Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2011  |  Volume : 29  |  Issue : 2  |  Page : 165--167

Hand, foot and mouth disease

Radhika Muppa, Prameela Bhupatiraju, Mahesh Duddu, Arthi Dandempally 
 Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental College and Hospital, Kamalanagar, Dilsukhnagar, Hyderabad, Andhra Pradesh, India

Correspondence Address:
Radhika Muppa
Panineeya Mahavidyalaya Institute of Dental College and Hospital, Kamalanagar, Dilsukhnagar, Hyderabad - 500 060, Andhra Pradesh


Hand, foot and mouth disease (HFMD) is an acute viral illness with a distinct clinical presentation of oral and characteristic distal extremity lesions. Knowledge of this is important for the dentists as the oral lesions are the first clinical signs and sometimes may be the only sign because the condition occasionally may regress even before the lesions appear on the extremities. This case describes a 5-year-old boy in whom low-grade fever of 38.7°C and oral lesions were the initial manifestations. Proper diagnosis was established later based on the typical location of the initial intraoral ulcers on the soft palate followed by cutaneous lesions on the hands and feet with vesicle formation surrounded by an erythematous halo. The recognition of HFMD is important for both pediatricians and pedodontists as oral manifestations are the first signs and may mimic many other conditions like acute herpetic gingivostomstomatitis, apthous stomatitis, chickenpox, erythema multiformae and misdiagnosis may involve an inappropriate prescription of medication.

How to cite this article:
Muppa R, Bhupatiraju P, Duddu M, Dandempally A. Hand, foot and mouth disease.J Indian Soc Pedod Prev Dent 2011;29:165-167

How to cite this URL:
Muppa R, Bhupatiraju P, Duddu M, Dandempally A. Hand, foot and mouth disease. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2021 Oct 26 ];29:165-167
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Full Text


Hand, foot, and mouth disease (HFMD) is a highly infectious disease characterized by multiple vesicles on the hands and feet and in the oral cavity. It usually occurs in children in summer. Coxsackievirus A16 is the most common virus causing HFMD; other causative viruses include coxsackieviruses A5, A7, A9, A10, B2, B5, and enterovirus 71. [1],[2] Clinically, the onset is characterized by fever and the appearance of papules on the hands, feet, and in the oral cavity, which progress to vesicles. [1],[3] Infection generally occurs via the fecal-oral route or via contact with skin lesions and oral secretions. Viremia develops, followed by invasion of the skin and mucous membranes. Widespread apoptosis likely results in the characteristic lesion formation. Symptoms usually subside within 7-10 days. [3] Although several cases of HFMD have been reported, it has been rarely reported having both oral and cutaneous lesions simultaneously.

 Case Report

A 5-year-old boy previously in good health presented with a chief complaint of sore throat, malaise and anorexia. The intraoral examination revealed remarkable ulcers of 2-3 mm with an erythematous base. Ulcers were involving the posterior third of the palate, buccal mucosa and tongue [Figure 1]a, b, and [Figure 2]. The total number of ulcers were 7-12. Physical examination revealed typical cutaneous lesions involving dorsal aspects of hands and sides of the fingers on both hands and feet [Figure 3] and [Figure 4]. Each lesion was an ∼2- to 10-mm erythematous macule on which a central gray oral vesicle was seen. These lesions were asymptomatic. The diagnosis of HFMD was made based on the history as well as typical clinical findings including typical location and distribution of skin lesions.{Figure 1}{Figure 2}{Figure 3}{Figure 4}

Treatment was palliative with an analgesic for severe oral pain and topical viscous lidocain gel application. On follow-up, the whole condition regressed by 10 days without any complications.


HFMD is a human syndrome caused by intestinal viruses of the Picornaviridae family. The most common strains causing HFMD are Coxsackie A virus and enterovirus. [4] HFMD usually affects infants and children, and is quite common. The incubation period is about 3-6 days. [5] The infection is highly contagious and is spread by horizontal transmission from a child to another child and from a mother to the fetus. The spread occurs through a direct contact with mucous, oral or nasal secretions, or feces of an infected person. Initial viral implantation in the buccal and ileal mucosa is followed by lymph nodes in 24 h. [6] Viremia occurs rapidly with a spread to the oral mucosa and skin; usually by the seventh day, neutralizing antibody levels increase and the virus is eliminated. [6] The initial presentation includes erythematous papules on the palms, feet and in the oral cavity, accompanied by prodromal symptoms such as myalgia, mild fever and abdominal pain. The lesions usually evolve into vesicles and then spontaneously resolve within 1 or 2 weeks. [7] Lesions are usually asymptomatic, but in some cases, pressure and touch can provoke pain. In addition, oral lesions may occur without cutaneous lesions, [8] and HFMD without oral mucosal lesions has also been reported in an immunocompromised adult. [9] HFMD usually occurs in the summer, from June to October, although it has been also reported in the winter. [9] The coxsackievirus belongs to the Picornaviridae family (small RNA viruses) together with echovirus, enterovirus, and poliovirus. Humans are thought to be the only natural host of the coxsackievirus.

Treatment is symptomatic, and the disease resolves spontaneously without complications within 7-10 days. However, there have been rare reports of severe complications such as pneumonia, cardiomyositis, and aseptic meningitis. [10],[11] Low-level laser therapy has been shown to reduce or shorten the duration of oral ulcers but it was not necessary in this case. [12]


In conclusion, pedodontists have an edge over others in diagnosing the condition more accurately as oral ulcerations may represent as the first sign of the disease and an early identification will prevent the infection from spreading to the children and vulnerable adults. Moreover, pedodontists have a key role in educating the patients on good oral hygiene and avoidance of rupture of the blisters.


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