Necrotizing periodontal diseases (NPDs) encompass necrotizing gingivitis (NG), necrotizing periodontitis (NP), necrotizing stomatitis (NS), and in extreme cases, NPDs can lead to noma (cancrum oris). These are all considered stages of the same condition due to their shared etiology and clinical presentation. The most typical features of NPDs are pain, gingival necrosis, interdental ulceration, and in more advanced stages, osteonecrosis.
Necrotizing gingivitis is the most common form and progresses to necrotizing periodontitis in susceptible populations, such as in immunosuppressed patients. The necrotic destruction is limited to the interdental papillae that exhibit the typical punched-out appearance. No loss of attachment has occurred, and at this point, the disease is reversible upon treatment. Necrotizing gingivitis may progress to rapid periodontal loss, pseudomembrane formation, and systemic symptoms like fever, pyrexia, and lymphadenopathy. This stage is known as necrotizing periodontitis. Although uncommon, the disease can then spread to affect alveolar bone with osteonecrosis and sequestration, receiving the name necrotizing stomatitis. The most severe form of NPDs is noma, a fast-spreading noncontagious orofacial gangrene affecting malnourished children from undeveloped countries, mainly in tropical regions like sub-Saharan Africa. Noma rapidly compromises the soft and hard tissues of the face and can be fatal.
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