PERIODONTICS : Managing Patients with Necrotizing Ulcerative Gingivitis

Acute infection of the gingiva characterized by gingival necrosis, bleeding and pain.  NUG is diagnosed at the onset of specific clinical signs and symptoms. 

NUG is different from other periodontal diseases in that it presents with interdental necrosis, “punched out” ulcerated papillae, gingival bleeding and pain. 




Usually young adults (age 18-30) 


a. Can be localized or generalized with rapid/sudden onset and intense pain 
b. Acute clinical presentation with distinctive characteristics of rapid onset of: 
  • Ulcerated and necrotic papillary and marginal gingiva and cratering (punched out) of papillae 
  • Intense gingival pain 
  • Bleeding gingiva with little or no provocation 
c. Secondary features: 
  • Fetid breath, yellowish-white or grayish slough “pseudomembrane” covering ulcerated papilla, lymphadenopathy, fever and malaise 
  • Bacterial involvement: fusiform bacteria, Prevotella intermedia, and spirochetes invade the gingival tissues 


a. Intense/excruciating pain 
b. Predisposing factors:
  • Psychological stress and anxiety 
  • Smoking 
  • Pre-existing gingivitis and trauma 
  • Poor oral hygiene 
  • Deficient nutrition 
  • HIV-positive 
c. All the factors above lead to immunosuppression: depressed polymorphonuclear leukocytes, antibody response, and lymphocyte mitogenesis. 
Canadian Dental Association 
Sylvia Todescan, DDS, MSc, PhD / Reem Nizar Atout, BDS, DDS, MS


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