Necrotising Ulcerative Gingivitis — ORE Part 1 MCQ

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EasyPeriodontologyNecrotising Ulcerative GingivitisORE Part 1

A 22-year-old man presents with pain, bleeding, and necrosis of the interdental papillae affecting the lower anterior teeth. He has halitosis and reports being under significant stress at university. He smokes 15 cigarettes per day. What is the most likely diagnosis?

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Correct answer: A — Necrotising ulcerative gingivitis

The diagnostic triad of pain, bleeding, and necrosis of interdental papillae is pathognomonic for necrotising ulcerative gingivitis (NUG). The patient exhibits all three mandatory features, with localised involvement of lower anterior teeth. Halitosis is a characteristic accompanying sign. The risk factors—psychological stress, tobacco use (15 cigarettes/day)—strongly support NUG diagnosis, which is more common in young adults and those who smoke. Desquamative gingivitis presents with erosions and desquamation, not interdental necrosis. Herpetic gingivostomatitis causes vesicular lesions and systemic symptoms (fever, lymphadenopathy), not localised interdental necrosis. Acute leukaemia may cause bleeding gingiva but not the specific pattern of interdental papillary necrosis. Pericoronitis is localised around an erupting tooth, not diffuse interdental involvement.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Treatment of Periodontal Diseases in Primary Care – Acute conditions. https://www.periodontalcare.sdcep.org.uk/guidance/managing-disease/other-periodontal-conditions/acute-conditions/; Lamster IB, et al. Necrotizing ulcerative gingivitis. PubMed. 2000. https://pubmed.ncbi.nlm.nih.gov/10863376/