Acute Necrotizing Gingivitis in Young Children in Niger

Objectives: Previous studies suggested that acute necrotizing gingivitis (ANG) precedes noma and that noma clusters in some villages in certain regions of developing countries. The objectives of this study were to assess the prevalence of gingivitis with bleeding in young children from villages with or without a history of noma and to analyse differences related to socio-demographic factors, 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. In each village we randomly selected 110 participants.
Results: The prevalence of ANG was significantly higher in the noma villages compared to the non-noma villages (6.8% vs. 0.9%, p=0.001). We found differences between the four villages regarding socio-economic 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 ANG (p=0.041).
Conclusions: This study suggests that efforts to prevent noma should focus on populations with high prevalence of ANG and include nutritional support and attempts to introduce safe and efficient oral hygiene practices to improve gingival health.