The onset of acute forms of ANUG is usually sudden, with pain, tenderness, profuse salivation, a peculiar metallic taste, and spontaneous bleeding from the gingival tissues. The patient commonly experiences a loss of the sense of taste and
a diminished pleasure from smoking. The teeth are frequently thought to be slightly extruded, sensitive to pressure, or to have a “woody sensation.” At times they are slightly movable. The signs noted most frequently are gingival bleeding and blunting of the interdental papillae (Figure 4-18).
The typical lesions of ANUG consist of necrotic punchedout ulcerations, developing most commonly on the interdental papillae and the marginal gingivae. These ulcerations can be observed most easily on the interdental papillae, but ulceration may develop on the cheeks, the lips, and the tongue, where these tissues come in contact with the gingival lesions or following trauma. Ulcerations also may be found on the palate and in the pharyngeal area (Figure 4-19). When the lesions have spread beyond the gingivae, blood dyscrasias and immunodeficiency should be ruled out by ordering appropriate laboratory tests, depending upon associated signs and symptoms.
The ulcerative lesions may progress to involve the alveolar process, with sequestration of the teeth and bone. When gingival hemorrhage is a prominent symptom, the teeth may become superficially stained a brown color, and the mouth odor is extremely offensive.
The tonsils should always be examined since these organs may be affected. The regional lymph nodes usually are slightly