Gangrenous stomatitis—better known today as noma or cancrum oris—is a fast-moving infection that destroys the gums, cheeks, lips, and sometimes the nose and jaw. It mainly affects children who are very malnourished, live in extreme poverty, have poor oral hygiene, or have a weak immune system. Without early treatment, the disease can be fatal; survivors often have severe scarring and difficulty eating, speaking, or breathing. World Health Organization+1
Gangrenous stomatitis, also called noma or cancrum oris, is a very fast and severe infection that starts inside the mouth and can quickly destroy the gums, cheeks, lips, and even the bones of the face. It mainly affects young children who are very undernourished, have poor oral hygiene, and live in extreme poverty. It can also appear in people with weak immune systems, including adults with conditions such as HIV or cancers. Without early care, many patients die; with early antibiotics, wound care, nutrition, and hydration, the disease can be stopped. Survivors often need later reconstructive surgery to eat, speak, and look better. Noma is preventable with enough food, vaccines (like measles), clean water, good oral hygiene, and prompt care of mouth sores. World Health Organization+2PubMed Central+2
Noma is a severe mouth and face infection that starts as a gum sore and quickly spreads. The tissues die (gangrene). The disease advances in days, not weeks. It happens most often in children aged 2–6 years who are weak from lack of food or recent infections like measles or malaria. Early treatment with antibiotics, good nutrition, fluids, and gentle wound care can save life and limit damage. Late treatment can still help, but surgery is often needed later to restore the face and mouth. World Health Organization+2ScienceDirect+2
Other names you may see
This condition appears under many names in books and articles. All of the terms below refer to the same disease process or closely related stages.
Noma
Cancrum oris
Gangrenous stomatitis / stomatitis gangrenosa
Necrotizing ulcerative stomatitis
Oro-facial gangrene
Public health and dental organizations commonly use “noma (cancrum oris),” and WHO officially recognizes noma as a neglected tropical disease. fdiworlddental.org+1
Types (clinical stages you may read about)
Doctors describe noma in stages. This helps with early detection and treatment.
Stage 1 – Acute necrotizing ulcerative gingivitis (ANUG): painful, bleeding gums; bad breath.
Stage 2 – Oedema (swelling): cheek and lip swelling; fever; the child looks unwell.
Stage 3 – Gangrene: black, dead tissue on face and inside mouth; rapid tissue loss.
Stage 4 – Scarring: wounds start to heal but leave tight scars that pull the mouth and face.
Stage 5 – Sequelae: permanent problems—trismus (limited mouth opening), feeding and speech difficulties, and facial deformity.
Some authors also refer to Stage 0 (simple gingivitis) as the earliest warning stage. PubMed Central+1
20 Causes (predisposing and triggering factors)
Noma does not come from one single germ. It is polymicrobial and happens when body defenses are very low. Think of the “cause” as a web of risks that pile up and break the body’s ability to control normal mouth bacteria.
Severe malnutrition: weakens immunity and mouth tissues; the top driver worldwide. World Health Organization+1
Extreme poverty: crowding, unsafe water, little access to care, and food insecurity. World Health Organization
Recent measles: measles suppresses the immune system for weeks to months. ScienceDirect+1
Malaria or severe parasitic infections: drain nutrients and weaken children. ScienceDirect+1
Untreated necrotizing gum disease (ANUG): common immediate precursor. PubMed Central
Poor oral hygiene and chronic mouth sores: allow bacteria to invade deeper tissues. World Health Organization
HIV infection or other immune-weakening illnesses: increase vulnerability in some settings. World Health Organization+1
Vitamin and micronutrient deficiency (e.g., vitamins A, B-complex, C, zinc): harms mucosal repair and immunity. ScienceDirect
Recent severe diarrhea or pneumonia: further depletes nutrition and strength. World Health Organization
Weaning stress (2–6 years): change in diet; higher exposure to infections. Usthadian
Unclean water and unsafe sanitation: higher burden of enteric disease and malnutrition. World Health Organization
Polymicrobial mouth flora overgrowth (anaerobes, spirochetes, Fusobacterium, Prevotella, etc.): act together when defenses fail. The Lancet
Exposure to smoke (household air pollution): irritates mucosa and worsens infections in vulnerable children. (Inference from general respiratory risk literature; included as a minor contributor when combined with malnutrition.)
