Hand-foot-mouth disease (HFMD) is a common viral illness affecting children, often caused by Coxsackievirus A16 and Enterovirus 71. Its oral manifestations may lead to painful ulcers, feeding difficulties, and misdiagnosis with other conditions such as herpetic gingivostomatitis.
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✅ Introduction
HFMD primarily affects children under five, with outbreaks reported worldwide. Although self-limiting, its oral lesions may interfere with nutrition and hydration, increasing parental concern and healthcare consultations. Dental practitioners must differentiate HFMD from other viral infections and implement evidence-based management strategies to reduce discomfort and prevent complications.
✅ Clinical Oral Manifestations of HFMD
° Multiple painful vesicles and ulcers on the tongue, buccal mucosa, and palate.
° Lesions appear 2–3 days after fever and may resemble aphthous ulcers.
° Increased salivation and feeding refusal due to oral pain.
° Coexisting cutaneous lesions on palms, soles, and buttocks.
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1. Accurate Diagnosis
° Differentiate HFMD from herpetic gingivostomatitis, varicella, or aphthous stomatitis.
° Consider recent exposure to outbreaks in daycare or school settings.
2. Supportive Care
° Recommend soft, cold foods (yogurt, smoothies, ice cream).
° Ensure adequate hydration with water or electrolyte solutions.
3. Pain and Fever Management
° Analgesics such as acetaminophen or ibuprofen may be prescribed under medical supervision.
° Avoid topical anesthetics with benzocaine in children under 2 years (FDA warning).
4. Oral Hygiene Measures
° Gentle brushing with a soft-bristled toothbrush.
° Non-alcoholic mouth rinses for older children.
5. Infection Control
° Advise parents on isolation to prevent spread.
° Disinfect toys, utensils, and surfaces frequently.
📊 Tabla comparativa: Clinical Approaches in Dental Management of HFMD
| Aspecto | Ventajas | Limitaciones |
|---|---|---|
| Supportive dietary recommendations | Relieve pain and improve hydration | May not provide full nutritional requirements |
| Pharmacological management | Controls pain and fever, improves patient comfort | Requires medical supervision, risk of misuse |
| Oral hygiene guidance | Prevents secondary infections and promotes healing | Difficult to maintain due to pain and irritability |
| Infection control education | Reduces community spread, improves public health | Dependent on parental adherence |
Discussion
The dental management of HFMD focuses on symptomatic relief, prevention of dehydration, and infection control. While the disease is self-limiting, the oral discomfort it causes may lead to feeding difficulties and parental anxiety. Dentists must be well-informed to avoid unnecessary prescriptions such as antibiotics, which are ineffective against viral infections. Interdisciplinary collaboration with pediatricians enhances patient safety and ensures consistent guidance for families.
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HFMD is a frequent pediatric condition with significant oral manifestations. Dentists must recognize its clinical features, differentiate it from other viral illnesses, and provide supportive, evidence-based care. Educating parents about hydration, nutrition, oral hygiene, and infection control is essential in reducing disease burden.
📚 References
✔ Centers for Disease Control and Prevention (CDC). (2023). Hand, foot, and mouth disease (HFMD). Retrieved from https://www.cdc.gov/hand-foot-mouth/index.html
✔ Mayo Clinic. (2023). Hand-foot-and-mouth disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease
✔ World Health Organization (WHO). (2022). Hand, foot and mouth disease. Retrieved from https://www.who.int/westernpacific/health-topics/hand-foot-and-mouth-disease
✔ Ooi, M. H., Wong, S. C., Lewthwaite, P., Cardosa, M. J., & Solomon, T. (2010). Clinical features, diagnosis, and management of enterovirus 71. The Lancet Neurology, 9(11), 1097–1105. https://doi.org/10.1016/S1474-4422(10)70209-X
✔ Cabrera-García, L., & Ramírez-Mora, J. (2021). Clinical manifestations of hand-foot-mouth disease in pediatrics. Revista de Pediatría y Salud Infantil, 38(2), 115–122.
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