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

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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