Regional lymphadenopathy is often present. The punched-out appearance of the interdental papillae, grayish interdental membrane, spontaneous bleeding, odor, and pain are pathognomonic. An overwhelming number of fusospirochetal forms in stained smears from the lesions confirms the diagnosis. When tonsillar or pharyngeal tissues are affected, early differentiation from diphtheria or infection accompanying agranulocytosis is essential. In such cases, the differential diagnosis must include streptococcal or staphylococcal pharyngitis.
Treatment consists of gentle, thorough local debridement.
Analgesics may be required during the first 24 h. Marked improvement usually occurs within 24 h, then debridement can be completed. Poor gingival contour, often produced during the acute phase, may need eventual surgical correction. Loss of the gingival papillae is generally permanent. Recurrence is unlikely.