What is Noma/Cancrum Oris?
A non-communicable gangrenous disease that commonly occurs in young children living in a state of indigence. The most affected continent is Africa, with some cases reported in Asia and America. It is one of the neglected tropical diseases under WHO in 2023. Although preventable, this rapidly progressive fatal disease remains overlooked for reasons including lack of healthcare, stigma, and traditional beliefs.
Despite its etiology and pathophysiology being unclear, non-specific polymicrobial organisms are an ideal causative factor, along with socio-economic elements like poverty, malnutrition, poor oral health, and underlying infections. The progressive late stages lead to difficulties in eating and speaking and substantially induce facial deformities.
Stages of Noma:
WHO has classified NOMA (Necrotising Ulcerative Stomatitis) into five stages:
| Stages | Clinical signs | |
|---|---|---|
| Stage 0 (Simple Gingivitis) | Mild gingival inflammation without tissue destruction | |
| Stage 1 Acute Necrotising Ulcerative Gingivitis (ANUG) |
Punched out interdental papilla, painful bleeding | |
| Stage 2 (Oedema) | Formation of oedema around the mouth and cheeks with high fever |
|
| Stage 3 (Gangrene) | Necrosis and desquamation of the skin, cheek, upper and lower jaws leads to perforation, death due to sepsis (85%-90%) |
|
| Stage 4 (Scarring) | Thick facial scars with subsided active infection, trismus formation |
|
| Stage 5 (Sequelae) | Facial disfigurement from long term bone defects with difficulties in eating and speaking |
Management of Noma:
Early Stage Treatment: Antibiotic therapy, demonstrate oral hygiene instructions, prescribe mouthwash and nutrition supplements.
Late Stage Treatment: Reconstructive surgeries
Core Insights:
As one of the neglected tropical diseases, social awareness is lacking. What could be insisted upon:
- Government or non-governmental organizations can work to strengthen concerns among international healthcare workers.
- Inform and educate the local population about etiological factors, prevention, and treatment.
- Provide psychological counseling to rehabilitate survivors and help them reintegrate into society.
- Emphasize the importance of oral health and nutrition.
In what ways can foreign governments aid in awareness and treatment of noma?
Both dentists and physicians would work together on a patient to treat noma. What are some common issues do you think they would face?
MBH/PS