An article recently published by ESPN discussed the West Virginia University football program’s postponement of their Fan Appreciation Day due to an outbreak of hand, foot, and mouth disease among the football team. This sparked a worthwhile discussion topic: what is hand, foot, and mouth Disease (HFMD)? How does it spread? Who is susceptible? And is it a big enough deal to cause West Virginia University to risk a disgruntled fan base?
What is Hand, Foot, and Mouth Disease?
Most adults with children will know HFMD as a mild, highly contagious viral infection common in young children, most commonly caused by the Coxsackievirus A16. It takes about 3-6 days after exposure for symptoms to appear, and usually begins with a fussy child and a fever that lasts maybe 24 hours. A day or two later, flat, reddish spots or bumps that may blister appear on the hands, feet, and mouth, and occasionally buttocks and groin. In another week or so, the symptoms are gone, although a small number of cases will continue and can become severe.
It’s a bit different in adults. Former Houston Astros pitcher J. Happ was placed on the 10-day Disabled List recently with HFMD. It can appear as a rash on the hands, feet, buttocks, and/or tongue. It can also appear as severe itching on one or both sides of the hands and/or feet and on the buttocks, sometimes with no visible signs! In other cases, the rashes on the hands and/or feet can appear and act like blisters.
Perhaps the most common complaint, though, are signs and symptoms on the tongue.
Signs are things that we can see, like small, white bumps or ulcers that are smaller than the common (and more painful) aphthous ulcers.They can appear on the underside of the tongue or anywhere in the mouth. Other signs include raw or “beefy” tongue, or enlarged “taste buds.”
Symptoms are things that we cannot see, like a very sensitive, sore, or “burning” tongue that might appear normal.
Rarely, HFMD can lead to other viral infections, and can even invade the brain causing meningitis.
There is a relatively new strain of HFMD that may be more serious. It is caused by the Coxsackievirus A6 virus that is spreading now through Europe, especially Scandinavia. The symptoms are worse, and although still very uncommon, more cases are leading to meningitis (because we don’t have as much resistance to this viral strain.)
How Does Hand, Foot, and Mouth Disease Spread?
HFMD spreads by saliva droplets (from coughing, or just breathing), contact with any bodily fluid or waste, and contact with contaminated people or things. Therefore, it is very difficult to prevent or contain. Handwashing helps, as does effective disinfecting.
There is little doubt that one of the WVU coaches or football players has a small child or niece/nephew who picked it up from daycare. This person likely began spreading it before they realized they had anything. If you put a mild, but highly contagious virus in a sports locker room, you can bet it will spread quickly!
Why Talk About This on a Dental Blog?
Like many other diseases, signs and symptoms of hand, foot, and mouth disease first appear in the mouth.
Dentists (at least in the U.S.) are doctors of the mouth, not just of the teeth. We are trained to diagnose, screen, refer, treat, and manage diseases of the mouth, including “hard tissue” (bones and teeth) and “soft tissue” (everything else in the mouth.)
In a perfect world, anyone who treats a human body would have an M.D. degree, and then would specialize in specific areas. However, modern scientific concepts of dentistry were developed between 1650 and 1800, whereas modern medicine didn’t begin until about 1878. That was when it was finally proved that bacteria and protozoa were vectors of disease, which eventually resulted in the merging of medicine and surgery, and medical schools based on both of these concepts.
So “modern” dental schools existed before “modern” medical schools! Politics in many various forms has prevented their merger.
Nevertheless, the fact remains that the mouth and teeth really are connected to the rest of the body, and one can’t be affected without affecting the other. Witness how often medications cause the mouth to be dry! This is a major reason why older patients have more trouble with tooth decay than they had in the past.
The fact is that over 200 diseases are manifest in the mouth. In my 38 years as a dentist, I have been a patient’s first practitioner to diagnose (or to refer for diagnosis) diseases not primary to the mouth, such as Type I diabetes; high blood pressure; various heart diseases; AIDS; a few recurrent cancers; shingles; the autoimmune diseases lichen planus, erythema multiforme, pemphigus vulgaris, pemphigoid, and lupus erythematosus; heavy metal poisoning; neurofibromatosis (von Recklinghausen disease of skin); leukemia; vitamin B12 deficiency; Hodgkin’s lymphoma, and, of course, HFMD (and, I’m sure, a few more that don’t come to mind.)
Every patient who comes to get their teeth cleaned receives a cancer screening. We look carefully at the soft tissues of the mouth to be sure nothing unusual is there.
We care about our patients’ overall health, not just their teeth and their mouths.
Management of Hand, Foot, and Mouth Disease
If you come down with HFMD, what can be done? First of all, see your regular physician to ensure that it is not actually something else, as there are more diseases than there are signs and symptoms. HFMD is usually diagnosed by the signs and symptoms and your recent history of contact with small children or the places where they have been.
There are presently no drugs that will specifically treat HFMD; but, we do have some specific ways to treat the symptoms in the mouth, depending on what they are and on your specific oral health. While they won’t shorten the course of the disease, I know they will make you feel better, because I had HFMD a couple of weeks ago, and I was able to try them out on myself!
One Final Thought
West Virginia University was right to postpone Fan Day. Better to have masses of disappointed football fans than masses of sick and highly contagious football fans! You can find the original ESPN article here.
Photo Credit: Neville, Brad. Oral and Maxillofacial Pathology, 3rd Edition. W.B. Saunders Company, 2008. VitalBook file.