___________________________________ DCA06DT Dental Treatment of Pediatric and Adolescent Patients
HAND, FOOT, AND MOUTH DISEASE Hand, foot, and mouth disease is usually caused by coxsacki- evirus A16, although other coxsackievirus genotypes can serve as etiologic agents [32]. The disease primarily affects children during the summer and early fall. It usually begins with fever, loss of appetite, fatigue, and sore throat, followed within one or two days by oral sores. The oral lesions of hand, foot, and mouth disease feature vesi- cles that quickly rupture to form shallow ulcerations encircled by an erythematous halo. Any area of the oral mucosa can be affected, but lesions occur most often on the palate, tongue, and buccal mucosa. The lesions can be difficult to distinguish from other oral ulcerative lesions, such as aphthous ulcers. However, hand, foot, and mouth disease usually features similar cutaneous lesions on the hands and feet, although the lesions may be limited to cutaneous or oral manifestations in some cases. Afflicted patients are most contagious during the initial week of their infection. Coxsackievirus A16 remains for weeks after symptoms have dissipated, and the patient remains infectious to others during this time [40]. Treatment for hand, foot, and mouth disease is supportive and palliative. Painful oral lesions can complicate a patient’s ability to masticate food and to swallow, so softer, blander foods and liquid nutritional supplements may be required. Analgesics compatible with the patient’s medical history may be used to decrease oral discomfort. Patients with hand, foot, and mouth disease should be instructed not to scratch or manipulate fluid-filled vesicles in any manner as the contents are infectious and can inoculate other areas. There is no current vaccine available to prevent hand, foot, and mouth disease. Recovery from the disease only confers immunity against the viral strain that caused the infection, not against other coxsackievirus genotypes. It is a self-limiting disease, but complications, such as viral meningitis or encepha- litis, can occur. RECURRENT APHTHOUS STOMATITIS Recurrent aphthous stomatitis features painful ulcerative lesions (also known as recurrent aphthous ulcers or more commonly as canker sores) that generally heal without scarring in immunocompetent patients but can recur at any time. The size is a demarcation for the categorization of these lesions. Minor aphthae are less than 1 cm at the greatest diameter; major aphthae exceed this dimension. Each type of lesion only involves nonkeratinized tissues, such as the buccal and labial mucosa, the soft palate, and the surface layer of the floor of the mouth. Movement of the mucosa affected by lesions of either size is painful and can interfere with speaking, eating, and swallowing. Major aphthae tend to have irregular shapes and borders and more depth. The numbers of both can vary, although solitary lesions are uncommon. Lesions of aphthous stomatitis feature a shallow yellow base and an intense ery- thematous halo peripherally.
too young to have received the vaccine series [76]. Since then, a major increase in the number of cases in the United States has been noted. In 2025, 2,144 confirmed measles cases were reported. This represents the largest number of cases since 1992 and the highest number since measles was considered eliminated in the United States in 2000. Of these patients, 93% were either unvaccinated or their vaccination status was unknown [77]. Vaccination levels among kindergarteners have fallen below the threshold needed for heard immunity necessary to protect vulnerable populations. Travel to or from a foreign country where the disease is endemic by unvaccinated individuals can instigate a measles outbreak [76; 77]. The measles virus causes cutaneous, red, maculopapular lesions. Oral manifestations of measles include grayish-white macules surrounded by an erythematous halo, known as Koplik spots. These lesions precede the eruption of the cutaneous lesions [45]. CHICKENPOX Chickenpox, also known as varicella, is caused by the varicella zoster virus (VZV). This disease is usually seen in children and features lesions that originate on the trunk then spread throughout the body. The oral lesions are white to grayish- white vesicles with an erythematous border involving the tongue, buccal mucosa, gingiva, palate, and oropharynx. They can cause varying degrees of pain, which can complicate eat- ing, swallowing, and maintaining oral hygiene [46]. Nutrition and hydration should be maintained via liquid nutritional supplements, if necessary. After the primary varicella infection ends, the VZV is trans- ported to the dorsal spinal ganglia and can remain dormant for decades, emerging later as herpes zoster virus, also known as shingles. However, shingles is much more common in older adults, and a vaccine is available for persons 50 years of age and older [47]. MUMPS The MMR/MMRV vaccines have also been instrumental in significantly decreasing the incidence of mumps. When it does develop, mumps involves the major salivary glands. In particular, the parotid glands’ inflammatory response to the mumps virus (known as parotitis) presents as bilateral swell- ing of variable severity. Children 10 years of age and younger are most commonly affected; however, a larger outbreak in 2006 involved 6,584 college students in multiple states, an outbreak of 3,000 high school students occurred in New York in 2009–2010, and nearly 20,000 cases occurred in 2015–2019 in a variety of settings, including households, schools, universi- ties, athletics teams and facilities, church groups, workplaces, and large parties and events. Since the end of 2019, cases of mumps have declined, but hundreds of cases per year continue to be reported [48]. Rarely, more serious complications such as temporary or permanent deafness, encephalitis, or meningitis, may occur. In some cases, mumps will present as unilateral involvement and swelling of the parotid gland, which can be mistaken for a local odontogenic infection.
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