Cancrum oris, also called noma, is a very fast, severe infection that eats the mouth and face. It usually starts inside the mouth as sore, swollen gums. In a few days it can destroy soft tissue, bone, and skin. It mostly affects young children who are weak from malnutrition, recent infections, and extreme poverty. It can also occur in people with weakened immunity (for example, HIV or leukemia). Doctors diagnose it mainly by how it looks and how fast it progresses. Without early treatment, many children die. Survivors often have severe facial scars and difficulties with eating, drinking, and speaking. World Health Organization+2WHO | Regional Office for Africa+2
Noma is a very fast-moving mouth and face infection. It usually starts as sore, bleeding gums, then quickly destroys the cheeks, lips, and jaw. Without quick treatment, many children die. Survivors often have severe scars and trouble eating, speaking, and breathing. Noma mostly affects children aged 2–6 years who are malnourished, have other infections (like measles or malaria), live in deep poverty, or have poor oral hygiene. In December 2023, the World Health Organization (WHO) officially listed noma as a Neglected Tropical Disease, which helps countries focus on prevention and care. World Health Organization+2World Health Organization+2
Noma can move from gum swelling to facial destruction in just days. Early treatment with nutrition, wound care, and antibiotics can stop the disease and save life and tissue. Many health workers may rarely see noma, so community awareness and rapid referral are critical. World Health Organization+1
Other names
People and papers use several names for the same disease. You may see noma, cancrum oris, gangrenous stomatitis, or necrotizing ulcerative stomatitis. These terms all describe the same rapid, gangrenous infection of the mouth and face. fdiworlddental.org+1
Types
Doctors often describe noma by stages because the disease changes very fast. The World Health Organization (WHO) lists five clinical stages (some guides also include a “stage 0” for simple gingivitis before the disease starts). The stages are:
- Stage 1 – Acute necrotizing gingivitis. Painful, bleeding gums with ulcers and a bad smell. This is the start. Early care can still stop the disease. World Health Organization+1
- Stage 2 – Oedema (swelling). The face, lips, and cheeks swell. Ulcers deepen. The child is ill and may drool and refuse food. World Health Organization
- Stage 3 – Gangrene. Dead tissue appears and spreads quickly. Parts of the cheek, lips, or nose can die and fall away, exposing teeth and bone. World Health Organization
- Stage 4 – Scarring. The acute infection calms but leaves tight scars. The jaw may not open well (trismus). World Health Organization
- Stage 5 – Sequelae. Long-term effects remain: missing tissue, deformity, trouble eating and speaking, and social stigma. World Health Organization
Noma is not caused by one single germ. It happens when a weakened child with poor mouth health is exposed to a mix of mouth bacteria, especially anaerobes. Poverty, poor diet, and recent infections make the body too weak to fight. Studies report bacterial imbalance with organisms such as Fusobacterium and Prevotella. PubMed Central+1
Causes
Severe malnutrition. Not enough protein and calories weakens the immune system. The gums break down easily and bacteria invade. This is the strongest known risk factor. World Health Organization+1
Recent measles. Measles suppresses immunity for weeks to months. Children after measles often develop mouth ulcers that can turn into noma. The Lancet+1
Malaria. Malaria causes anemia and weakness, making the body less able to stop mouth infections. The Lancet
HIV infection. HIV lowers immunity and raises the risk of severe mouth infections, including noma in adults. World Health Organization
Leukemia and other cancers. These diseases and their treatments weaken defense cells and increase severe oral infections. World Health Organization
Extreme poverty. Limited food, crowded housing, and lack of access to care make noma more likely and more deadly. WHO | Regional Office for Africa
