Noma is a disease that usually manifests in the poorest countries, due to poor hygiene and poor nutrition, and causes the destruction of the mouth and face, starting with the appearance of a small wound inside the mouth, which spreads for the rest of the tissues of the mouth and bones.
This disease still has no treatment, causing death in most cases, unless it is detected early and the infection can be stopped with good hygiene and administration of antibiotics.
What are the signs and symptoms
The first signs and symptoms that usually appear in people with this disease is a small wound inside the mouth, usually on the gums, which spreads, giving rise to necrotizing ulcerative gingivitis.
Noma spreads very quickly, leading to the destruction of the tissues and bones of the mouth and eventually perforating the hard tissues and skin of the face, generally leading to death, caused by sepsis. There are several stages of the disease that are listed in the following table:
| Disease stage | Signals and symptons |
|---|---|
| Warning sign: Simple gingivitis | Red and swollen gums, which bleed on touch or during brushing. |
| Acute necrotizing gingivitis stage | Bad breath, painful sores on the gums, which bleed spontaneously, excess production of saliva. |
| Edema stage | Swelling of the face, difficulty eating, bad breath, spread of wounds and pain to the lips and cheeks, high fever, increased saliva and anorexia. |
| Gangrenous Stadium | Destruction of the tissues of the mouth, presence of a well-defined lesion with the black and destroyed center, leaving a hole in the face, bluish discoloration in the cheeks and lips, difficulty eating, perforation of the cheek with exposure of the teeth and bones and anorexia. |
| Healing stage | Jaw constriction, loss of teeth with exposure of bone structure, difficulty eating and beginning of healing |
| Sequela Stadium | Disfigurement, difficulty in moving the mouth and speaking, loss of teeth, difficulty in eating, discharge of saliva and displacement of the teeth. |
Possible causes
It is not yet known for certain which microorganisms are responsible for causing this disease, but it is known that it spreads due to poor oral hygiene, poor nutrition and weakened immune system, being more common in children between 2 and 4 years old. 6 years old.
Other causes that may be at the origin of Noma is the existence of other diseases such as measles, malaria or HIV infection, for example, which make children more susceptible to the spread of the disease.
How the treatment is done
There is still no treatment for the disease in an advanced stage and therefore it is very important to make an early diagnosis, as soon as the first symptoms appear.
Thus, when observing the child's mouth, if he has swollen and red gums, bleeding at the touch or during brushing, it may be a sign of the beginning of Noma and in these cases, oral hygiene should be reinforced, using warm salted water previously boiled or an antiseptic elixir, eat a daily diet with a higher amount of protein and supplement with Vitamin A.
In a phase of acute necrotizing gingivitis, the mentioned treatment should be reinforced with supplementation of nutrients and antibiotics, such as amoxicillin and metronidazole and administration of analgesics and anti-inflammatory drugs such as aspirin or paracetamol.
If the child enters the stage of edema, gangrene, or scarring, treatment should be carried out with antibiotics in higher doses, such as amoxicillin and clavulanic acid + gentamicin + metronidazole, slowly intravenously or with ampicillin + gentamicin + metronidazole, for example. slow intravenous use. It is also advisable to use a 0.2% chlorhexidine elixir, 3 times a day. In the gangrenous stage, ketamine can also be administered intramuscularly, to reduce pain.
In addition, if possible, the child can still rinse daily with a chlorhexidine elixir, take supplements of folic acid, iron, ascorbic acid and vitamin B, treat pre-existing diseases, perform adequate nutrition, treat injuries with a antiseptic, correct dehydration, perform deworming and control bleeding. In the last stages, if the child survives, it is advisable to undergo physical therapy so that he can open and close his mouth, extract loose teeth, perform facial reconstruction surgeries and provide psychological support.
