Noma starts with gingivitis, an inflammation and bleeding of the gums. In three or four days, an ulcer appears and the gums and cheek begin to swell. Before a week has passed the disease has destroyed cheek tissue and a hole appears. In the following days, the infection spreads and gangrene covers the affected area. Depending on where the infection has started, it quickly destroys the jaw, lips, cheeks, nose or eyes.