Webinar: Clinically applicable Pulpotomy for the Primary Tooth - Dr. Joby Peter

Clinically applicable pulpotomy in primary teeth remains a cornerstone of pediatric dentistry, evolving with advances in diagnostic precision and biocompatible medicaments.

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By combining clinical and radiographic evaluation with evidence-based protocols, pulpotomy ensures the preservation of primary teeth, maintaining arch integrity and supporting proper oral development.

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Modern pulpotomy techniques emphasize the selection of safe and effective medicaments, accurate diagnosis, and careful execution of the procedure. This approach not only improves treatment outcomes but also promotes long-term oral health in children by managing pulp vitality while minimizing complications.

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Integrating new materials with established clinical practice is redefining how pediatric dentists approach pulpal therapy, ensuring reliability, safety, and functionality in every case.

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Viral Diseases of the Oral Mucosa in Pediatric Dentistry: Symptoms, Diagnosis, and Treatment - Comparative Table 📊

Viral diseases affecting the oral mucosa are frequent in pediatric dentistry and often present diagnostic and therapeutic challenges. The most common conditions include primary herpetic gingivostomatitis (HSV-1), hand-foot-mouth disease (HFMD, caused by Coxsackie and enteroviruses), and herpangina. Other relevant viral infections include varicella-zoster virus (VZV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV).

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This article reviews the main viral oral diseases in children, including their signs, symptoms, diagnostic approaches, clinical features, pharmacological management, and therapeutic options, ending with a discussion and clinical conclusion.

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1. Major Viral Oral Diseases in Children

1.1 Primary Herpetic Gingivostomatitis (HSV-1)

➤ Signs and symptoms: Painful vesicles and ulcers on gingiva, lips, and oral mucosa; fever, malaise, cervical lymphadenopathy, and refusal to eat or drink, increasing the risk of dehydration.
➤ Diagnosis: Mainly clinical. In uncertain cases, PCR, viral culture, or Tzanck smear may be used.
➤ Treatment: Oral acyclovir (40–80 mg/kg/day in 3–4 doses for 7–14 days) is the drug of choice. Valacyclovir or famciclovir are options for recurrences. Topical antivirals are less effective.
➤ Clinical features: Highly contagious; recurrences are common and may benefit from daily prophylaxis in selected cases.

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1.2 Hand-Foot-Mouth Disease (HFMD)

➤ Signs and symptoms: Painful ulcers (2–4 mm) on tongue, gingiva, and palate; accompanied by papules and vesicles on hands and feet; fever and malaise are common.
➤ Diagnosis: Clinical. In atypical presentations, throat or stool samples may confirm viral etiology.
➤ Treatment: No specific antiviral therapy exists. Management includes analgesics (acetaminophen, ibuprofen), hydration, and topical anesthetics for oral pain. Aspirin should be avoided in children.
➤ Clinical features: Self-limiting, resolving within 7–10 days. High transmissibility in children under 5 years of age.

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1.3 Herpangina

➤ Signs and symptoms: High fever, sore throat, and headache, followed by small vesicles on the soft palate, tonsillar pillars, and uvula that evolve into ulcers ≤5 mm.
➤ Diagnosis: Clinical; differentiation from HSV is based on posterior vs. anterior lesion distribution.
➤ Treatment: Supportive; pain relief and hydration. Symptoms usually resolve within 5–7 days.

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2. Other Viral Infections of the Oral Cavity
Other less frequent but clinically relevant infections include varicella-zoster (chickenpox and herpes zoster), infectious mononucleosis (EBV), CMV infections, and oral papillomavirus lesions. These conditions may present with vesicles, erythematous patches, or papillary growths such as squamous papilloma and focal epithelial hyperplasia.

3. Diagnostic Considerations
A careful evaluation of lesion distribution, systemic symptoms, and medical history is crucial. In complex or atypical cases, laboratory tests such as PCR, serology, or biopsy may be required to confirm viral etiology.

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4. Management and Pharmacological Interventions

° Herpangina & HFMD: Supportive care with analgesics and hydration.
° HSV-1: Oral acyclovir remains the gold standard; valacyclovir and famciclovir are effective alternatives in adolescents and recurrent cases.
° Other viral infections: Generally self-limited; antiviral therapy is rarely required, except in immunocompromised patients or severe cases.

