___________________________________ DCA06DT Dental Treatment of Pediatric and Adolescent Patients
and a protracted healing period. Antiviral medications such as acyclovir can accelerate the healing time. Acyclovir is available as a cream, capsule, tablet, or suspension, with the dosage and frequency of administration adjusted according to the patient’s age, weight, and medical history. MEASLES Many of the systemic viral diseases that were once common among young children and adolescents, such as measles, mumps, and chickenpox, have been significantly reduced in the United States through the use of effective vaccines. The combined vaccine for measles, mumps, and rubella (MMR) was developed in the late 1960s [41]. In 1995, a chickenpox (varicella) vaccine was introduced, and by 2005, a combination vaccine for all four diseases (MMRV) was introduced [42]. In the 1990s, a study was published implicating the MMR vaccine with the development of autism [43]. Although the basis of this work was later declared fraudulent, many parents refused to have their children vaccinated on the basis of this initial report, which resulted in small increases in the incidence of these diseases [44]. The Centers for Disease Control and Prevention (CDC) has documented several outbreaks of measles in the last decade among unvaccinated groups (e.g., the Amish, orthodox Jewish communities, children of the anti-vaccination movement); one such incidence was the 2015 Disney California theme parks outbreak, which infected at least 125 individuals, most of whom had not been vaccinated due to personal beliefs; others had unknown vaccine status, were undervaccinated, or were 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. 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].
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