Poor oral hygiene. Plaque and gum disease let harmful bacteria grow. Early gum disease is often the first step toward noma. World Health Organization
Untreated necrotizing gingivitis. When this severe gum infection is not treated, it can spread and become noma. World Health Organization
Vitamin A deficiency. Vitamin A helps protect the lining of the mouth and supports immunity; low levels raise infection risk. (Discussed in public health noma modules and reviews.) www3.paho.org
Zinc and other micronutrient deficiencies. Mineral and vitamin shortages impair wound healing and immune function. scienceportal.msf.org
Chronic diarrhea/enteric infections. These conditions worsen malnutrition and reduce nutrient absorption, which weakens oral tissues. scienceportal.msf.org
Unsafe water and poor sanitation. Repeated infections and poor hygiene allow mouth bacteria to flourish and immunity to drop. WHO | Regional Office for Africa
Weaning with low-quality foods. After breastfeeding stops, thin porridges with low protein do not meet needs and raise risk. scienceportal.msf.org
Recent respiratory infections. Illnesses that inflame the mouth/throat can be a tipping point in a malnourished child. scienceportal.msf.org
Anaerobic mouth bacteria overgrowth (dysbiosis). Overgrowth of Fusobacterium, Prevotella, and others is reported in noma lesions. Frontiers
Traditional harmful oral practices. Some practices injure gums or teeth, opening a door to severe infection. (Noted in field reviews.) scienceportal.msf.org
Delayed care and long distance to clinics. The disease advances very fast; late care increases damage and death. WHO | Regional Office for Africa
Low birth weight or prematurity. Early life undernutrition and weak immunity may continue into toddler years. scienceportal.msf.org
War, displacement, and famine. Crisis settings worsen food supply, sanitation, and access to care, raising noma risk. PubMed Central
General immunosuppression from any cause. Any condition or drug that weakens defense cells can increase the chance of noma. World Health Organization
Symptoms
Painful, bleeding gums. The gums are red and tender and bleed easily when touched or brushed. This is often the first sign. World Health Organization
Mouth ulcers. Shallow ulcers appear on the gums and inside the cheeks and spread quickly. World Health Organization
Very bad breath (fetid odor). Dead tissue and anaerobic bacteria cause a strong smell. SAGE Journals
Facial swelling. The cheek, lip, or eyelid becomes puffy and painful as the infection deepens. World Health Organization
Fever. The child feels hot and unwell due to infection and inflammation. SAGE Journals
Drooling and difficulty swallowing. Pain and swelling make swallowing hard and messy. SAGE Journals
Refusal to eat or drink. Mouth pain, ulcers, and bad taste stop normal feeding, which worsens malnutrition. SAGE Journals
Rapid tissue death (gangrene). The skin and soft tissue turn dark and break down, sometimes leaving holes. World Health Organization
Exposed teeth and bone. As tissue dies, teeth and jawbone may become visible. World Health Organization
Trismus (reduced mouth opening). Scarring and muscle spasm limit jaw movement. World Health Organization
Swollen lymph nodes. Tender nodes appear around the jaw and neck. SAGE Journals
Weight loss and dehydration. Poor intake and fever cause fast weight loss and dry mouth. SAGE Journals
Sepsis signs. Fast heart rate, fast breathing, confusion, or cold hands can mean body-wide infection. SAGE Journals
Speech problems. Pain, swelling, and later scarring make speech unclear. SAGE Journals
Psychosocial distress and stigma. Visible facial damage leads to isolation and sadness. WHO | Regional Office for Africa
Diagnostic tests
Noma is primarily a clinical diagnosis based on the child’s history, risk factors, and the very rapid, destructive course in the mouth/face. There is no point-of-care test for noma itself. Tests below help confirm the stage, look for complications, plan surgery, and find the underlying problems such as malnutrition, anemia, and co-infections. World Health Organization
Physical examination
Full mouth and facial inspection. The clinician looks for bleeding gums, ulcers, the area of dead tissue, exposed bone/teeth, odor, and side-to-side facial asymmetry. The fast change from ulcer to gangrene is a key clue. World Health Organization
