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Acute Necrotising Gingivitis in Young Children From Villages With and Without Noma in Niger and Its Association With Sociodemographic Factors, Nutritional Status and Oral Hygiene Practices: Results of a Population-Based Survey

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Acute Necrotising Gingivitis in Young Children From Villages With and Without Noma in Niger and Its Association With Sociodemographic Factors, Nutritional Status and Oral Hygiene Practices: Results of a Population-Based Survey

Denise Baratti-Mayer et al. BMJ Glob Health.

Abstract

Background: Previous studies have suggested that acute necrotising gingivitis precedes noma disease and that noma clusters in some villages in certain regions of low- and middle-income countries. We sought to assess the prevalence of gingivitis with bleeding in young children from villages with or without a history of noma and to analyse epidemiological differences related to sociodemographic characteristics, nutritional status and oral hygiene practices.

Methods: We conducted a cross-sectional study in 440 children aged between 2 and 6 years from four villages in the Zinder region of southeast Niger in Africa. In two villages, cases of noma have repeatedly been detected; in the other two, noma has never been identified. We randomly selected 110 participants from each village.

Results: The prevalence of acute necrotising gingivitis was significantly higher in the noma villages compared with the non-noma villages (6.8% vs 0.9%; p=0.001). We found differences between the four villages regarding socioeconomic factors, stunting, undernourishment and oral hygiene practices. The type of oral hygiene procedures influenced the amount of dental plaque and gingival inflammation. Children using sand, coal or other abrasive products instead of a toothbrush had a significantly increased likelihood to be diagnosed with acute necrotising gingivitis (p=0.041).

Conclusions: Our data suggest that efforts to prevent noma should focus on populations with a high prevalence of acute necrotising gingivitis and include nutritional support and attempts to introduce safe and efficient oral hygiene practices to improve gingival health.

Keywords: Niger; acute necrotizing gingivitis; cross-sectional study; epidemiology; noma; risk factors.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Mild to moderate acute necrotising gingivitis (ANG) in a 3-year-old girl from the village of Droum. In the region of the upper-right incisors and the canine, the gingiva is oedematous and the interdental papillae have been lost due to ulceration. Soft and hard bacterial deposits are visible. (B) Advanced ANG in a 4-year-old girl from the village of Guidimouni. There are marked signs of ulceration and necrosis of the gingiva, with greyish pseudo-membranes and disappearance of the gingival papillae. The crowns of the teeth are covered with large amounts of soft and hard bacterial deposits.
Figure 2
Figure 2
(A) Geographical localisation of the study population, Zinder region (in grey), Niger, Africa. (B) Geographical localisation of the four villages (framed in black) included in the study: Droum, Wacha, Guidimouni and Guidiguir.
Figure 3
Figure 3
Schematic representation of the links between different factors associated with acute necrotising gingivitis (ANG) and noma.

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