Overview of necrotising periodontal disease

Necrotising periodontal disease is an acute painful condition characterised by gingival bleeding and necrosis or ulceration of the interdental papillae, which is often covered with a greyish pseudomembrane. It is usually associated with halitosis and can be associated with swollen glands (lymphadenopathy) and fever.

Necrotising periodontal disease is classified by the extent of inflammation or necrosis.

• Necrotising gingivitis  (previously known as acute necrotising ulcerative gingivitis [ANUG]) affects the interdental papillae and gingivae; if not managed appropriately, it can spread to involve the bone. Necrotising gingivitis most commonly occurs in young adult smokers and rarely occurs in children. Children thought to have necrotising gingivitis should be assessed for acute herpetic gingivostomatitis (see Oral mucocutaneous herpes).
• Necrotising periodontitis affects the periodontium and results in bone loss. Promptly refer for specialist management.
• Necrotising stomatitis affects the periodontium, bone and soft tissues of the oral cavity. Promptly refer for specialist management.