Vital signs check. Temperature, heart rate, breathing rate, and blood pressure are checked to detect fever and sepsis risk. This guides urgent care. SAGE Journals
Jaw movement and mouth-opening check. The clinician measures how wide the mouth opens and notes pain or locking that suggests trismus. This matters for feeding and later surgery. World Health Organization
Neck and jaw lymph node palpation. Enlarged, tender nodes support active infection. Hard or fixed nodes may suggest a different disease. SAGE Journals
Manual bedside assessments
Nutritional status by MUAC (mid-upper arm circumference). A simple tape measure helps grade malnutrition, which drives noma risk and outcomes. scienceportal.msf.org
Skin pinch test for dehydration. This quick test helps assess fluid loss from fever and poor intake. It guides rehydration. scienceportal.msf.org
Gentle gingival probing/bleeding index. Light probing shows gum fragility and bleeding, supporting severe gingival disease at early stages. World Health Organization
Tooth percussion and mobility check. Tapping teeth and checking looseness detect periodontal destruction and bone involvement around teeth. SAGE Journals
Laboratory and pathological tests
Complete blood count (CBC). Looks for anemia, leukocytosis, or neutropenia; results guide infection and nutrition care. (Common in noma work-ups reported in field reviews.) scienceportal.msf.org
Inflammatory markers (CRP, ESR). High levels suggest active infection and help monitor response. scienceportal.msf.org
Serum albumin and pre-albumin. Low levels point to protein-energy malnutrition, a core risk factor. scienceportal.msf.org
Electrolytes, renal function, and glucose. These guide fluid therapy, antibiotics, and surgical planning in sick children. scienceportal.msf.org
HIV testing and malaria testing (as indicated). Detects key co-infections that worsen noma. World Health Organization+1
Lesion swab/tissue for microscopy and culture (including anaerobes). Helps document mixed anaerobic flora such as Fusobacterium and Prevotella; results can support antibiotic choice. Tissue biopsy may show necrosis and heavy bacterial load. Frontiers
Electrodiagnostic tests
Electrocardiogram (ECG). Useful in very ill or septic patients and before anesthesia, because electrolyte problems, fever, and sepsis can affect the heart. (Standard peri-operative and sepsis care practice.) scienceportal.msf.org
Facial nerve function testing (with EMG or nerve studies in sequelae clinics). In the reconstructive phase, these tests help plan surgery if scarring affects facial movement. (Used selectively in specialty centers.) SAGE Journals
Imaging tests
Panoramic dental X-ray (orthopantomogram). Shows the jaws and teeth, detects bone loss, dead bone (sequestra), or tooth root infection helpful for surgical planning. (Reported in surgical/rehabilitation literature.) SAGE Journals
CT scan of the face (maxillofacial CT). Defines the 3-D extent of tissue loss, sinus involvement, and bone destruction to guide debridement and reconstruction. SAGE Journals
MRI (selected cases). Maps soft-tissue damage and scarring, nerves, and muscle involvement to plan complex surgery. UCL Imaging
Ultrasound of facial soft tissues. Bedside ultrasound can show abscess pockets, fluid levels, and help drainage decisions when CT/MRI are not available. (Practical imaging approach in low-resource settings.) scienceportal.msf.org
Non-pharmacological treatments (therapies & other care)
1) Urgent nutrition therapy
Give energy-dense therapeutic foods (F-75, then F-100, or RUTF) to reverse starvation, stabilize blood sugar, and support immunity. Good nutrition helps the body fight infection and heal wounds. Start feeding early, monitor electrolytes, and treat coexisting dehydration. nnsop.gov.bd+1
2) Safe rehydration & electrolyte correction
Use oral rehydration or careful IV fluids to fix dehydration and salt imbalance from infection and poor intake. Gentle rehydration prevents shock and supports kidney and tissue perfusion. scienceportal.msf.org
3) Gentle wound cleansing & moist dressings
