title: Noma (cancrum oris): questions and answers.
abstract: Noma (cancrum oris) is an infectious disease which destroys the oro-facial tissues and other neighboring structures in its fulminating course. It affects predominantly children aged 2-16 years in sub-Saharan Africa where the estimated frequency in some communities may vary from one to seven cases per 1000 children. The key risk factors are poverty, malnutrition, poor oral hygiene, deplorable environmental sanitation, close residential proximity to livestock, and infectious diseases, particularly measles. Malnutrition acts synergistically with endemic infections in promoting an immunodeficient state, and noma results from the interaction of general and local factors with a weakened immune system as the common denominator. Acute necrotizing gingivitis (ANG) is considered the antecedent lesion. Current studies suggest that evolution of ANG to noma requires infection by a consortium of microorganisms with Fusobacterium necrophorum and Prevotella intermedia as the suspected key players. Without appropriate treatment, mortality rate is 70-90%. Survivors suffer the two-fold affliction of oro-facial disfigurement and functional impairment. Reconstructive surgery of the resulting deformity is time-consuming and financially prohibitive for the victims who are poor.
authors.affiliation: School of Dentistry, University of Maryland, Baltimore 21201, USA.
authors.forename: C O
authors.initials: CO
authors.lastname: Enwonwu
authors.forename: W A
authors.initials: WA
authors.lastname: Falkler
authors.forename: E O
authors.initials: EO
authors.lastname: Idigbe
authors.forename: K O
authors.initials: KO
authors.lastname: Savage
mesh_terms: D000208:Acute Disease; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D003906:Developing Countries; D005892:Gingivitis, Necrotizing Ulcerative / Q000150:complications / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D009625:Noma / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000473:pathology; D009748:Nutrition Disorders / Q000150:complications; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors