Hand-foot-and-mouth disease is caused by infection with coxsackievirus A16 in a majority of cases, although instances have been described in which A5, A7, A9, A10, B2, or B5 or enterovirus 71 has been isolated. The disease is characterized by low-grade fever, oral vesicles and ulcers, and nonpruritic macules, papules, and vesicles, particularly on the extensor surfaces of the hands and feet. The oral lesions are more extensive than are those described for herpangina, and
lesions of the hard palate, tongue, and buccal mucosa are common. Severe cases with central nervous system involvement, myocarditis, and pulmonary edema have been reported in epidemics caused by enterovirus 71.Adler and colleagues studied 20 cases of hand-foot-andmouth disease. The patients ranged in age from 8 months to 33 years, with 75% of cases occurring below 4 years of age. The clinical manifestations lasted 3 to 7 days. The most common complaint of the 20 patients was a sore mouth, and, clinically, all 20 patients had lesions involving the oral mucosa. Because of the frequent oral involvement, dentists are more likely to see
patients with this disease than with herpangina, and they should remember to examine the hands and feet for maculopapular and vesicular lesions when patients present with an acute stomatitis and fever. Treatment is supportive.