Aphthous Ulcer in Children: Diagnosis And Management

Aphthous ulcers, also known as canker sores, are small, painful ulcers that occur on the oral mucosa, most commonly on the inner lips, cheeks, and tongue.

• Genign and self-limiting, affecting up to 25% of the general population, including children.
• Exact cause of aphthous ulcers is unclear, but they may be related to factors such as genetics, stress, trauma(toothbrushing), food hypersensitivities( chocolate coffee, peanuts, cereals,almonds,cow milk), drugs (NSAIDs, Phenobarbitol) ,nutritional deficiency (Vitamin B1, B2, or B6) and immune system dysfunction.

History and examination

History: family history, frequency of ulceration, duration of ulceration,associated medical conditions, genital ulceration, skin problems, gastrointestinal disturbances, drug history,

Symptoms	Signs
Oral pain Burning sensation Difficulty eating or speaking Drooling of saliva	-Well-defined round or oval ulcers with a yellow-gray base and an erythematous halo, usually less than 1 cm in diameter – Examine cervical lymphnode – Note number of ulcers, site of ulcers (non-keratinized or keratinized), size and shape of ulcers,edge of ulcer, base of ulcer, and surrounding tissue – Base of the ulcer can be necrotic, granular purulent, or covered with mucus

Differential diagnosis (D/D) & Complication

D/D:

• Herpetic stomatitis (clustered vesicles that rupture and form ulcers, associated with fever and lymphadenopathy)
• Hand, Foot, and Mouth disease (vesicles or ulcers on hands, feet, and oral mucosa, associated with fever)
• Behçet’s disease (recurrent oral and genital ulcers, ocular inflammation, skin lesions)

Complications: Secondary bacterial infection, difficulty eating or drinking, dehydration

Investigation

• Diagnosed based on clinical history and examination; no specific tests are required
• In case of recurrent apthous ulcer send Hemoglobin and full blood count, erythrocyte sedimentation rate/C-reactive protein, serum B12.

Management

Advices

• Encourage children to maintain good oral hygiene.
• Avoid hot, salty and spicy foods

Referral

• Refer to a pediatric dentist or pediatrician if there are concerns about underlying medical conditions or recurrent, severe ulcers

Follow up

• Follow up within 1-2 weeks to monitor healing and response to treatment

References:

1. Belenguer-Guallar, I., Jiménez-Soriano, Y., & Claramunt-Lozano, A. (2014). Treatment of recurrent aphthous stomatitis: A literature review. Journal of Clinical and Experimental Dentistry, 6(2), e168-e174.
2. Šurlan Popovič, K., & Avcin, T. (2018). Recurrent aphthous stomatitis in children and adolescents. Acta Dermatovenerologica Alpina Pannonica et Adriatica, 27(4), 221-224