Leukemia and other blood cancers (in older children/adults): profound immunosuppression. World Health Organization
Uncontrolled diabetes (rare in affected age group): impairs wound healing; relevant in adults. (General medical principle; used rarely in noma literature.)
Trauma to oral tissues (e.g., sharp teeth, seizures biting): creates an entry point for infection. (General surgical/dental principle echoed in reviews.) PubMed Central
Delay in seeking care: allows early gum disease to progress unchecked. PubMed Central
Seasonal food shortages/drought or conflict: spikes in undernutrition and disease clusters. fdiworlddental.org
Co-existing tuberculosis or chronic illness: additional immune stressors. (Occasional case links in reviews.) PubMed Central
No vaccines or incomplete immunization: higher risk of measles and other drivers. World Health Organization
Key idea: Malnutrition + infection + poor oral hygiene + weak immunity create the “perfect storm.” Treating any one factor early (nutrition, oral care, or childhood infections) can stop noma before it starts. World Health Organization+1
15 Symptoms and signs (what families and clinicians see)
Painful, bleeding gums that look “punched out” between teeth—often the first visible sign. PubMed Central
Very bad breath (fetor oris) out of proportion to routine gum disease. PubMed Central
Swelling of cheek or lip with tenderness and fever. PubMed Central
Ulcer on the gum or inner cheek that expands quickly over hours to days. World Health Organization
Greyish or black dead tissue (eschar/gangrene) inside the mouth or on the face. World Health Organization
Drooling and difficulty swallowing because the mouth cannot close well. (Common clinical description.)
Fever, weakness, and loss of appetite due to systemic infection and poor intake. World Health Organization
Facial numbness or pain around the infected area as tissues die. (Clinical observation in case reviews.) PubMed Central
Loose teeth or tooth loss near the ulcer. (Dental sequelae commonly reported.) PubMed Central
Trismus (stiff jaw; cannot open mouth) from scarring or muscle spasm, especially later. PubMed
Difficulty speaking because of pain, swelling, or tissue loss. (Common sequelae reports.) PubMed Central
Nasal regurgitation of liquids if the palate is destroyed. (Classical sequela.) PubMed
Weight loss and dehydration from not being able to eat or drink. PubMed Central
Sepsis signs (fast heart rate, fast breathing, confusion) in severe cases. (General infectious disease principle applied to noma.) World Health Organization
Psychosocial distress—fear, isolation, and stigma for the child and family. Wikipedia
20 Diagnostic tests (how clinicians confirm and stage the problem)
Important: Noma is mainly a clinical diagnosis—made by history and exam in a malnourished child with rapidly spreading mouth/face gangrene. Tests support care decisions (nutrition needs, antibiotics choice, surgery timing) and look for complications like bone infection. World Health Organization
A) Physical examination (bedside assessment)
Full mouth and facial exam: look for gum ulcers, swelling, black necrotic tissue, foul odor, and exposed bone. This confirms suspicion and maps the extent. PubMed Central
Vital signs and sepsis check: temperature, heart rate, breathing, blood pressure; screens for systemic infection and shock. (Standard infectious care.)
Nutritional assessment: mid-upper arm circumference, weight-for-age/height, visible wasting; guides urgent nutrition therapy. World Health Organization
Hydration status: mucous membranes, skin turgor, urine output; dehydration is common when swallowing is painful. (Standard pediatric assessment.)
Airway and trismus assessment: mouth opening (inter-incisal distance) and nasal/oral patency to plan airway safety and feeding method. (Surgical/dental prep.) PubMed
B) Manual/bedside tests and simple procedures
Bedside glucose (finger-stick): detects hypoglycemia or diabetes (rare in toddlers but important in adults). (General pediatric protocol.)
Point-of-care hemoglobin: screens for anemia from malnutrition or infection to plan transfusion if severely low. PubMed Central
Wound swab/aspirate for Gram stain: shows mixed anaerobes/spirochetes typical of necrotizing infections; helps early antibiotic choices when culture is delayed. The Lancet
Bedside mouth opening measurement (in mm): tracks trismus over time and rehabilitation progress. (Standard maxillofacial practice.)