Clean necrotic areas with safe solutions, remove debris, and keep wounds moist to promote granulation. Proper dressing technique limits secondary infection and speeds healing. Medical Guidelines
4) Nutritional micronutrient repletion
Severely malnourished children lack vitamins and minerals. Provide broad micronutrient support (built into therapeutic feeds). Delay iron until sepsis risk lowers to avoid fuelling bacterial growth. NCBI
5) Oral hygiene support
Gently brush or swab softened plaque, rinse as tolerated, and teach caregivers basic oral care. This reduces the bacterial load in the mouth and lowers the chance of progression or relapse. NCBI
6) Pain control without NSAIDs when unstable
Use acetaminophen first for pain and fever; avoid NSAIDs initially in unstable or dehydrated children. Good pain control enables nutrition and dressing changes. (Drug label references for dosing appear below.) FDA Access Data
7) Early trismus (jaw lock) prevention exercises
Begin gentle mouth opening with simple sticks or devices once pain and swelling allow. This helps prevent long-term jaw stiffness and improves feeding and speech later. scienceportal.msf.org
8) Pressure injury prevention & positioning
Reposition, pad bony areas, and keep the head side-lying if drooling or at aspiration risk. This lowers complications while the child is weak. scienceportal.msf.org
9) Thermal protection and infection control
Keep the child warm, reduce crowding, wash hands, and isolate if there are open wounds. Simple infection-control steps reduce hospital-acquired infections. scienceportal.msf.org
10) Tetanus prevention (wound care and vaccination check)
Clean away dead tissue and verify tetanus protection. In dirty wounds with uncertain vaccination, tetanus immune globulin and vaccine may be indicated (see drug section). CDC+1
11) Measles catch-up vaccination planning (after stabilization)
Since measles makes noma more likely and severe, ensure MMR catch-up after the acute phase. Vaccination is key prevention for the future. U.S. Food and Drug Administration
12) Treat co-infections (e.g., malaria, pneumonia)
Screen for and manage common infections that worsen malnutrition and sepsis risk; this supports overall recovery and survival. scienceportal.msf.org
13) Speech and feeding therapy (as healing begins)
Teach safe swallowing, use soft adaptive utensils, and gradually re-train chewing and speech. Early rehab lowers aspiration risk and improves nutrition. scienceportal.msf.org
14) Psychosocial support and stigma reduction
Children with facial damage may face bullying and withdrawal. Counseling and caregiver support reduce trauma and help return to school and community life. The Guardian
15) Scar management (after acute phase)
Use massage, silicone gels/sheets, and stretching to soften scars and improve mouth opening while awaiting reconstructive surgery. scienceportal.msf.org
16) Sun and dust protection for healing skin
Cover healing skin from sun and dust to reduce irritation and pigment change, and to keep dressings clean. Medical Guidelines
17) Safe feeding techniques
Offer small, frequent, soft feeds that the child can handle. Use cups/spoons instead of bottles to lower infection risk. Position upright to prevent aspiration. nnsop.gov.bd
18) Community health worker follow-up
Home visits track weight, oral care, and dressing changes; this reduces relapse and supports adherence to antibiotics. UNICEF
19) Caregiver education
Teach danger signs (fever, swelling, bleeding gums, foul odor, reduced feeding) and when to seek help immediately. Knowledge speeds re-presentation if relapse starts. World Health Organization
20) Safe delay to reconstruction
Avoid early complex surgery during acute infection. Plan reconstruction after months, when the child is nourished and inflammation has settled, to improve outcomes. scienceportal.msf.org
Drug treatments
Notes: Real-world noma regimens commonly combine anti-anaerobic therapy (e.g., metronidazole or clindamycin) with a beta-lactam (e.g., penicillin G or amoxicillin/clavulanate). Severe cases or sepsis may need parenteral broad-spectrum coverage. Always adjust for age, weight, kidney/liver function, pregnancy, and local resistance patterns.
