Gangrenous Stomatitis (Noma, Cancrum Oris): An Overview of Causes and Treatments

This is an infective condition of the orofacial tissues that may cause extensive tissue destruction with severe morbidity. The condition may initially manifest as an acute ulcerative necrotizing gingival infection that rapidly involves a block of the contiguous tissues culminating in their breakdown. Unfortunately, the clinical picture and changes associated  with this condition may often be so  rapid that even the keenest clinician may not notice the progression of the pathological events.


  1. Admit the patient for empirical parenteral antimicrobial therapy (benzylpenicillin 1.2g IV 6 hourly and metronidazole 500mg IV 8 hourly).
  2. Give diclofenac 75mg IM 12 hourly.
  3. Institute parenteral nutritional support.
  4. Improve oral hygiene accordingly.
  5. Initiate prompt specialist consultation where feasible. This will probably require a multidisciplinary approach.

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