Nasal regurgitation test (sip of water, supervised): crude screen for palatal defects; used cautiously to avoid aspiration. (Clinical practice note.)
C) Laboratory and pathological tests
Complete blood count (CBC): looks for anemia, leukocytosis or leukopenia; helps detect severe infection or bone marrow problems. (Common lab in noma care plans.) PubMed Central
C-reactive protein (CRP) and ESR: markers of inflammation; guide response to antibiotics and timing of debridement. (General infectious markers.)
Electrolytes, urea/creatinine, and liver function tests: assess dehydration, sepsis effects, and drug dosing safety. (Standard in severe infection.)
HIV testing (per local policy and consent): identifies immunosuppression and guides comprehensive care. World Health Organization
Measles serology or record check (if uncertain): supports the risk assessment and public health response. ScienceDirect
Blood cultures (when febrile or toxic): look for bacteremia/sepsis to refine antibiotic coverage. (General pediatric sepsis care.)
Deep tissue culture/anaerobic culture from debridement: more accurate than surface swabs; shapes targeted therapy when available. The Lancet
D) Electrodiagnostic tests (rare, situation-specific)
Facial nerve EMG/nerve conduction studies: not routine, but can document facial nerve damage in complex sequelae before reconstructive surgery or when paralysis is suspected. These tests help plan rehabilitation if available. (General maxillofacial/neurology practice; used selectively.)
E) Imaging tests
Plain X-ray of jaws/sinuses: quick screen for bone destruction, sequestra, or sinus involvement when CT is not available. (First-line in low-resource settings.)
CT scan of the maxillofacial region: best test to map necrosis, osteomyelitis of the mandible/maxilla, and sinus or nasal cavity destruction; guides surgery and long-term planning. ResearchGate+1
Why imaging matters: bone infection and hidden pus pockets change the antibiotic plan and the timing/extent of surgery. CT is especially helpful when the child is stable enough to travel and sedation is safe. FI Administration
Non-pharmacological treatments (therapies & other supports)
Urgent nutrition rehabilitation
Description (≈150 words): The first lifesaving treatment is to feed the child safely and enough. Severe malnutrition weakens immunity and slows healing. Clinicians start with oral or nasogastric feeds that are easy to digest and rich in energy and protein (e.g., therapeutic milks or ready-to-use therapeutic foods). Small, frequent feeds are used at first to avoid refeeding problems. Extra protein helps repair skin, mouth lining, and muscle. Fluids and electrolytes are provided to correct dehydration. Vitamin and mineral gaps are filled (vitamin A, zinc, and others) because these nutrients help immune cells and skin rebuild. Feeding is adapted to pain and trismus; soft or pureed foods are used to prevent further tissue injury. The goal is to reverse catabolism, support immune defense, and make antibiotics work better. As appetite returns, feeds are increased until weight gain is steady. Purpose: reverse malnutrition, lower death risk. Mechanism: restores energy, protein, and micronutrients needed for immunity and tissue repair. World Health Organization+1Early gentle wound hygiene
Description: Clean the mouth and wound edges with boiled, cooled saline or recommended antiseptic solutions. Caregivers are shown how to moisten crusts, avoid scrubbing live tissue, and wick away debris. Good wound hygiene reduces bacteria, odor, and pain, and makes antibiotics more effective. Purpose: lower germ load and ease healing. Mechanism: mechanical cleaning plus antisepsis reduces harmful microbes and local toxins. ennonline.netDebridement by trained staff (as needed)
Description: When dead tissue remains, trained clinicians carefully remove only necrotic tissue to allow healthy tissue to grow. This is done in small sessions with pain control. Purpose: speed healing and prevent spread. Mechanism: removing necrosis lowers bacterial growth and inflammation. MSF Science PortalHydration and electrolyte therapy
Description: Children with fever and poor intake need fluids (oral rehydration or IV if needed). Purpose: correct dehydration and support circulation. Mechanism: restores perfusion so immune cells and antibiotics reach the tissues. MSF Science PortalPain relief and comfort positioning
Description: Use safe analgesia and help the child rest with head elevated. Purpose: reduce stress and allow feeding and hygiene. Mechanism: pain control lowers catecholamines and improves intake and healing. MSF Science PortalOral hygiene education for caregiver