1) Penicillin G (aqueous potassium or sodium)
Class: Beta-lactam. Purpose: Core drug against many oral anaerobe-associated pathogens when combined with anaerobic coverage. Mechanism: Inhibits bacterial cell wall synthesis. Typical dosing: Parenteral dosing varies by age/weight and severity—see label; frequent dosing every 4–6 h is common in severe infections. Side effects: Allergy/anaphylaxis, electrolyte shifts (high sodium/potassium loads), seizures with very high doses in renal impairment. FDA Access Data+1
2) Metronidazole (IV/PO)
Class: Nitroimidazole (anti-anaerobe, anti-protozoal). Purpose: Essential anaerobic coverage for necrotic mouth tissues. Mechanism: Damages anaerobic DNA after reduction. Typical dosing: 500 mg IV/PO every 8–12 h in adults; pediatric weight-based per label; reduce dose in severe hepatic impairment. Side effects: Metallic taste, nausea, disulfiram-like reaction with alcohol; rare neuropathy with prolonged use. FDA Access Data+2FDA Access Data+2
3) Amoxicillin–Clavulanate (PO/IV)
Class: Beta-lactam + beta-lactamase inhibitor. Purpose: Single-agent option covering many oral aerobes + beta-lactamase producers; useful once stable for step-down. Mechanism: Cell-wall block plus beta-lactamase inhibition. Typical dosing: Multiple adult/pediatric regimens; take with food; adjust in renal impairment. Side effects: GI upset, rash; rare cholestatic hepatitis. FDA Access Data+2FDA Access Data+2
4) Clindamycin (IV/PO)
Class: Lincosamide. Purpose: Strong anaerobic and streptococcal coverage; alternative to metronidazole or in penicillin allergy. Mechanism: Inhibits bacterial protein synthesis (50S). Typical dosing: See injection label for IV; weight-based pediatric dosing. Side effects: Diarrhea and C. difficile risk; rash, elevated LFTs. FDA Access Data+1
5) Ceftriaxone (IV/IM)
Class: Third-generation cephalosporin. Purpose: Broad Gram-negative/positive coverage; pair with metronidazole for anaerobes; useful in sepsis. Mechanism: Cell-wall inhibitor. Typical dosing: Once-daily adult dosing common; pediatric per weight; avoid calcium co-infusion in neonates. Side effects: Biliary sludging, diarrhea, hypersensitivity. FDA Access Data+1
6) Ampicillin–Sulbactam (IV)
Class: Beta-lactam + inhibitor. Purpose: Broad oral flora coverage for severe facial infections; good step when IV therapy is needed. Mechanism: Cell-wall block + beta-lactamase inhibition. Typical dosing: Weight-based; adjust for renal function. Side effects: Rash, diarrhea, hepatic enzyme elevations. FDA Access Data+1
7) Piperacillin–Tazobactam (IV)
Class: Antipseudomonal penicillin + inhibitor. Purpose: Escalation option in severe sepsis or mixed infections from necrotic tissue. Mechanism: Broad cell-wall inhibition + enzyme blockade. Typical dosing: 3.375–4.5 g q6–8h adults; adjust for renal dysfunction. Side effects: Electrolyte shifts, GI upset, hypersensitivity. FDA Access Data+2FDA Access Data+2
8) Cefotaxime (IV)
Class: Third-generation cephalosporin. Purpose: Alternative to ceftriaxone in sepsis protocols; combine with anaerobic agent. Mechanism: Cell-wall inhibitor. Typical dosing: Weight-based; frequent dosing. Side effects: GI upset, hypersensitivity. FDA Access Data+2FDA Access Data+2
9) Gentamicin (IV/IM)
Class: Aminoglycoside. Purpose: Add for severe sepsis targeting Gram-negatives; not for anaerobes. Mechanism: 30S ribosomal inhibition (bactericidal). Typical dosing: Weight-based; use therapeutic drug monitoring. Side effects: Nephrotoxicity, ototoxicity. FDA Access Data
10) Doxycycline (PO/IV)
Class: Tetracycline. Purpose: Alternative for mixed oral infections in penicillin allergy in older children/adults; avoid in young children depending on local guidance. Mechanism: 30S inhibitor. Typical dosing: 100 mg bid adults; pediatric per label and age. Side effects: Photosensitivity, esophagitis, tooth discoloration concerns in younger children. FDA Access Data+1
11) Azithromycin (PO/IV)
Class: Macrolide. Purpose: Add-on or alternative for selected pathogens or co-infections; not primary anaerobe therapy. Mechanism: 50S inhibitor. Typical dosing: Multiple adult/ped regimens. Side effects: GI upset, QT prolongation; hepatic warnings. FDA Access Data+1
12) Acetaminophen / Paracetamol (IV/PO)
Class: Analgesic/antipyretic. Purpose: Pain and fever control to enable feeding and care. Mechanism: Central COX inhibition. Typical dosing: Pediatric and adult dose by label; watch total daily dose. Side effects: Hepatotoxicity with overdose. FDA Access Data
13) Ibuprofen (PO suspension)
Class: NSAID. Purpose: Pain/fever in stable, hydrated patients with good renal perfusion. Mechanism: COX inhibition. Typical dosing: Pediatric suspension per label age/weight; avoid in dehydration or kidney disease. Side effects: GI irritation, kidney risk. FDA Access Data+1
14) Tetanus Immune Globulin (Human) (TIG)
