Condition which may lead to Noma

 # Which of the following conditions if not treated properly may lead to Noma?

A. Diphtheria

B. Herpangina

C. Herpetic gingivostomatitis

D. ANUG

The correct answer is D. ANUG

Clinical course of ANUG (Acute Necrotizing Ulcerative Gingivitis)  is indefinite. If untreated, NUG (Necrotizing Ulcerative Gingivitis) may lead to NUP (Necrotizing Ulcerative Periodontitis) with a progressive destruction of the periodontium and denudation of roots, accompanied by an increase in severity of toxic systemic complication. 

Horning and Cohen Staging of Oral Necrotizing Diseases

Necrotizing Ulcerative Gingivitis --> Periodontitis --> Stomatitis -->Noma

Stage 1: Necrosis of the tip of interdental papilla

Stage 2: Necrosis of entire interdental papilla or marginal gingiva or attached gingiva

Stage 3: Necrosis extending to gingival margin

Stage 4: Necrosis extending also to attached gingiva

Stage 5: Necrosis extending into buccal or labial mucosa

Stage 6: Necrosis exposing alveolar bone

Stage 7: Necrosis perforating skin of cheek

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