Description: Teach gentle, daily cleaning of teeth/gums with a soft brush or clean cloth, plus safe rinses. Purpose: prevent recurrence and protect siblings. Mechanism: lowers plaque bacteria and gum inflammation. World Health OrganizationMicronutrient repletion (non-drug nutrition)
Description: Provide WHO-style supplementation (e.g., vitamin A, zinc) within a balanced feeding plan. Purpose: correct deficiencies tied to poor immunity and delayed epithelial repair. Mechanism: restores immune and epithelial function. World Health OrganizationMeasles vaccination catch-up and household immunization review
Description: Many noma cases follow measles; checking and updating vaccines for the child and close contacts prevents another immune hit. Purpose: prevention. Mechanism: vaccine-induced immunity reduces measles-related immune suppression. PubMed Central+1Physiotherapy for mouth opening (after acute pain settles)
Description: Gentle jaw-stretching exercises help avoid long-term trismus. Purpose: maintain mouth opening for eating and cleaning. Mechanism: gradual stretching counters scar contracture. PubMed CentralPsychosocial support and stigma reduction
Description: Families need counseling and community education; stigma harms nutrition, schooling, and follow-up. Purpose: encourage long-term care and reintegration. Mechanism: education corrects myths; support builds adherence. MSF Science PortalSafe feeding techniques and texture modification
Description: Use soft, high-protein purees; avoid spicy, acidic, or hard foods that traumatize wounds. Purpose: maintain intake while protecting tissue. Mechanism: reduces mechanical injury to the ulcer base. World Health OrganizationInfection-control practices at home and clinic
Description: Hand hygiene, clean utensils, safe water, and waste handling. Purpose: reduce secondary infections. Mechanism: lowers overall pathogen exposure. World Health OrganizationManagement of co-infections (non-drug steps)
Description: Screen for malaria, TB, worms; provide bed nets and sanitation guidance alongside medical care. Purpose: reduce immune burden. Mechanism: removes other energy drains on the body. BioMed CentralSun and fly protection for facial wounds
Description: Cover with clean dressings and use netting to deter myiasis. Purpose: prevent maggot infestation and photo-injury. Mechanism: barrier protection stops egg-laying and drying. MSF Science PortalSpeech and swallowing therapy (post-acute)
Description: Teach safe swallow and articulation strategies. Purpose: restore function and nutrition. Mechanism: compensatory techniques plus practice rebuild coordination. PubMed CentralScar-care and contracture prevention
Description: Silicone gels, massage, and splints when appropriate. Purpose: limit deformity. Mechanism: modulates collagen remodeling. PubMed CentralCommunity screening and caregiver training
Description: Teach early signs (bleeding gums, ulcers, swelling) so care starts before gangrene. Purpose: earlier treatment, fewer deaths. Mechanism: faster recognition triggers antibiotics and feeding sooner. World Health OrganizationSocial support (food security, cash or in-kind help)
Description: Link families to food programs or social aid. Purpose: prevent relapse and protect siblings. Mechanism: sustained nutrition maintains immunity. ennonline.netDental care for sources of mouth infection
Description: Treat severe caries, periodontal disease, and sharp teeth that injure mucosa. Purpose: reduce triggers. Mechanism: removes bacterial reservoirs and trauma. PubMed CentralPre- and post-operative rehabilitation planning
Description: For sequelae, plan timing, nutrition, airway, and rehab around reconstructive surgery. Purpose: safe surgery and better outcomes. Mechanism: multidisciplinary optimization improves healing and function. PubMed Central+1
Drug treatments
Important: Exact antibiotic choice and route depend on severity, age/weight, and local resistance. WHO/MSF programs commonly use amoxicillin–clavulanate plus metronidazole, or ampicillin + gentamicin + metronidazole in severe cases, together with nutrition and wound care. Doses below are typical label or guideline anchors; clinicians must individualize therapy. WHO | Regional Office for Africa+2MSF Science Portal+2
Amoxicillin–clavulanate (PO/IV)
Class: β-lactam/β-lactamase inhibitor. Typical dosing/time: Given with meals; pediatric weight-based dosing; IV for severe disease. Purpose: cover many oral aerobes/anaerobes producing β-lactamases. Mechanism: inhibits cell-wall synthesis plus blocks β-lactamases. Key label effects/risks: GI upset, rash; adjust in renal impairment. FDA Access Data+1Metronidazole (IV/PO)
Class: Nitroimidazole. Dosing/time: Weight-based; IV in severe sepsis. Purpose: strong anaerobe cover for mouth flora. Mechanism: DNA strand breakage in anaerobes. Adverse effects: metallic taste, neuropathy with long courses; avoid alcohol. Label note: indicated for serious anaerobic infections. FDA Access Data+1Gentamicin (IV)
