Khammissa, Razia Abdool GafaarLemmer, JohanFeller, Liviu2023-10-242023-10-242022-06-13Khammissa, R.A.G., Lemmer, J., Feller, L. 2022, 'Noma staging', Tropical Medicine and Health, vol. 50, no. 40, pp. 1-6. https://DOI.org/10.1186/s41182-022-00431-6.1349-4147 (online)1348-8945 (print)10.1186/s41182-022-00431-6http://hdl.handle.net/2263/93021Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, povertystricken communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of noma, which if used should improve the quality and value of future epidemiological data about noma.en© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License.Noma classificationAcute nomaArrested nomaNecrotising gingivitisNecrotising periodontitisNecrotising stomatitisArticle