Gangrenous stomatitis

Gangrenous stomatitis, also known as noma, is a severe form of gum disease that results in the necrosis (death) of the tissues in the mouth. This condition is rare and occurs most frequently in young children living in extreme poverty, primarily in sub-Saharan Africa, although cases have been reported in other parts of the world. The disease is characterized by rapid onset and progression, leading to severe tissue damage in the mouth and face if left untreated.

Causes and Risk Factors

Gangrenous stomatitis is caused by a combination of poor oral hygiene, malnutrition, dehydration, and a weakened immune system. The condition is often associated with other infectious diseases such as measles, which can further compromise the immune system. The exact mechanism by which the disease progresses from gingivitis to noma is not fully understood, but it is believed that a bacterial infection, involving organisms such as Fusobacterium necrophorum and Prevotella intermedia, plays a critical role.

Symptoms

The initial symptoms of gangrenous stomatitis may include halitosis (bad breath), gingivitis (gum inflammation), and ulcers in the mouth. As the condition progresses, the ulcers increase in size, leading to necrosis of the cheek, lips, or jawbone. The rapid progression of the disease can result in significant facial disfigurement.

Diagnosis

Diagnosis of gangrenous stomatitis is primarily based on the clinical presentation and medical history of the patient. Laboratory tests may be conducted to identify the presence of specific bacteria and to assess the overall health and nutritional status of the patient.

Treatment

Treatment of gangrenous stomatitis requires immediate medical intervention to prevent the spread of infection and to manage pain. The initial approach includes improving oral hygiene, managing pain, and administering antibiotics to fight the bacterial infection. In severe cases, surgical intervention may be necessary to remove necrotic tissue and to reconstruct damaged areas of the face. Nutritional support is also critical to improve the patient's immune response.

Prevention

Prevention of gangrenous stomatitis involves improving living conditions, such as access to clean water and adequate nutrition, and promoting good oral hygiene practices. Vaccination against diseases like measles can also reduce the risk of noma by preventing the infections that contribute to its development.

Prognosis

The prognosis for individuals with gangrenous stomatitis depends on the timeliness of treatment. Early intervention can significantly improve outcomes, but severe cases can lead to life-threatening complications or permanent disfigurement.