Class: Aminoglycoside. Use: add in severe infections for gram-negative coverage alongside β-lactam and metronidazole. Mechanism: 30S ribosomal inhibition. Risks: nephrotoxicity/ototoxicity; monitor levels. Label guidance: often combined with penicillins/cephalosporins for serious infections. FDA Access DataAmpicillin (IV)
Class: Aminopenicillin. Use: backbone for severe sepsis in combination regimens. Mechanism: cell-wall synthesis inhibition. Risks: allergy, GI upset. (FDA label not linked above; use local label/product information.) WHO | Regional Office for AfricaCeftriaxone (IV/IM)
Class: 3rd-gen cephalosporin. Use: broad gram-negative/positive coverage when penicillin allergy or severe sepsis. Mechanism: cell-wall synthesis inhibition. Risks: biliary sludging, diarrhea. Label indications: serious infections; consider local susceptibility. FDA Access Data+1Clindamycin (IV/PO)
Class: Lincosamide. Use: alternative anaerobe and streptococcal coverage, especially with penicillin allergy. Mechanism: 50S inhibition. Risks: C. difficile diarrhea. Label: injection and premix details provided. FDA Access Data+1Penicillin G (benzathine/procaine forms IM; aqueous IV in hospital)
Class: Penicillin. Use: some programs historically used penicillin; modern regimens often prefer amoxicillin-clavulanate for β-lactamase producers. Mechanism: cell-wall inhibition. Risks: anaphylaxis in allergic patients. Label: Bicillin products describe IM long-acting forms. FDA Access Data+1Chlorhexidine 0.12% oral rinse (adjunct)
Class: Antiseptic mouthwash (topical). Use: reduce dental plaque/gingivitis burden alongside systemic antibiotics. Mechanism: disrupts bacterial membranes. Risks: tooth staining, taste change. Label: Peridex oral rinse. FDA Access Data+1Paracetamol/Acetaminophen (PO/PR)
Class: Analgesic/antipyretic. Use: pain and fever control to allow feeding/hygiene. Mechanism: central COX modulation. Risks: liver toxicity in overdose. (Use national label.) MSF Science PortalIbuprofen (PO)
Class: NSAID. Use: alternative antipyretic/analgesic if not contraindicated. Mechanism: COX inhibition. Risks: gastric/renal adverse effects; avoid dehydration. (Use national label.) MSF Science PortalTopical lidocaine viscous (oral)
Class: Local anesthetic. Use: short-term mucosal pain relief to enable feeding/hygiene. Mechanism: sodium-channel blockade. Risks: methemoglobinemia with excess; careful dosing. (Use national label.) MSF Science PortalOndansetron (PO/IV)
Class: 5-HT3 antagonist. Use: reduce vomiting so oral feeds/meds can continue. Mechanism: blocks vagal/central 5-HT3. Risks: QT prolongation. (Use national label.) MSF Science PortalVitamin A (therapeutic dosing per age)
Class: Micronutrient. Use: correct deficiency common in severe malnutrition and post-measles. Mechanism: supports epithelial and immune function. Risks: toxicity if overdosed; follow WHO dosing. World Health OrganizationZinc (oral)
Class: Micronutrient. Use: supports immunity and wound healing; often included in nutrition protocols. Mechanism: cofactor for immune enzymes and epithelial repair. Risks: nausea; separate from some antibiotics. World Health OrganizationIron (deferred until infection controlled)
Class: Micronutrient. Use: treat iron deficiency after acute infection improves. Mechanism: rebuilds hemoglobin. Risks: can worsen infection if given too early; time carefully. World Health OrganizationAlbendazole or mebendazole (deworming in endemic settings)
Class: Anthelmintic. Use: treat helminths that worsen malnutrition. Mechanism: inhibits parasite microtubules. Risks: mild GI upset. (Use national label.) BioMed CentralAntimalarials (per local protocol)
Class: e.g., artemisinin-based combos. Use: treat malaria co-infection to reduce catabolic stress. Mechanism: parasite killing. Risks: drug-specific. BioMed CentralHIV antiretroviral therapy (if HIV positive)
Class: cART. Use: restore immunity to lower risk of recurrence/infections. Mechanism: suppresses viral replication. Risks: drug interactions; coordinate care. World Health OrganizationProton-pump inhibitor (if NSAID use or stress ulcers)
Class: Acid suppression. Use: protect stomach and improve comfort for feeding. Mechanism: blocks gastric acid pump. Risks: diarrhea; use only when indicated. MSF Science PortalTetanus toxoid update (if needed)
Class: Vaccine/immunization. Use: protect during extensive oral wounds. Mechanism: antibody protection against tetanus toxin. Risks: local soreness. World Health Organization
Dietary molecular supplements
These are adjuncts to a full feeding program; they are not substitutes for antibiotics or hospital care.
