Noma

Noma is also termed: stomatitis gangrenosa, necrotizing ulcerative stomatitis, cancrum oris or a ‘poverty ulcer’. It is an infective pathology of the oral cavity, which is highly disabling with a rapid progression. It is caused by opportunistic micro-organisms which become virulent in specific, debilitating situations for the host. These include: severe malnutrition, dehydration, no access to clean water and poor oral hygiene. In industrialised countries, Noma is often associated with immune disorders such as AIDS and onco-haematological pathologies (such as leukaemia). The bacterial species implicated are those of the aggressive, periodontal diseases such as Prevotella intermedia and Fusobacterium necrophourum, which are also associated with other bacteria such as Treponema denticola, Porphyromanas gingivalis and Staphylococcus aureus. Noma frequently affects children (1 – 10 years) and elderly patients.
The term Noma derives from the Greek nomein, which means to devour, a term particularly indicative of the natural history of this pathology. Indeed, during initial stages it manifests itself as a painful ulcer, located mainly on the gingival or buccal mucosa. It is differentiated from other ulcer-necrotizing pathologies [e.g. Necrotizing Ulcerative Gingivitis (NUG) or Necrotizing Ulcerative Periodontitis (NUP)]) by its rapid progress and the involvement of all the tissues of the oral cavity. Noma is not only limited to the supporting areas of dental parts but the necrosis can spread via the anatomical barriers, such as muscles. If left untreated in time, prognosis is poor with a mortality rate of 95%.
The main therapy is a qualitative improvement in lifestyle (e.g. improved nutrition and hydration to restore the hydro-electrolyte balance) and access to a cure. Pharmacological treatment also includes the administration of penicillin and Metrodinazole; if the infection involves the Pseudomonas species of bacteria, Gentamicin and Clindamycine are also used. A non-aggressive removal of the necrotic area is also indicated (where the bone is involved and only if sequestri are present).