Comparative Table: Viral Oral Diseases in Children

Feature	Primary Herpetic Gingivostomatitis (HSV-1)	Hand-Foot-Mouth Disease (HFMD)	Herpangina
Etiology	Herpes simplex virus type 1 (HSV-1)	Coxsackie A16, Enterovirus 71	Coxsackie A, B
Age group	6 months – 5 years	<5 years	<10 years
Oral lesion location	Anterior mucosa, gingiva, lips	Tongue, gingiva, hard palate	Soft palate, tonsillar pillars, uvula
Lesion type	Vesicles → painful ulcers	Vesicles and small ulcers	Small gray vesicles → ulcers
Systemic symptoms	High fever, malaise, lymphadenopathy	Low-grade fever, malaise	High fever, sore throat, headache
Transmission	Saliva, direct contact	Fecal-oral, droplets	Fecal-oral, droplets
Duration	10–14 days	7–10 days	5–7 days
Treatment	Oral acyclovir, hydration, pain control	Symptomatic: analgesics, hydration	Symptomatic: analgesics, hydration
Complications	Dehydration, recurrence, secondary infection	Dehydration, nail changes (rare)	Dehydration, rare complications

5. Discussion
Viral oral infections in children are highly prevalent and must be correctly identified to ensure proper management. Although most are self-limiting, they can significantly affect nutrition, hydration, and quality of life. Pediatric dentists must differentiate among herpetic gingivostomatitis, HFMD, and herpangina to prevent misdiagnosis and overtreatment.
Recent literature emphasizes decision-making algorithms for pediatric oral lesions, highlighting the need for continuous education in pediatric dentistry.

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6. Conclusion
The most common viral diseases of the oral mucosa in children—HSV-1, HFMD, and herpangina—present distinct features that allow clinical differentiation. While HSV requires specific antiviral therapy, HFMD and herpangina rely on symptomatic management. Accurate diagnosis prevents complications such as dehydration and secondary infections. Pediatric dentists must remain updated on viral oral manifestations to provide evidence-based care.

📚 References

✔ American Academy of Family Physicians (AAFP). (2010). Nongenital herpes simplex virus. American Family Physician, 82(9), 1075-1082. Retrieved from https://www.aafp.org/pubs/afp/issues/2010/1101/p1075.html
✔ Guillouet, C., et al. (2022). Oral lesions of viral, bacterial, and fungal diseases in children: Diagnostic decision tools. Frontiers in Pediatrics. https://pmc.ncbi.nlm.nih.gov/articles/PMC9358008/
✔ Mayo Clinic. (2025, July 26). Hand-foot-and-mouth disease: Diagnosis & treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/diagnosis-treatment/drc-20353041
✔ Santosh, A. B. R., & Muddana, K. (2020). Viral infections of the oral cavity: Clinical presentation, pathogenic mechanism, investigations, and management. Journal of Family Medicine and Primary Care, 9(1), 36–42. https://journals.lww.com/jfmpc/fulltext/2020/09010/viral_infections_of_oral_cavity.8.aspx


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Adverse Effects of Local Anesthesia in Pediatric Dentistry: Types, Symptoms, and Management

Local anesthetics are indispensable for ensuring pain-free dental procedures and reducing anxiety in children.

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However, due to factors such as age, body weight, and immature metabolism, pediatric patients are at higher risk of adverse reactions (Malamed, 2022). Understanding the potential complications and their management is critical to ensuring safe dental practice.

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✅ Types of Local Anesthetics in Pediatric Dentistry

➤ Lidocaine 2% with epinephrine: considered the “gold standard,” safe with low toxicity risk.
➤ Mepivacaine 2% and 3%: useful for patients sensitive to vasoconstrictors, though the 3% plain solution has a higher risk of systemic toxicity.
➤ Articaine 4% with epinephrine: highly effective with superior bone diffusion, but associated with an increased risk of paresthesia.
➤ Prilocaine 3%: lower vasodilatory effect, but may induce methemoglobinemia in high doses.
➤ Bupivacaine 0.5%: long-acting, recommended for extensive procedures, but carries a higher risk of cardiotoxicity.

