dominant and recessive variants , and kindler syndrome , which is a mixed level of cleavage . oral features include repeated blistering and scar formation leading to limited oral opening , ankyloglossia , elimination of buccal and vestibular sulci , perioral stricture , severe periodontal disease and alveolar bone resorption , atrophy of the maxilla with mandibular prognathism , increased mandibular angle , and predisposition to oral carcinoma . we report a case of a 16-year - old female who complained of bleeding gums and bad breath with a past history of the formation of blisters all over the body and was diagnosed as a case of eb with mottled pigmentation . a 16-year - old female presented to the department of periodontics and implantology with the chief complains of bleeding from gums and bad breath since past 12 years and difficulty in taking any hot , spicy and hard food since childhood . the patient gave a history of spontaneous bleeding from gingiva since 56 years and frequent ulcerations in the oral cavity . a detailed medical and dental history of the patient revealed a history of the formation of blisters all over the body of the patient within hours after birth , and which had started to regress after the onset of puberty . the patient was poorly built and nourished and also complained of frequent constipation and difficulty in urination since childhood . blisters on buccal mucosa and areas of depapillation of tongue were seen during intra - oral examination [ figure 1 ] . the gingival tissue was red , edematous , ulcerated , and bled easily on probing . grade 2 mobility was present in respect to 11 , 12 , 21 , 22 , 31 , 32 , 41 , 42 . pathologic migration was also seen in respect to upper anterior teeth [ figure 2 ] . the panoramic radiograph of the patient showed generalized extensive horizontal bone loss with some areas having vertical defects [ figure 3 ] . blisters of oral mucosa periodontal status of patient showing extensive calculus deposition and generalized gingival inflammation orthopantomogram of patient showing generalized extensive horizontal bone loss with some areas having vertical defects the patient was referred to department of dermatology , sms medical college , jaipur , where a detailed physical examination revealed that bullous lesions with scarring and milia formation were present all over the body . some dystrophy of nails was also observed . the patient was diagnosed with eb dystrophic on the basis of clinical findings [ figure 4 ] . dermal manifestations of patient showing cigarette paper like appearance of skin the patient was subjected to hematological investigations and a punch biopsy of the skin lesion was obtained . light microscopic examination of a skin biopsy demonstrated a subepithelial cleft [ figure 5 ] . histopathology of skin biopsy showing subepithelial cleft the patient was informed about her condition and was advised to take a nutritious balanced diet . a conservative treatment plan was adopted for the patient due to excessive bleeding and frequent ulcerations developing even with mild trauma . full mouth scaling , root planning , and local drug delivery with tetracycline fibers was done . the patient was asked to strictly follow the oral hygiene instructions given and was also advised to rinse with 10 ml of 0.2% chlorhexidine mouthwash twice a day . a topical hydrocortisone crme and the anesthetic gel the patient is under follow - up for skin lesions in the department of dermatology and for the periodontal condition in the department of periodontics and implantology and is responding well to the treatment plan . eb refers to an uncommon group of skin disorders that are either acquired or genetically transmitted as either autosomal - dominant and autosomal - recessive traits . the prominent clinical characteristic of the disease is the development of bullae or vesicles in response to minor mechanical trauma . accurate diagnosis is necessary prior to the institution of any form of therapy , and oral manifestations are invaluable in providing this diagnosis . the condition is caused by anomalous adhesion of the epithelial components . due to the lack of cohesion , blisters form following minor trauma . the dystrophic form presents as greatest oral manifestations vesicles that rapidly tear , even with a diet of soft foods , leaving erosive surfaces on the mucosa of cheeks , tongue , uvula , and lips . other possible manifestations of this disease are tongue denudation , vestibule obliteration , ankyloglossia , and microstomia . in this reported case , the patient presented most of these oral manifestations ; only ankyloglossia and microstomia was not evident . liversidge et al . , 2005 . suggested that permanent tooth maturation proceeds normally in children with dystrophic type , which was in correlation with the findings in our case , but not in correlation with the study conducted by wright et al . in 1993 . which stated that severe enamel and dentin defects are seen in patients with eb . wright et al . 1994 . have shown that the prevalence of caries was significantly higher in eb individuals than among healthy people which was not in correlation with the findings in our case report . a protein - rich diet , along with supplements containing iron and zinc must be provided . oral ulceration due to trauma during dental manipulation can be limited by the mucosa lubrication with hydrocortisone cream or petroleum jelly . for the skin lesions , genetically corrected cell grafts and gene - carrying modified viruses are promising , but drawbacks include cost , graft fragility , and viral vector safety . this case report clearly depicts that how the dental and periodontal manifestations can lead to the diagnosis of a systemic disease . dentists should be aware of its presentation to assist in early diagnosis and to provide the patient with the proper preventive treatment extreme care during the dental treatment should be adopted to minimize the blisters and erosions lesions in the oral cavity . the present case report outlines the clinical presentation and management of this disease , which would help the dental clinician to better recognize its signs and symptoms and to provide a better oral care to these individuals .
epidermolysis bullosa ( eb ) is a genetic disease associated with fragility and bullous lesions of the skin and mucous membranes . 
 there are various patterns of inheritance and histopathology . 
 the disease is associated with systemic and oral manifestations . 
 treatment of this disease is multidisciplinary and remains only palliative till today . 
 the present case report describes periodontal manifestations of eb and the treatment plan for the same .