Adolescents complain of soreness and point tenderness at the gingiva They often tell the physician they feel as if they “cannot remove a piece of food that is painfully stuck between their teeth” (a wedging sensation) They may also complain of a metallic taste in their mouth or bleeding gums Upon examination, the breath has an obvious fetid odor The gingivae are hyperemic, and the usually triangular gingiva between the teeth is missing or “punched out” ( Fig 117.1 ) A gray, necrotic pseudomembrane may cover some areas Intense pain is produced with probing The adolescent should be advised to maintain better oral hygiene, rest and reduce stress, and use oral rinses such as Peridex (0.12% chlorhexidine) Alternatively, hydrogen peroxide diluted 1:1 with warm water may be used as often as possible throughout the acute phase Because of the rapidity of tissue destruction and the risk of secondary infection, antibiotic therapy should be initiated Penicillin, metronidazole, tetracycline, or erythromycin should be prescribed for to 10 days When the acute phase is over, the patient should be