# Necrotising Periodontal Disease > Necrotising periodontal disease for NEET-MDS Periodontics: NUG and NUP features, fusospirochaetal flora, metronidazole and staged management. - Canonical URL: https://prepelephant.com/topics/neet-mds/periodontics/necrotising-periodontal-disease-mds - Exam / course: NEET-MDS · Subject: Periodontics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Necrotising Periodontal Disease", PrepElephant, https://prepelephant.com/topics/neet-mds/periodontics/necrotising-periodontal-disease-mds ## Direct answer Punched-out, cratered interdental papillae with a grey-yellow pseudomembrane, spontaneous bleeding, severe pain and a fetid odour define necrotising ulcerative gingivitis — the 2017 classification's "necrotising gingivitis" — an acute fusospirochaetal infection (Treponema species with Fusobacterium nucleatum and Prevotella intermedia) that strikes lowered-resistance hosts: stressed, smoking, sleep-deprived, malnourished or immunosuppressed. When the necrosis extends through the attachment to bone, the disease is necrotising periodontitis, strongly associated with marked immunosuppression such as advanced HIV infection; spread beyond the gingiva to mucosa is necrotising stomatitis, and the gangrenous noma is its end of the spectrum. Management is staged: relief of pain and gentle debridement at the first visit, removal of the pseudomembrane and instruction in hydrogen peroxide or chlorhexidine rinsing, systemic metronidazole when systemic features exist, and definitive periodontal therapy once the acute phase resolves. ## What you must remember - **Clinical pentad:** punched-out crateriform necrosis of interdental papillae, pseudomembranous slough, spontaneous bleeding, severe pain (unlike ordinary gingivitis), and fetor oris — with fever and lymphadenopathy in more toxic presentations. - **The flora:** fusospirochaetal complex — spirochaetes with Fusobacterium nucleatum and Prevotella intermedia predominating; the lesion is one of the few acute periodontal emergencies. - **Host setting:** emotional stress, smoking, poor sleep and malnutrition classically (the "trench mouth" of soldiers); HIV infection and other immunosuppression, and measles in malnourished children, are key systemic backgrounds. - **The 2017 spectrum:** necrotising gingivitis (gingiva only), necrotising periodontitis (attachment and bone loss), necrotising stomatitis (beyond the gingiva), noma (gangrenous, mostly in malnourished children — a public-health marker of extreme deprivation). - **Not contagious:** the disease arises from the patient's own flora in a compromised host — a classic MCQ assertion. - **First-visit prescription:** gentle ultrasonic debridement, cotton removal of pseudomembrane, hydrogen peroxide (commonly 1.5-3 per cent) or chlorhexidine rinsing, analgesia, and metronidazole (commonly 250-400 mg three times daily for three to five days) when fever, lymphadenopathy or immunosuppression is present. - **Counselling that is treatment:** hydration, rest, soft diet, abstinence from alcohol and tobacco, and gentle brushing; pericoronitis-associated cases around erupting third molars get local management plus the same protocol. - **Definitive phase:** after one to two weeks, complete scaling and root planing; residual interdental craters are later reshaped by gingivoplasty; recurrence demands immunological workup including HIV testing and blood glucose. ## Managing an acute case across three visits A 22-year-old hostel student during examinations presents with sudden severe gingival pain, inability to eat, bleeding papillae and a metallic, fetid breath; examination shows cratered, necrotic papillae anteriorly with grey slough and tender submandibular nodes. First visit (that day): reassure, give a non-steroidal analgesic, gently debride with an ultrasonic tip under water irrigation without anaesthesia if tolerated (or topical), swab off the pseudomembrane, prescribe hydrogen peroxide or chlorhexidine rinsing, start metronidazole because nodes and fever are present, and order fluids, rest, no tobacco or alcohol. Second visit (one to two days): pain should be sharply less; repeat debridement and membrane removal. Third visit (about a week): acute signs resolved; proceed to full-mouth scaling, plaque control instruction, and — given his stress and smoking — risk counselling. At one month, the persistent interdental craters that always remain are corrected by gingivoplasty, and he enters ordinary periodontal maintenance. Had his presentation instead shown exposed bone and loose teeth in a known HIV-positive patient, the framework shifts to necrotising periodontitis: same acute protocol, urgent physician involvement, antiretroviral co-management and a guarded prognosis for affected teeth. ## Where the exam frames it Feature-recognition items hinge on the punched-out papilla and pseudomembrane with severe pain — and on what the disease is not: contagious, or chronic, or plaque-proportional. Aetiology questions want the fusospirochaetal complex plus the predisposing quartet of stress, smoking, malnutrition and immunosuppression. Classification questions test the 2017 hierarchy from gingivitis through periodontitis to stomatitis and noma, and the HIV association of the deeper forms. Management MCQs reward the staged answer — debridement and antiseptics first, metronidazole when systemic signs exist, definitive therapy later — and punish answers that begin with scaling and root planing alone in a febrile patient. ## Frequently asked questions ### What distinguishes necrotising gingivitis from ordinary plaque-induced gingivitis? Acute onset, severe pain, punched-out necrotic papillae with pseudomembrane, spontaneous bleeding and fetor — versus painless, diffuse plaque-proportional inflammation. ### Which organisms characterise the necrotising lesion? A fusospirochaetal complex — oral spirochaetes with Fusobacterium nucleatum and Prevotella intermedia — in a host with lowered resistance. ### When is a systemic antibiotic indicated? With fever, lymphadenopathy, immunosuppression or inability to debride — metronidazole (commonly 250-400 mg three times daily for three to five days) is the drug of choice. ### What separates necrotising periodontitis from necrotising gingivitis? Extension of necrosis through the attachment with bone exposure, rapid bone loss and tooth loosening — strongly associated with marked immunosuppression. ### Can the interdental craters be corrected? Yes, electively — once the acute phase has fully resolved, gingivoplasty reshapes the persistent crater defects that debridement leaves behind.