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Unfortunately, the child will probably need surgery, to release the scar. Without this surgery, the child will not be able to open his mouth properly.

Send the child for medical help when the infection is finished and the wound starts to close.

You may also need a dentist's help at this time. The child's jaws may need to be wired. The wires are put on the healthy teeth in a way that holds the mouth open while the tight scar is forming. When the wires are removed, the child will be able to open and close his mouth to chew food.

PREVENTION of Noma:

Noma need not occur. We can prevent it. Always give special attention to the mouth of a sick child, to be sure to keep his teeth clean.

Whenever someone is nursing or caring for a sick child, that person should clean the child's teeth as a normal activity. This is especially true for a child who is weak, undernourished, and with little body water (dehydration).

Such a child should always:

(1) have his teeth carefully cleaned each day with a soft brush.

(2) rinse his mouth with a warm salt water solution (page 7), 2 times a day.

(3) eat fresh fruits and vegetables, especially the kind that have Vitamin C—guavas, oranges, pineapples, papayas, tomatoes, peas, and dark green leaves.

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