SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences

View all Images (3)

Other Resources UpToDate PubMed


Contributors: Negar Esfandiari MD, Keith Morley MD, Susan Burgin MD
Other Resources UpToDate PubMed


Noma, also known as cancrum oris, is a polybacterial destructive infection of the mouth that typically occurs in impoverished children living in developing countries with limited access to health care, proper nutrition, and clean living situations.

Noma is thought to arise when primary necrotizing gingivitis (acute necrotizing ulcerative gingivitis [ANUG]) progresses to necrosis of oral mucosal tissue and surrounding fascia, muscle, and bone. Risk factors include poor oral hygiene and overgrowth of anaerobic bacteria in gingival plaque, in concert with malnutrition and a preceding or intercurrent infection (such as tuberculosis, scarlet fever, or measles), immunodeficiency (such as HIV), or malignancy. While most affected individuals are children aged younger than 7 years, adults with noma have also been reported. Some of the common bacteria identified in the pathogenesis of this disease include Prevotella intermedia, Peptostreptococcus species, and Fusobacterium necrophorum.

In the early stage of noma, there is often perioral edema, halitosis, and necrosis of the oral mucosa beyond the gums. The disease quickly progresses, destroying muscle and bone, and can leave a full-thickness orofacial defect within days. Fever, dehydration, and pain accompany the condition. In the absence of treatment, the mortality rate is as high as 90%, usually due to sepsis; this rate drops to 10% with proper antibiotic and supportive treatment. In those who survive, sequelae include permanent facial defects that may interfere with eating and speech, scarring, and trismus.

Noma has also been rarely reported on the perineum, scrotum, and vulva (noma pudendi). Noma neonatorum is the presence of necrotizing lesions of the mouth and anus in neonates who are premature or small for gestational age with intercurrent malnutrition and sepsis (usually due to Pseudomonas aeruginosa).


A69.0 – Necrotizing ulcerative stomatitis

18116006 – Cancrum oris

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Necrotizing ulcerative gingivitis
  • Necrotizing fasciitis
  • Ecthyma gangrenosum
  • Orofacial herpes simplex virus
  • Clostridial or streptococcal Gas gangrene
  • Fournier gangrene
  • Oral squamous cell carcinoma
  • Mucocutaneous leishmaniasis

      Best Tests

      Subscription Required

      Management Pearls

      Subscription Required


      Subscription Required


      Subscription Required

      Last Reviewed:05/05/2021
      Last Updated:05/09/2021
      Copyright © 2024 VisualDx®. All rights reserved.
      A medical illustration showing key findings of Noma (Acute Phase) : Facial edema, Fever, Oral ulcers, Halitosis, Lymphadenopathy, Malnutrition, Gingival hemorrhage, Excessive salivation
      Clinical image of Noma - imageId=7395913. Click to open in gallery.  caption: 'An extensive eschar on the upper and lateral lip with loss of tissue around it.'
      An extensive eschar on the upper and lateral lip with loss of tissue around it.
      Copyright © 2024 VisualDx®. All rights reserved.