Etiology • Fusobacterium nucleatum, Borrelia vincentii, and other
bacterial species including Prevotella and oral treponemes • Infection requires modification of local or systemic factors
including immunosuppression, local hygiene, nutritional deficiencies, intense smoking, and psychological stress.
Clinical Presentation • Engorged, enlarged, and blunted interdental papillae with cra-
teriform necrosis • Symptoms include pain, regional lymphadenitis, fetid breath,
bacterial species including Prevotella and oral treponemes • Infection requires modification of local or systemic factors
including immunosuppression, local hygiene, nutritional deficiencies, intense smoking, and psychological stress.
Clinical Presentation • Engorged, enlarged, and blunted interdental papillae with cra-
teriform necrosis • Symptoms include pain, regional lymphadenitis, fetid breath,
fever, and malaise. • Ulcerated areas covered with grayish pseudomembrane • Often accompanied by dental plaque and calculus • Bleeding noted spontaneously or with minimal tissue
manipulation • Extension of disease process into adjacent soft tissues noted
on occasion
Diagnosis • Observation of characteristic blunted, necrotizing interdental
papillae with “punched-out” appearance • Lesions on gingiva only
Differential Diagnosis • Leukemia • Immunosuppression-related conditions • Primary herpetic gingivostomatitis • Acute forms of leukemia • Vesiculobullous mucosal diseases (mucous membrane
[cicatricial] pemphigoid, erosive/bullous lichen planus, pemphigus vulgaris, paraneoplastic pemphigus)
Treatment • Local débridement, ultrasonic scaling, good oral hygiene, and
home care
• Rinses of chlorhexidine, topical povidone-iodine • Systemic antibiotics (tetracycline, metronidazole) may be
beneficial. • Identification and elimination of predisposing factor(s) • Underlying immunosuppression should be suspected if no
improvement noted
Prognosis • Excellent