Signs and Symptoms - Feeling of tightness around the teeth in early stages - Severe gum pain - Profuse gum bleeding - Ulcerated interdental papillae with dead tissue - Other possible signs: foul breath, bad taste, malaise, fever, cervical lymph node enlargement (rare), localised pain, more pronounced systemic reactions in children, rare complication of cancrum oris

Causes - Mixed bacterial infection including anaerobes such as P. intermedia and Fusobacterium, and spirochetes such as Treponema - Associated with diseases that compromise the immune system, such as HIV/AIDS - Opportunistic infection on a background of impaired local or systemic host defenses - Predisposing factors: smoking, psychological stress, malnutrition, immunosuppression - Infection zones: bacterial, neutrophil rich, necrotic, spirochetal

Diagnosis - Usually clinical diagnosis - Smear for fusospirochaetal bacteria and leukocytes; occasional blood picture - Differentiation from acute leukemia or herpetic stomatitis is important

Classification - Necrotizing gingivitis is part of the spectrum of necrotizing periodontal diseases - More advanced stages include necrotizing periodontitis, necrotizing stomatitis, and cancrum oris - Necrotizing periodontitis involves attachment loss, gingiva, periodontal ligament, and alveolar ligament - Necrotizing stomatitis involves tissue beyond the mucogingival junction

Treatment - Irrigation and debridement of necrotic areas - Oral hygiene instruction and use of mouth rinses - Pain medication - Oral antibiotics (e.g., metronidazole) if systemic involvement - Proper management of associated systemic disorders