Not an answer, but a recommendation; biopsy the tissue in a less conspicuous area before surgery.

This is not an official FDA opinion or recommendaton.  It is my personal opinion/recommendation.

Dear Dr Robert

I will do biopsy. 

Then what are the differential diagnosis?

Then what are the treatment ?

I am not an oral medicine expert.  The following could be considered as some of the "rule outs" for this disease:  bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, linea IgA bullous disease, and pemphigus. The biopsy results should provide information about the diagnosis as well as possible treatments such as systemic corticosteroids.  Referral to an Oral Medicine expert is recommended.

This is not an official FDA response.  This is my own personal opinion.

did you check for cyclic neutropenia?. I have seen a similar picture in a patient with cyclic neutropenia

Sometimes is better dont do nothing. If you are aware of the possible dd it is better to refer and keep contact with the specialist, this way you will be safer.

Was the patient on any medication, contraceptive pills etc before you start your treatment?

Dear Dr Caroline

He has not taken any medicine before I  started the treatment.

Who will take care for the gingival disease? obviously it is me, as periodontist.

after phase I therapy , there is about 60% reduction of this linear erythema. but it does not completely resolve.

thank you .

Best regards

Abhaya

Thanks for your answer Dr Das, 

Assuming  that the patient is following your oral hygiene instructions and the plaque index is low, I would repeat the AIDS test and call for a complete blood investigation.

Thanks dr Carolina for your suggestion.

I will ask him to repeat the test. However he doesn't maintain his oral hygiene good. That gives me little confusions . Let's see next appointment how far he maintains his oral hygiene.

Best regards

Abhaya

Yes, Dr. try to motivate him using disclosing agents, even if you dont have it in the market you can replace it by food coloring. I dont know his age and general health condition but sometimes electric toothbrushes can help also. Besides 2 weeks of cariax gingival , 2 times a day may help to improve...