Necrotizing ulcerative gingivitis (NUG) is an acute and occasionally recurrent infection of complex aetiology which is characterised by the sudden occurrence of gingival pain, necrosis of interdental tissue, and bleeding.1

The bacterial flora develops as the result of an altered host response, especially in teenagers and young adults. Precipitating factors reported include: stress, smoking, poor dietary habits, and oral hygiene.1

A 19-year-old male presented with a 1 day history of general malaise, halitosis, foul taste in the mouth, and painful upper/lower left jaws. He was a non-smoker and he had no other past medical history of note.

During the examination, the patient admitted to having used “Ecstasy” (3, 4-methylenedioxymethamphetamine, MDMA) as a recreational drug 3 days before the onset of symptoms and to storing the drug next to the site of the periodontal necrosis. Local drug induced necrotising gingivitis was diagnosed (figs 1 and 2). A differential diagnosis of desquamative gingivitis and herpetic gingivostomatitis was also made.

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Figure 1

Marginal gingival necrosis in upper and lower left jaws related to use of Ecstasy (MDMA). Note that plaque control is rather good in this patient.

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Figure 2

Close up of ulceration. Note characteristic gingival crater defects and marginal pseudomembranes.

The patient was advised to stop using MDMA. Treatment included surgical debridement—scaling and root planing—of the teeth involved with chlorhexidine 0.20% irrigation and 5 days oral amoxicillin/clavulanic acid 875+125 mg every 8h and metronidazole 500 mg every 8h. The recovery was satisfactory.

Several cases of NUG have been associated with the consumption of MDMA. The possible mechanism might be related to a direct contact between the drug and oral mucosa, the acid components of the tablet and the dry mouth induced by MDMA.2^,3

In some patients, NUG can progress to necrotising periodontitis and even to necrotising stomatitis, potentially leading to a fulminating orofacial infection known as noma or cancrum oris.1