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Three Part Question

In [children presenting with painful infectious mouth conditions], is a [topical local anesthetic better than placebo] at [improving oral intake] ?

Clinical Scenario

A 3 year old girl presents to the Emergency department with 48 hr history of low grade fever, anorexia, malaise and lesions to her hands, feet and oral mucosa (buccal mucosa, gingiva and tongue). Her mother states she is now refusing to eat and drink due to her painful mouth ulcers. Upon physical examination you diagnose her with Hand-foot and mouth disease and deem her to be mildly dehydrated. You wonder if administering a topical anesthetic (i.e. viscous lidocaine) to her mouth lesions would result in an improved oral fluid intake.

Search Strategy

Medline 1966-08/2009 using the EBSCOhost interface and The Cochrane Library 2009, Issue 3, 18/9/2009 and Embase


The details of the search are as follows:


Medline:
MH Oral Ulcer or Mouth diseases or MH Stomatitis or MH Stomatitis, Herpetic, or Stomatitis Aphthous or Vesicular stomatitis or Ulcer or Coxsackievirus infections+ or Mucositis or mucous membrane AND Administration, Topical or administration, buccal or Anesthetics, local or lidocaine. Limiters – 196601-200912, Age related: all children: 0-18 years.


Cochrane:

Mouth ulcer* or mouth lesions or gingivostomatitis or gingivo-stomatitis or gingivo stomatitis or gingivostomatitides or gingivo-stomatitides or coxsackie virus or coxsackievirus or aphthous ulcer* of “hand foot and mouth” of “hand-foot mouth or “herpetic lesion or herpetic ulcer” or stomatitis herpetic OR MeSH descriptor Stomatitis OR MeSH descriptor Oral Ulcer explode all trees OR MeSH descriptor Mucositis explode all trees OR MeSH descriptor Mucositis explode all trees AND topical anesthetic* or topical anesthetic* or lidocaine or lignocaine or xylocaine OR MeSH descriptor Administration, Topical explode all trees OR MeSH descriptor Anesthesia, Local explode all trees


Embase:

‘mouth ulcer’/exp or ‘mouth disease/exp or ‘stomatitis’/exp or ‘gingiva ulcer’/exp OR ‘ tongue ulcer’/exp OR ‘coxsackie virus infection’/exp OR ‘gingivitis’/exp OR ‘mucosa inflammation’/exp OR mouth mucosa’/exp AND (‘topical drug administration’/exp OR ‘topical treatment’/exp OR ‘buccal drug administration’/exp OR ‘local anesthesia’/exp OR ‘lidocaine’/exp) AND ([infant]/lim OR [preschool]/lim OR [school]/lim OR [child]/lim) AND [english]/lim

Search Outcome

Altogether 101 papers were found in Medline 5 papers were reviewed and deemed not relevant. However, there references lists were check with no further yield. 110 papers were found in Cochrane, of which 7 were reviewed and all were irrelevant or of insufficient quality. 359 papers found 15 reviewed and deemed not relevant. A further 0 papers were found by scanning the references of relevant papers.

Comment(s)

No published evidence was found to answer the 3 part question. A well designed RCT should be conducted.

Clinical Bottom Line

Local advice should be followed.