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It’s not a disease that many are familiar with, but with World Oral Health Day, which fell on March 20, just past us, it is perhaps time to find out just what noma, a neglected tropical disease, is. What is Noma? Noma is a severe, gangrenous disease of the mouth. According to the World Health Organization, which classified it as a neglected tropical disease in December 2023, noma mostly affects children aged 2–6 years suffering from malnutrition, affected by infectious diseases, living in extreme poverty with poor oral health or with weakened immune systems.
Noma is a rapidly-progressing condition, and can also occur among immunocompromised adults due to HIV, leukaemia and other diseases. Africa is the most affected continent (primarily sub-Saharan Africa), though cases have been reported from Asia and elsewhere as well. The history of Noma Noma is reportedly derived from the Latin word ‘nomē’, meaning ‘feed, devour or spread of’.
According to a 2017 paper, ‘Noma: Overview of a Neglected Disease and Human Rights Violation’ in the American Journal of Tropical Medicine and Hygiene , Noma has been an old companion of humankind. “Described by classical and medieval authors, the disease was common in Europe and the United States for centuries. In 1649, noma was included in the first book about neglected diseases, Observationes Medicae de Affectibus Omissis , by Arnoldus Bootius.
By the end of the 19th century, noma gradually disappeared from European and U.S. hospitals due to increasing improvements in the welfare of the population,” the paper states.
In 1912, it adds, Noma was found to be not a specific infection, but an opportunistic one. What are the risk factors for Noma? Noma, the WHO says, is a marker of absolute poverty. Risk factors include malnutrition, underlying infections, other causes of immunosuppression and poor oral hygiene.
The 2017 paper states that the condition is particularly prevalent in children who were preterm and low birth weight babies, and the the age of the onset of noma corresponds nutritionally to a period of vulnerability, coinciding with the period of weaning, with underweight infants particularly at risk. Various diseases have been described in association with noma, such as malaria, typhus, measles, chickenpox, tuberculosis, and HIV infection, it states. The causative agents of noma are non-specific polymicrobial organisms, says the WHO.
A 2024 paper, ‘Noma (Cancrum oris) in Africa: A newly added neglected tropical disease’ , in Rare , states that studies have shown that a bacterial infection is the main factor associated with noma development. How does it develop? Noma is also known as cancrum oris or gangrenous stomatitis. It is a non-contagious disease.
It has different signs and symptoms, and the WHO classifies it in five stages. These are: stage 0 – simple gingivitis (gum inflammation); stage 1 – acute necrotising gingivitis; stage 2 – oedema; stage 3 – gangrene; stage 4 – scarring; and stage 5 – sequelae. The disease is preceded by an intraoral ulcer, aphthous lesion (canker sores that develop in the soft tissue inside your mouth) or acute necrotising gingivitis (an infection of the gums with inflammation, bleeding and ulceration).
If untreated, the disease may progress rapidly and it could destroys the soft tissues of the face, and then involve the hard tissues and skin of the face as well. What is the treatment? Early detection of the disease is crucial. At the acute necrotising gingivitis stage, it can be treated with improved oral hygiene, antibiotics, disinfectant mouthwash and nutrition supplements.
If diagnosed during the early stages of the disease, treatment can lead to proper wound healing and no long-term sequelae, say the WHO. The 2017 paper says only approximately 15% of children survive acute noma, and most survivors may have facial deformities resulting in eating problems, oral incontinence, speech difficulties, and social isolation and may need reconstructive surgery. The next steps Accurate estimation of the number of noma cases is challenging due to the rapid progression of the disease, high case fatality rate, weak health systems and epidemiological surveillance, changing or varying disease definitions, substantial social stigma, and a lack of awareness of noma by healthcare workers and caregivers, says the WHO.
The 2024 paper points our strategies such as programmes that ensure food security, vaccinations against measles, treatment of concurrent illnesses like HIV and malaria constitute primary medical prevention of noma. Surveillance programmes in marginalised populations are also needed, it says. Published - March 23, 2025 04:24 pm IST Copy link Email Facebook Twitter Telegram LinkedIn WhatsApp Reddit dentistry / disease.