Class: Passive immunization. Purpose: For dirty wounds with uncertain vaccine history. Mechanism: Provides anti-toxin antibodies immediately. Typical dosing: Commonly 250 IU IM; see product PI. Side effects: Injection-site pain, rare hypersensitivity. hypertet.com+1
15) Tetanus-containing vaccine (per schedule)
Class: Active immunization. Purpose: Long-term protection against tetanus after wound care. Mechanism: Induces protective antibodies. Dosing: As per national schedule. Side effects: Local soreness, fever. World Health Organization
16) Measles-Mumps-Rubella (MMR) Vaccine (after stabilization)
Class: Live attenuated vaccine. Purpose: Prevent measles-related immune suppression that predisposes to noma. Mechanism: Active immunization. Dosing: 0.5 mL at 12–15 mo and 4–6 yr (catch-up if needed). Side effects: Fever, rash; rare febrile seizures. U.S. Food and Drug Administration+1
17) Topical antiseptic mouth care (adjunct)
Class: Antiseptic solutions. Purpose: Reduce surface bacterial load. Mechanism: Disrupts microbial membranes/proteins. Use: Only as adjunct to debridement/nutrition/antibiotics; avoid harsh agents in children. Side effects: Local irritation. Medical Guidelines
18) Broad-spectrum parenteral beta-lactam (escalation)
Examples: Piperacillin-tazobactam or ceftriaxone + metronidazole for unstable sepsis where mixed flora suspected. Purpose: Rapid source control pending cultures. Side effects: See individual labels above. FDA Access Data+1
19) Chlorhexidine (dilute oral rinse; adjunct)
Class: Antiseptic. Purpose: Interim oral hygiene in care settings. Mechanism: Membrane disruption. Use: Low-concentration, short-term; avoid in very young children unless directed. Side effects: Taste changes, rare mucosal irritation. Medical Guidelines
20) Tailored antibiotics per culture (when available)
Purpose: Adjust regimen once culture/susceptibility returns, balancing efficacy with safety and stewardship. Mechanism: Targeted therapy reduces resistance and adverse effects. Side effects: Drug-specific. FDA Access Data
Important evidence context: High-quality trials comparing antibiotic regimens for noma are limited; choices are guided by pathophysiology, general severe-infection principles, and expert consensus. BMJ Global Health+1
Dietary molecular supplements
1) Vitamin A (context-specific)
When a child is vitamin-A deficient or has measles, vitamin A can reduce complications and support mucosal healing. In SAM programs using fortified therapeutic foods (F-75/F-100/RUTF), extra high-dose vitamin A is not routinely needed unless the feeds aren’t fortified. Dosing and timing follow WHO guidance. Avoid unsupervised megadoses. files.magicapp.org+2World Health Organization+2
2) Zinc
Zinc supports immune function and epithelial repair. In children with diarrhea—common in malnutrition—zinc shortens illness and improves recovery; typical dosing is 10–20 mg daily for 10–14 days depending on age. World Health Organization+2PubMed Central+2
3) Multimicronutrient mix (built into therapeutic feeds)
F-75/F-100/RUTF include broad micronutrients (zinc, copper, B-complex, etc.) that correct deficiencies and support healing. Use standard SAM protocols to guide refeeding. nnsop.gov.bd
4) Protein-energy supplementation
Readily absorbed proteins and calories in therapeutic foods rebuild tissue and immune cells. Frequent small feeds are safer than large boluses early on. nnsop.gov.bd
5) Vitamin C (dietary)
As part of balanced refeeding, vitamin C supports collagen formation and wound repair; obtain through therapeutic foods/fruit purees as tolerated—avoid megadoses. nnsop.gov.bd
6) Vitamin D (as per deficiency risk)
Deficiency is common in undernourished children; replacement per local guidelines supports bone/immune health during recovery. nnsop.gov.bd
7) B-complex vitamins
Included in therapeutic feeds; support energy metabolism and mucosal healing. Avoid extra dosing beyond SAM protocols unless a deficiency is diagnosed. nnsop.gov.bd
8) Folate
Replace per SAM guidance; helps cell division and tissue repair during rapid catch-up growth. nnsop.gov.bd
9) Iron (timed, not in the first week)
In SAM, iron is delayed until infection risk drops and appetite/weight gain begin, then added to restore stores and support hematopoiesis. NCBI
10) Safe probiotics (context-dependent)
Some programs use probiotics to help gut recovery after severe illness, but evidence in noma is limited; prioritize nutrition, antibiotics, and hygiene first. BMJ Global Health
Immunity-booster / regenerative / stem cell” drugs
There is no approved “stem cell drug” or proven regenerative medicine that cures noma. Care focuses on nutrition, infection control, and later reconstructive surgery. Below are contexts you may hear about; consider them investigational or supportive, not standards of care for noma.
