Oral ulcers occur in approximately 9% of children and adolescents, often posing diagnostic challenges due to their nonspecific presentation.
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✅ Diagnosis & Clinical Features
➤ Clinical Presentation
° Aphthous stomatitis: small, round/ovoid ulcers with gray-white or yellowish pseudomembrane and red halo; typically heal in 7–14 days and may recur.
° Herpetic gingivostomatitis: grouped vesicles evolving into ulcers, often with fever, common under age six.
° Hand-Foot-Mouth Disease / Herpangina: small ulcers (2–4 mm) on soft palate or tonsillar pillars, often accompanied by systemic signs like fever and lesions on palms/soles.
° Traumatic ulcers: solitary ulcers with yellowish pseudomembrane on lips, tongue or buccal mucosa; heal within ~10 days if cause removed.
➤ Diagnostic Work-up
Diagnosis is primarily clinical, supported by full history and examination. Laboratory tests (blood count, nutritional panels), lesion cultures, or biopsy may be indicated for atypical, persistent, or recurrent ulcers; malignancy must be considered if lesions persist beyond two weeks
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° Aphthous ulcers (RAS): Immune-mediated with triggering factors including trauma, stress, nutritional deficiencies (B-1, B-2, B-6, B-12, iron, folate), GI disorders (e.g. celiac, IBD), food allergies, and chemical exposures like sodium lauryl sulfate (SLS).
° Viral causes: Coxsackievirus (hand-foot-mouth, herpangina), HSV-1 (herpetic ulcers), and other viral agents.
° Contact allergens: Substances such as cinnamaldehyde, Balsam of Peru, toothpaste additives, and nickel may provoke allergic stomatitis with ulceration.
° Systemic diseases: Beh莽et’s disease (oral ulcers plus ≥2 other hallmark signs), immune compromise, gastrointestinal or hematological disorders.
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➤ General Supportive Care
° Encourage hydration and soft, bland diet; avoid spicy, acidic, or salty foods.
° Pain control with acetaminophen or ibuprofen as needed.
➤ Topical & Local Therapies
° Topical corticosteroids: Gels or pastes (e.g., triamcinolone) applied 2–4× daily can reduce severity and duration; in rare cases, local injection may be used.
° Amlexanox paste 5%: Early application at prodrome may mitigate ulcer development and pain.
° Mouth rinses or elixirs with anesthetics or coatings (e.g., lidocaine, diphenhydramine, antacid-containing rinses) for symptomatic relief, especially in viral ulcers.
➤ Adjunct & Preventive Measures
° Nutritional supplements (vitamin B12, zinc, iron) may reduce recurrence in deficiency states.
° Avoid SLS-containing oral hygiene products.
° Stress reduction may be beneficial, although evidence is limited.
➤ Specialist Referral
° Refer to pediatrician or oral medicine specialist if ulcers persist >2 weeks, systemic symptoms develop, dehydration/poor intake, failure to thrive, or suspicion of systemic disease
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Effective management of pediatric oral ulcers relies on discerning their etiology and tailoring therapy accordingly. While most cases are benign and self-limiting, attention to hydration, pain relief, proper oral hygiene, and trigger avoidance significantly improves outcomes. Identification and correction of underlying causes—such as nutritional deficiencies or systemic conditions—can reduce recurrence and morbidity. Vigilance is essential for atypical, persistent, or severe presentations that may signal systemic or malignant processes.
馃挕 Conclusions
Pediatric oral ulcers are common and usually benign, yet they can significantly impact comfort and nutrition. A systematic approach—clinical diagnosis, symptomatic support, targeted topical therapy, and addressing underlying factors—generally leads to resolution. Referral and further evaluation are warranted when lesions persist, recur frequently, or occur in the context of systemic signs.
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✔ Johnston, L. (2022). Fifteen-minute consultation: oral ulceration in children. BMJ Paediatrics Open. ep.bmj.com
✔ L茅geret, C. (2021). Oral ulcers in children: A clinical narrative overview. PMC.
✔ Children’s Colorado. (n.d.). Mouth ulcers in children.
✔ EMedicine. (2024, March 1). Pediatric aphthous ulcers treatment & management.
✔ Mortazavi, H., et al. (2016). Diagnostic features of common oral ulcerative lesions.
✔ JCDA. (2014, January 21). How to manage a pediatric patient with oral ulcers. Journal of the Canadian Dental Association.
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