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✅ Local Adverse Effects

➤ Injection site pain: localized inflammation or hematoma.
➤ Trismus: muscle trauma or irritation from improper technique.
➤ Paresthesia: most commonly linked to articaine and prilocaine, involving the lingual or inferior alveolar nerve.
➤ Tissue necrosis: associated with high vasoconstrictor concentration.

✅ Systemic Adverse Effects
Often linked to overdose, rapid absorption, or idiosyncratic reactions:

➤ Central Nervous System (CNS): dizziness, drowsiness, blurred vision, tremors, seizures.
➤ Cardiovascular system: bradycardia, hypotension, arrhythmias, cardiovascular collapse.
➤ Allergic reactions: rare, but may include urticaria, bronchospasm, or anaphylaxis.
➤ Methemoglobinemia: related to high doses of prilocaine, leading to cyanosis and respiratory distress.

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✅ Clinical Signs and Symptoms

➤ Pale skin, dizziness, blurred vision after injection.
➤ Drowsiness or unusual behavior in children.
➤ Seizures in severe overdose cases.
➤ Tachycardia or bradycardia depending on drug and dosage.
➤ Cyanosis and breathing difficulties in methemoglobinemia.

✅ Management and Treatment

1. Prevention:
° Calculate maximum safe dose in mg/kg (e.g., lidocaine 4.4 mg/kg; mepivacaine 4.4 mg/kg; articaine 7 mg/kg).
° Avoid high concentrations in underweight patients.
° Aspirate before injection to prevent intravascular administration.
2. Treatment:
° Stop anesthetic administration immediately.
° Place patient in a supine position with a clear airway.
° Provide supplemental oxygen.
° Manage seizures with benzodiazepines (midazolam or diazepam).
° Severe allergic reactions: intramuscular epinephrine, corticosteroids, and antihistamines.
° Methemoglobinemia: intravenous methylene blue (1%).
° Continuous monitoring and hospital transfer if necessary.

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💬 Discussion
Balancing analgesic efficacy with safety is crucial when using local anesthetics in pediatric dentistry. Solutions at 2% concentration generally present lower toxicity risk compared to higher concentrations, making them preferable in younger patients. While severe complications are rare, their potential impact highlights the importance of proper pharmacological knowledge, accurate dosage calculation, and readiness to handle emergencies.

✍️ Conclusion
Local anesthesia is safe in pediatric dentistry when applied correctly and within recommended dosages. Early recognition of adverse effects and proper clinical management are key to minimizing risks. Continuous education in dental pharmacology and the availability of emergency protocols in the dental office are essential for optimal patient care.

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📚 References

✔ Malamed, S. F. (2022). Handbook of Local Anesthesia (7th ed.). Elsevier.
✔ Haas, D. A. (2022). Adverse effects of local anesthetics in dentistry. Journal of the Canadian Dental Association, 88, m8.
✔ Pogrel, M. A. (2019). Permanent nerve damage from inferior alveolar nerve blocks—An update to include articaine. Journal of the California Dental Association, 47(3), 127–133.
✔ Becker, D. E., & Reed, K. L. (2012). Local anesthetics: Review of pharmacological considerations. Anesthesia Progress, 59(2), 90–102. https://doi.org/10.2344/0003-3006-59.2.90
✔ Meechan, J. G. (2018). Local anaesthesia for children. British Dental Journal, 225(4), 299–304. https://doi.org/10.1038/sj.bdj.2018.633

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Enfermedades víricas de la mucosa oral en odontopediatría: Signos, diagnóstico y tratamiento actual - Tabla Comparativa 📊

Las enfermedades víricas que afectan la mucosa oral en odontopediatría representan un desafío clínico frecuente debido a su presentación variada y a los síntomas sistémicos que suelen acompañarlas.

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Entre las más comunes se encuentran la gingivoestomatitis herpética primaria (HSV-1), mano-pie-boca (Coxsackie y enterovirus), y herpangina; además, se consideran otras infecciones virales como varicela-zóster, mononucleosis infecciosa, y citomegalovirus.

