Necrotizing ulcerative gingivitis is different from the other periodontal diseases, in that it presents

with interdental gingival necrosis as often describes by “punched out” ulcerated papillae, gingival
bleeding, and pain.

Interproximal gingival necrosis is easy to detect. However, tooth shape, size, and alignment may
alter the form of papillae. Consequently, these factors must be consider when assessing
interdental papillae. It is possible for inexperienced clinicians to misclassify papillae as necrotic
when in fact the papillae are blunted due to the presence of a diastema and inflamed due to
bacterial plaque. Loss of attachment and bone in NUG is probably the least distinctive of the
clinical signs of NUG, since it is a frequent finding in other periodontal diseases, a substantial
stimuls such as tooth brushing or periodontal probing is required to elicit bleeding. In comparison,
gingival bleeding in NUG occurs with the little or no provocation. Pain is the hallmark of NUG. The
quality of pain in NUG is intense and results in patients seeking treatment. Typical gingivitis and
periodontitis are not associated with severe gingival pain.