Age and Sex: Occurs equally in both sexes. Most common between 17 and 35 years of age, but may occur at any age.

Signs and Symptoms: This condition is often recurrent. The patient often complains of discomfort or increasingly intense pain associated with the gingivae. They may complain of a bad taste, often described as a "metallic" taste, may (but not always) have a foul or foetid mouth odour, and may show evidence of lassitude. They will usually be febrile and painful regional lymphadenopathy will be present.

On examination, it will be noted that one or several - or even all - of the interdental crests will have been destroyed and are covered by a greyish necrotic pseudomembrane. This pseudomembrane can be easily removed by gentle abrasion, although this is painful for the patient, to reveal a raw, bleeding surface beneath. In more serious cases, there may also be destruction of the marginal gingivae. Spontaneous gingival bleeding may be present.

Predisposing Factors: Stress may be an aetiological factor, along with genetic factors, and possibly poor oral hygiene. Infection is due to anaerobes including fusiforms and spirochaetes, and there is often an underlying gingival or periodontal problem.