Enlaces Patrocinados

1. Principales enfermedades virales de la mucosa oral en pediatría

1.1 Gingivoestomatitis herpética primaria (HSV-1)
➤ Signos y síntomas: Vesículas dolorosas sobre mucosa oral, encías, labios; fiebre, malestar general, adenopatías; posible rechazo a la ingesta e incluso deshidratación.
➤ Diagnóstico: Clínico; en casos dudosos, se confirma mediante PCR, cultivo viral, inmunofluorescencia o test de Tzanck.
➤ Tratamiento: Acyclovir oral (40–80 mg/kg/d en 3-4 tomas por 7–14 días), valacyclovir o famciclovir en recurrencias; tópicos (aciclovir, docosanol) son menos efectivos.
➤ Características: Alta transmisibilidad; reactivaciones son frecuentes y pueden mejorar con profilaxis diaria.

1.2 Enfermedad mano-pie-boca (HFMD)

➤ Signos y síntomas: Vesículas o úlceras de 2–4 mm en encías, lengua, paladar; también pápulas en manos y pies; fiebre y malestar.
➤ Diagnóstico: Clínico; si es necesario, se hace hisopado faríngeo o muestra fecal para identificar el virus.
➤ Tratamiento: No existe tratamiento curativo—se maneja de forma sintomática: analgésicos (acetaminofén, ibuprofeno); anestésicos tópicos para el dolor; evitar aspirina en niños.
➤ Características: Muy contagiosa, especialmente en menores de 5 años; se autolimita entre 7–10 días

1.3 Herpangina

➤ Signos y síntomas: Fiebre alta, cefalea, odinofagia; tras 1–2 días aparecen vesículas grises en m. blanda orofaríngea, evolucionan a úlceras de ≤5 mm; localizadas en pilares amigdalares, paladar blando, úvula.
➤ Diagnóstico: Clínico, diferenciándose principalmente de HSV por la localización posterior versus anterior.
➤ Tratamiento: Sintomático, orientado a mitigar el dolor; la enfermedad suele resolverse en menos de una semana

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2. Otras infecciones virales orales relevantes
Se incluyen entidades como varicela-zóster (varicela y herpes zóster), mononucleosis infecciosa, citomegalovirus, entre otras, con manifestaciones que van desde vesículas, úlceras o enrojecimiento hasta lesiones de crecimiento epitelial como papilomas o hiperplasia focal.

3. Diagnóstico diferencial y complementarios
Para distinguir entre estas entidades, se valoran localización de lesiones, síntomas sistémicos y antecedentes clínicos. En cuadros atípicos o difíciles, se recurre a biopsia, PCR, serología o cultivo viral.

4. Intervenciones terapéuticas y farmacología

° Herpangina y HFMD: Atención sintomática fundamental, con analgésicos y soporte hidratación.
° HSV-1: Acyclovir oral es tratamiento de elección; valacyclovir y famciclovir para recurrencias; uso tópico como complemento menos efectivo.
° Otras infecciones virales: No suelen requerir antivirales específicos; la mayoría se resuelve con tratamiento de soporte, salvo casos complicados o pacientes inmunocomprometidos.

📊 Tabla comparativa: Enfermedades bucales virales en niños

Característica	Gingivoestomatitis herpética primaria (HSV-1)	Enfermedad mano-pie-boca (HFMD)	Herpangina
Etiología	Virus herpes simple tipo 1 (HSV-1)	Coxsackie A16, Enterovirus 71	Coxsackie A, B
Grupo etario	6 meses – 5 años (pico en preescolares)	<5 años	<10 años
Localización oral	Mucosa anterior, encías, labios	Lengua, encías, paladar duro	Paladar blando, pilares amigdalinos, úvula
Tipo de lesión	Vesículas → úlceras dolorosas	Vesículas y úlceras pequeñas	Vesículas grises pequeñas → úlceras
Síntomas sistémicos	Fiebre alta, malestar, linfadenopatía	Fiebre leve, malestar	Fiebre alta, odinofagia, cefalea
Transmisión	Saliva, contacto directo	Fecal-oral, gotas respiratorias	Fecal-oral, gotas respiratorias
Duración	10–14 días (sin antivirales)	7–10 días	5–7 días
Tratamiento	Aciclovir oral (sistémico), hidratación, analgesia	Sintomático: analgésicos, hidratación	Sintomático: analgésicos, hidratación
Complicaciones	Deshidratación, recurrencias, sobreinfección	Deshidratación, cambios ungueales (raros)	Deshidratación, complicaciones raras

