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# 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.

Updated Nov 12, 2026

## Key points

- Pain + bleeding + punched-out papillae = necrotising gingivitis.
- Look for HIV, malnutrition, smoking and stress.
- In malnourished children it can become noma.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/necrotising-gingivitis-and-periodontitis/)

## Connections

## Related 3

- [Gingivitis: bleeding gums](https://durgical.com/en/dentistry/gingivitis-bleeding-gums/)
- [HIV and the mouth](https://durgical.com/en/dentistry/hiv-and-the-mouth/)
- [Bad breath (halitosis): approach](https://durgical.com/en/dentistry/bad-breath-approach/)

## Related conditions 2

- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)
- [Acute leukaemia (AML and ALL)](https://durgical.com/en/conditions/acute-leukaemia/)

## In Pharmacology 2

- [Metronidazole](https://durgical.com/en/pharmacology/metronidazole/)
- [Chlorhexidine](https://durgical.com/en/pharmacology/chlorhexidine/)

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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](https://www.ncbi.nlm.nih.gov/books/NBK562243/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Necrotizing Periodontal Diseases](https://www.ncbi.nlm.nih.gov/books/NBK557417/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Metronidazole](https://www.ncbi.nlm.nih.gov/books/NBK539728/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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