Necrotising gingivitis — ORE Part 1 MCQ

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ModeratePeriodontologyNecrotising gingivitisORE Part 1

A 27-year-old smoker presents with painful bleeding gingivae, punched-out interdental papillae and halitosis. He reports poor sleep during examinations. He is afebrile, with no facial swelling or cervical lymphadenopathy. What is the most appropriate initial management?

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Correct answer: E — Provide local debridement, hygiene advice and chlorhexidine

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

This is necrotising gingivitis: pain, halitosis and punched-out interdental papillae in a smoker with a relevant stress-related risk factor. In a patient without fever, facial swelling or lymphadenopathy, SDCEP recommends local plaque/calculus removal as tolerated, oral-hygiene instruction and short-term chemical plaque control, such as 0.2% chlorhexidine. Therefore D is the best initial management. A inappropriately delays treatment of an acute destructive condition. B is unjustified before conservative management and assessment of prognosis. C is incorrect because antibiotics do not replace local measures and are reserved for spreading/systemic infection or inability to complete local treatment. E is not initial management; acute tissue excision would be unnecessarily destructive.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Treatment of Periodontal Diseases in Primary Care, 2nd ed., "Acute conditions" (2025). https://www.periodontalcare.sdcep.org.uk/guidance/managing-disease/other-periodontal-conditions/acute-conditions/