1) Vaccines (MMR, tetanus series)
Vaccines don’t treat active noma, but they prevent diseases (measles, tetanus) that raise noma risk. Use catch-up schedules after stabilization. U.S. Food and Drug Administration+1
2) Vitamin A (when deficient/measles)
Supports mucosal/immune recovery in specific contexts, not a general “booster.” Follow WHO/SAM rules to avoid toxicity. files.magicapp.org
3) Zinc (for diarrhea management)
Improves mucosal defenses and shortens diarrheal illness; adjunct to nutrition, not a stand-alone immune drug. World Health Organization
4) Broad nutrition therapy (F-75/F-100/RUTF)
Restores immune competence by correcting macro/micronutrient deficits. This is the most effective “immune support” for malnourished children. nnsop.gov.bd
5) Experimental tissue engineering / flaps context
True regeneration in noma relies on surgical reconstruction (bone/soft tissue flaps), not cell injections. Research in regenerative biology does not replace surgery. scienceportal.msf.org
6) Probiotics (adjunct)
Explored for gut health in malnutrition; evidence in noma is insufficient. Use only within nutrition protocols. BMJ Global Health
Surgeries (what they are and why they’re done)
1) Debridement (acute phase, selective)
Careful removal of dead tissue helps control infection and allows healthy tissue to form. In early noma, this is limited and paired with antibiotics and dressing care. scienceportal.msf.org
2) Scar release and mouth opening (trismus release)
After healing, scars can lock the jaw. Releasing scar bands and reconstructing the mouth opening restores chewing, speech, and oral hygiene. scienceportal.msf.org
3) Local/regional flaps (cheek/lip reconstruction)
Surgeons move nearby tissue with its blood supply to replace destroyed cheek or lip. This restores oral competence, appearance, and function. scienceportal.msf.org
4) Skin grafts (coverage)
Split-thickness or full-thickness grafts cover defects after contracture release or flap surgery, protecting deeper structures and improving mouth opening. scienceportal.msf.org
5) Bone reconstruction (mandible/maxilla)
In advanced cases, surgeons reconstruct jaw segments (e.g., bone grafts/vascularized bone flaps) to restore bite and facial contour, improving nutrition and speech. scienceportal.msf.org
Prevention actions
Good nutrition and growth monitoring—regular community nutrition programs reduce risk. nnsop.gov.bd
Measles vaccination on time and catch-up where needed. U.S. Food and Drug Administration
Complete tetanus vaccination and proper wound care. CDC+1
Oral hygiene education—daily cleaning, safe water, and early care for mouth sores. NCBI
Prompt care for gum bleeding or mouth ulcers—early antibiotics can stop progression. World Health Organization
Treat common childhood illnesses quickly (diarrhea with zinc/ORS; malaria, pneumonia). World Health Organization
Reduce overcrowding and improve sanitation to limit infections. World Health Organization
Community health worker outreach—screen, educate, refer early. UNICEF
Address poverty-linked risks—access to food, clean water, and care lowers noma burden. The Lancet
Health worker training on noma—awareness improves early detection and survival. World Health Organization
When to see a doctor urgently
Seek immediate medical care if a child has bleeding gums, mouth pain, swelling of the cheek, foul mouth odor, fever, drooling, inability to open the mouth, refuses to eat or drink, or has a dark/black mouth lesion. Noma worsens very fast; days matter. Early treatment with nutrition and antibiotics can save life and face. World Health Organization
What to eat and what to avoid (during recovery)
What to eat: soft, energy-dense foods given frequently (fortified therapeutic foods per SAM protocols; soft porridge, mashed legumes, eggs, dairy/yogurt if tolerated, fruit/vegetable purees). Encourage sips of clean fluids between small meals. These choices supply protein, calories, and micronutrients for healing. nnsop.gov.bd
What to avoid: hard, sharp, spicy, or very hot foods that hurt mouth wounds; sugary drinks that promote oral bacteria; alcohol or herbal products not prescribed; unsupervised high-dose vitamins (risk of toxicity, especially vitamin A). Follow the SAM plan and clinician advice. files.magicapp.org
Frequently asked questions (FAQs)
1) Is noma contagious?