Vitamin A — Dose per WHO age protocol; supports mucosal healing and immune cell function by regulating epithelial gene expression. Overdose can harm; use program dosing. World Health Organization
Zinc — Typical pediatric 10–20 mg/day for short courses; cofactor in many immune enzymes and collagen synthesis; improves wound repair. Excess causes nausea. World Health Organization
Multivitamin–mineral mix — Program formulas fill broad gaps (B-complex, vitamin C, D, selenium). Helps energy metabolism and antioxidant defenses. World Health Organization
Protein fortifiers (milk/legume blends, RUTF) — Supply amino acids for collagen and immune proteins; key for catch-up growth. MSF Science Portal
Omega-3 fatty acids (food-based) — From fish/fortified foods; may modulate inflammation and support membrane repair. Use food first. MSF Science Portal
Probiotics (food sources like yogurt where safe) — May support gut barrier and nutrient absorption during rehabilitation; ensure hygienic preparation. MSF Science Portal
Vitamin C — Helps collagen cross-linking and antioxidant defense; include citrus/guava or fortified foods. MSF Science Portal
Vitamin D (per national guidance) — Supports immune modulation and bone health during recovery; dose per age and baseline status. MSF Science Portal
Iron (timed after infection control) — Restores hemoglobin for oxygen delivery; give only when acute infection has settled. World Health Organization
Folate/B-complex — Supports cell division and tissue repair during catch-up growth. MSF Science Portal
Immunity booster / regenerative / stem-cell drugs
There are no approved “stem-cell drugs” to treat noma. Recovery depends on antibiotics, nutrition, wound care, vaccines, and, later, reconstructive surgery. Below are safer, evidence-aligned supportive measures instead. World Health Organization+1
Measles vaccination (catch-up) — Dose: per EPI schedule. Function: prevents measles-induced immune suppression linked to noma. Mechanism: active immunity to measles virus. PubMed Central
Vitamin A therapy — Dose: WHO age-based. Function: restores epithelial integrity and immune responses. Mechanism: regulates epithelial gene transcription. World Health Organization
Zinc supplementation — Dose: short course 10–20 mg/day in children. Function: boosts innate/adaptive immunity; improves wound healing. Mechanism: enzyme cofactor for immune cells. World Health Organization
Nutritional rehabilitation (RUTF/therapeutic feeds) — Dose: program-set caloric/protein targets. Function: reverses catabolism and supports immune function. Mechanism: energy and amino acids for immune proteins. MSF Science Portal
Deworming in endemic areas — Dose: per national program. Function: reduces chronic nutrient loss that weakens immunity. Mechanism: eliminates helminths that steal nutrients. BioMed Central
HIV care (if positive): cART — Dose: per HIV program. Function: rebuilds immunity and lowers infection risk. Mechanism: suppresses HIV replication. World Health Organization
Surgeries (procedures and why done)
Acute debridement and limited soft-tissue procedures — Remove dead tissue and control sepsis; goal is to stop spread and create a clean bed for healing. MSF Science Portal
Delayed reconstructive flaps (cheek/lip) — Local, regional, or free flaps rebuild missing cheek or lip to close the mouth and restore saliva control, speech, and eating. PubMed Central
Commissuroplasty / lip reconstruction — Re-form the mouth corner to improve oral competence and speech. PubMed Central
Release of trismus with scar excision and interpositional flaps — Improve jaw opening for feeding, hygiene, and anesthesia access. PubMed Central
Bone reconstruction (onlay grafts, distraction, or free osseous flaps) — Restore jaw contour and support for teeth and soft tissue; staged planning is common. PubMed Central
Notes on timing: Extensive reconstructions are usually done after the acute infection is fully quiet and nutrition is restored to reduce complications and improve outcomes. PubMed Central
Preventions
