Necrotising gingivitis and periodontitis
- Oral pathology
A painful gum infection with punched-out, grey-covered papillae, bleeding and foul breath. It signals stress, smoking, malnutrition or a weak immune system.
What it is
Necrotising periodontal diseases are acute infections in which the tips of the papillae between teeth die, leaving punched-out ulcers covered by a grey pseudomembrane. They are very painful, bleed easily and cause a characteristic foul smell. Necrotising gingivitis affects only the gum; necrotising periodontitis also destroys bone; necrotising stomatitis spreads into the mucosa. Fusobacteria and spirochaetes are involved, but the key is a host problem: psychological stress, smoking, poor sleep, malnutrition, HIV infection or other immunosuppression. In malnourished children it can progress to noma, a gangrene of the face.
How to recognise it
- Triad: pain, bleeding and necrotic, punched-out papillae.
- Foul breath, metallic taste, sometimes fever and lymph nodes.
- Typical patients: young adults under stress who smoke, people with HIV, malnourished children.
- Responds quickly to gentle debridement, rinses and, when there are systemic signs, metronidazole.
- Recurrent or severe cases need HIV testing and a blood count.
Differential and risks
- Noma (cancrum oris) in malnourished children is a medical emergency with high mortality; it begins as necrotising gingivitis.
- Acute leukaemia can present with gum necrosis and bleeding.
- Primary herpetic gingivostomatitis differs: vesicles and ulcers across the mucosa, not only at the papillae, mostly in children.
Next step / Initial management
- Refer to the dentist within days for debridement; advise soft brushing, warm saline or chlorhexidine rinses and stopping smoking.
- Systemic signs (fever, nodes, malaise): add metronidazole, or another agent per local guidance.
- Offer HIV testing and a full blood count, and assess nutrition, especially in children; suspected noma needs immediate hospital referral.
Test yourself
Think of the answer, then tap the question to see it.
What are the three classic features of necrotising gingivitis?
Pain, bleeding gums and necrotic, punched-out interdental papillae.
Which antibiotic is commonly used when necrotising gingivitis has systemic signs?
Metronidazole.
Which tests should recurrent necrotising periodontal disease prompt?
HIV testing and a full blood count, with a nutritional assessment.
Connections
In Pharmacology2
Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.
Sources: Acute Necrotizing Ulcerative Gingivitis (StatPearls Publishing (NCBI Bookshelf), 2026); Necrotizing Periodontal Diseases (StatPearls Publishing (NCBI Bookshelf), 2025); Metronidazole (StatPearls Publishing (NCBI Bookshelf), 2023).
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Representative model, for educational purposes only.