Periodontics · patient case question
What is the most likely diagnosis?
Patient case: Painful gums and a foul odour
Patient: Male, 24 years old
Chief Complaint: “My gums are killing me and my breath is terrible.”
Background: University finals week. Smokes half a pack a day, sleeping four hours a night, eating poorly. Reports a sore throat two weeks ago.
Vital Signs: BP 124/78 mmHg · HR 88 bpm · T 99.6°F
Findings: Cratered, punched-out interdental papillae in the mandibular anterior region covered by a greyish pseudomembrane. Spontaneous bleeding on gentle retraction. Marked fetor oris. Submandibular lymphadenopathy. Generalised plaque and calculus; dry mucosa.
Show answer and explanation
Correct answer: C. Necrotising ulcerative gingivitis
- A. Primary herpetic gingivostomatitis is a childhood illness with high fever, malaise and vesicles that ulcerate across ALL mucosal surfaces, including non-keratinised tissue. It does not selectively crater the papillae.
- B. Plaque-induced gingivitis gives erythema, oedema and bleeding on probing, but no necrosis, no pseudomembrane and no characteristic odour.
- C. CORRECT. The diagnostic triad is PAIN, spontaneous BLEEDING and NECROSIS of the interdental papillae, which is what gives the cratered or punched-out appearance. Add the grey pseudomembrane, the distinctive fetid odour and the classic predisposing background — stress, smoking, sleep deprivation, poor nutrition — and the diagnosis is necrotising ulcerative gingivitis. Fusiform bacteria and spirochaetes predominate.
- D. Desquamative gingivitis is a clinical description, not a diagnosis — diffuse erythema with epithelial sloughing, usually from lichen planus or mucous membrane pemphigoid. There is no papillary necrosis or fetor.