Make sure children get enough food every day — Prevents malnutrition that weakens immunity. World Health Organization
Vaccinate on time (especially measles) — Prevents a major trigger of noma. PubMed Central
Brush or wipe teeth and gums daily — Reduces gum infections that can start noma. World Health Organization
Treat mouth sores early — See a clinic at the first ulcer or bleeding gums. World Health Organization
Use clean water and safe food — Lowers overall infection burden. World Health Organization
Sleep under insecticide-treated nets in malaria areas — Less malaria means stronger immunity. BioMed Central
Deworm regularly in endemic areas — Keeps nutrients for the child, not the worms. BioMed Central
Keep up with HIV testing/care when indicated — Protects immune function. World Health Organization
Reduce stigma; seek help early — Families should know noma is preventable and treatable. MSF Science Portal
Community screening for gum disease in high-risk villages — Finds cases early. World Health Organization
When to see a doctor (urgent signs)
Seek care immediately if a child has sore or bleeding gums, mouth ulcers, facial swelling, foul breath, fever, trouble feeding, or becomes very weak. In any undernourished or recently measles-infected child, these signs need same-day evaluation because early antibiotics and nutrition save lives and prevent disfigurement. World Health Organization+1
What to eat and what to avoid
Eat: soft, high-protein purees (eggs, milk/legumes, fish where safe), energy-dense therapeutic foods, fruits rich in vitamin C (or fortified options), and safe, clean water. These choices help the body rebuild skin and fight infection. Avoid: spicy, acidic, very salty, or rough/chewy foods that hurt the mouth; alcohol (for caregivers/patients of age) and smoke exposure; unsafe street foods or unboiled water. If chewing is painful, use pureed textures and small, frequent meals until healing improves. MSF Science Portal+1
Frequently asked questions
Is noma contagious? No. It is not spread person-to-person; it happens when severe malnutrition and mouth infection combine in a vulnerable child. MSF Science Portal
Who is most at risk? Children 2–6 years old in extreme poverty with poor diet, poor oral hygiene, recent measles, or other infections. World Health Organization+1
What is the first sign? Sore, bleeding gums or a mouth ulcer with swelling and bad breath. Wikipedia
How fast does it progress? Very fast—days. Early care is critical. World Health Organization
What saves lives early? Antibiotics, nutrition, fluids, pain control, and gentle wound care. MSF Science Portal+1
Which antibiotics are common? Amoxicillin–clavulanate plus metronidazole; in severe cases ampicillin + gentamicin + metronidazole, tailored by clinicians. WHO | Regional Office for Africa
Do survivors need surgery? Often yes, later, to improve eating, speech, and appearance. PubMed Central
Can good mouth care prevent noma? Yes—daily brushing or wiping of teeth and gums helps, alongside food security and vaccines. World Health Organization
Why is measles linked to noma? Measles causes strong immune suppression that increases risk. Vaccination protects. PubMed Central
Does clean water matter? Yes—fewer infections and better nutrition. World Health Organization
Is hospital admission always needed? Severe cases need hospital care; mild early cases may be managed per program protocols, but evaluation is essential. MSF Science Portal
Are “stem-cell drugs” used? No—there are no approved stem-cell drugs for noma; focus on antibiotics, nutrition, and surgery when stable. PubMed Central
Can adults get noma? Rarely, mostly in immunocompromised adults. World Health Organization
What is the fatality rate without treatment? Very high; early care greatly lowers death and disability. The Guardian
What about mental health? Counseling helps children and families cope with trauma and stigma; it supports recovery and adherence. MSF Science Portal
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: November 10, 2025.