Noma is not spread like measles; instead, it arises from normal mouth germs taking over when a child is malnourished, sick, and has poor oral hygiene. Good nutrition, hygiene, and vaccines prevent most cases. World Health Organization
2) Who is most at risk?
Children aged 2–6 years with malnutrition, acute infections (especially measles), poor oral care, and extreme poverty. Some immunocompromised adults can also be affected. World Health Organization
3) How fast does noma progress?
Very quickly—days from gum soreness to facial tissue death. Early care is essential. World Health Organization
4) What is the first-line treatment?
Stabilize with nutrition, fluids, wound care, and antibiotics that cover anaerobes and oral flora (e.g., penicillin + metronidazole, or amoxicillin-clavulanate, or clindamycin if penicillin-allergic). Severe sepsis may need IV broad-spectrum therapy. Hopkins Guides+2FDA Access Data+2
5) Are there standard antibiotic trials for noma?
Evidence directly comparing regimens is limited; choices rely on general severe-infection principles and expert guidelines. BMJ Global Health
6) Does vitamin A cure noma?
No. Vitamin A can help deficient or measles cases, but it is not a cure and should follow WHO/SAM rules to avoid toxicity. Vaccines (MMR) prevent measles, which lowers noma risk. files.magicapp.org+1
7) When is surgery done?
Once infection is controlled and nutrition restored—often months later—surgeons release contractures and reconstruct soft tissue and bone to restore function and appearance. scienceportal.msf.org
8) Can noma be completely prevented?
Most cases are preventable with nutrition support, immunization (MMR, tetanus), oral hygiene, and early treatment of mouth sores and childhood illnesses. World Health Organization
9) What about tetanus shots after a dirty wound?
Clean the wound thoroughly. If vaccination history is uncertain, clinicians may give TIG plus tetanus vaccine per guidelines. CDC
10) What is the role of zinc?
Zinc treats diarrhea and supports mucosal healing in under-5s, which indirectly improves nutrition and recovery. World Health Organization
11) Are probiotics needed?
Evidence in noma is limited. Focus on nutrition, antibiotics, and hygiene; any probiotic use should be clinician-directed. BMJ Global Health
12) Do children with noma need iron?
Yes—but not in the first week of severe malnutrition treatment; add once appetite returns and weight gain begins. NCBI
13) Are NSAIDs safe?
Use carefully; in dehydrated or septic children, acetaminophen is preferred initially. NSAIDs may be used later in stable, hydrated patients as directed. FDA Access Data+1
14) Why is measles vaccination mentioned so often?
Measles weakens immunity and is a strong risk factor for noma. MMR prevents measles and lowers noma risk. U.S. Food and Drug Administration
15) Where can health workers find more detail?
See WHO fact sheets and SAM/wasting guidelines; MSF wound/acute noma care notes; and recent reviews on epidemiology and evidence gaps. The Lancet+3World Health Organization+3files.magicapp.org+3
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Last Updated: November 10, 2025.
