What can be given for comfort due to oral mouth sores associated with Hand, Foot, and Mouth Disease (HFMD)?

Management of Oral Mouth Sores in Hand, Foot, and Mouth Disease

For comfort due to oral mouth sores in Hand, Foot, and Mouth Disease, topical anesthetic mouthwashes such as 2% viscous lidocaine and benzydamine hydrochloride rinses are recommended as first-line treatments, along with supportive care measures including frequent saline rinses and adequate hydration. 1, 2, 3

Pain Management Options

• Use topical anesthetic preparations such as 2% viscous lidocaine for direct pain relief of oral lesions 2, 3
• Apply benzydamine hydrochloride oral rinses or sprays every 3 hours, particularly before eating, to reduce pain and inflammation 1
• For moderate pain, consider topical NSAIDs (e.g., amlexanox 5% oral paste) 1, 2
• For more severe pain, systemic analgesics following the WHO pain management ladder may be necessary 1, 2

Basic Oral Care Protocol

• Rinse mouth with warm saline or alcohol-free, sodium bicarbonate-containing mouthwash 4-6 times daily to keep the mouth clean and reduce bacterial colonization 4, 2
• Use a soft toothbrush after meals and before sleep to maintain oral hygiene without causing additional trauma to inflamed tissues 4, 2
• Drink ample fluids to keep the mouth moist and prevent dehydration 4
• Lubricate lips with lip balm or cream if affected (avoid long-term use of petroleum jelly as it can promote mucosal dehydration) 4, 2

Dietary Modifications

• Avoid painful stimuli including:
  • Hot, spicy, acidic, or rough-textured foods 4
  • Citrus fruits and tomatoes 4
  • Hot drinks 4
  • Alcohol 4
• Choose cool, soft, bland foods that are easier to tolerate 2
• Consider cold foods like popsicles or ice cream which may provide temporary numbing effect 2

Additional Supportive Measures

• For patients with signs of secondary fungal infection, consider antifungal treatments such as nystatin oral suspension or miconazole oral gel 1
• Use antiseptic oral rinses like 0.2% chlorhexidine digluconate or 1.5% hydrogen peroxide mouthwash twice daily if secondary bacterial infection is suspected 1
• Apply mucoprotectant mouthwashes three times daily to protect ulcerated surfaces 1

Important Considerations

• HFMD is typically self-limiting, with symptoms resolving within 7-10 days without specific treatment 5, 6
• The mainstay of treatment remains supportive care focused on pain relief and maintaining hydration 5
• Monitor for rare complications, especially in children infected with Enterovirus 71, which can cause more severe disease 7, 6
• Implement good hygiene practices to prevent transmission to others, as HFMD is highly contagious 7, 6

Treatment Algorithm

1. First line: Topical pain management with viscous lidocaine 2% or benzydamine rinses
2. Second line: Add topical NSAIDs for persistent moderate pain
3. Third line: Consider systemic analgesics for severe pain following WHO pain ladder
4. Throughout treatment: Maintain basic oral care protocol with saline rinses, soft diet, and adequate hydration
5. If secondary infection suspected: Add appropriate antimicrobial therapy (antifungal or antibacterial)