5. Discussión
Estas patologías representan parte esencial del ejercicio en odontopediatría. Es clave un diagnóstico preciso, ya que muchas son autolimitadas pero dolorosas, afectando alimentación, calidad de vida y riesgo de complicaciones como deshidratación o sobreinfección bacteriana. La capacidad de distinguir entre herpes, HFMD y herpangina facilita la toma de decisiones sobre tratamiento y manejo domiciliario.
Además, la literatura reciente valida guías diagnóstico-terapéuticas claras; por ejemplo, la revisión y árbol decisional propuestos por Guillouet et al., basados en 20 entidades virales pediátricas. Esto refuerza la importancia de formación continua y herramientas prácticas en odontología infantil.

6. Conclusión
Las principales enfermedades virales de la mucosa oral en odontopediatría —HSV-1, HFMD y herpangina— presentan signos distintivos que permiten diferenciarlas clínicamente. El diagnóstico certero y oportuno facilita un tratamiento sintomático adecuado y previene complicaciones. Acyclovir oral sigue siendo el fundamento para HSV-1, mientras que para HFMD y herpangina, el manejo centrado en analgesia, hidratación y observación es suficiente. Las herramientas diagnósticas recientes enriquecen la práctica clínica. Se recomienda fomentar estrategias preventivas y educación familiar para reducir transmisión y mejorar pronóstico infantil.

7. Referencias

✔ Guillouet, C., et al. (2022). Oral lesions of viral, bacterial, and fungal diseases in children. Pediatric decision tools based on oral lesions, PMC, revisión. en PubMed.
✔ Ruiz-Mojica, C. A. (2023). Acute herpetic stomatitis: Clinical manifestations, diagnostics and treatment strategies. StatPearls.
✔ Santosh, A. B. R., & Muddana, K. (2020). Viral infections of the oral cavity: clinical presentation, pathogenic mechanism, investigations, and management. Journal of Family Medicine and Primary Care, 9(1), 36–42.
✔ Mayo Clinic. (2025, julio 26). Hand-foot-and-mouth disease—Diagnosis & treatment. Mayo Clinic.

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Webinar: Ortopedia y Ortodoncia para la dentición primaria - Dra. Silvia Chedid

El tratamiento ortopédico y ortodóncico en la dentición primaria se centra en detectar y manejar precozmente las alteraciones funcionales y estructurales que pueden condicionar la salud bucal a largo plazo.

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A través de un enfoque multidisciplinario, que involucra pediatras, odontopediatras y ortodoncistas, se busca no solo corregir maloclusiones tempranas, sino también prevenir su aparición mediante estrategias personalizadas de evaluación y seguimiento.

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La identificación de asimetrías craneales, hábitos orales disfuncionales y factores de riesgo ambientales resulta clave para decidir los criterios de tratamiento más adecuados.

Este enfoque preventivo y basado en la evidencia permite guiar el crecimiento y desarrollo del sistema estomatognático, favoreciendo la estética, la función y la calidad de vida en la infancia.

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Webinar: Minimally Invasive Dentistry - Dra. Aisha Mohamed

In pediatric dentistry, minimally invasive approaches emphasize a preventive philosophy supported by early risk assessment and tailored care. Advances in diagnostics allow clinicians to identify caries lesions at their earliest stages, enabling interventions that stop or slow progression without the need for extensive drilling or removal of tooth structure.

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Equally important are the preferences and expectations of families, as their involvement is central to adherence and outcomes. A carefully structured plan not only resolves the immediate dental disease but also establishes healthier oral environments, reduces the likelihood of relapse, and supports the child’s overall well-being.

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