Oral Sores in Children

Causes:

Oral sores, also known as ‘ulcers’, are often seen in children. Particularly common is the aphthous ulcer, which is also known as the ‘canker sore’. The aphthous ulcer occurs in 39 percent of children. It is not known what causes aphthous ulcers. They can be extremely painful and usually take two weeks to heal.

There are many other types of mouth ulcers. They are caused by viral infection, poor nutrition, a poorly functioning immune system, (which is needed to fight infection), trauma, and also, rarely, cancer. All ulcers look similar which makes them generally difficult to diagnose. If an ulcer fails to heal on its own in two weeks then your dentist or an oral surgeon should do a biopsy and lab testing.

General information on treatment:

Treatment begins with topical creams or oral rinses. If these attempts at a cure do not succeed then further workup may be necessary. For all mouth sores, expect healing within two weeks. If the sore persists, then it is necessary to check for other causes as mentioned above. Note that oral cancer in children is rare, and well over 90 percent of mouth sores are non-cancerous.

Herpes ulcer

Some common ulcers:

Herpes ulcers

Are found in the front or back of the mouth. They can occur on the tonsils, result in a sore throat and also be accompanied by fever and weakness. They can also cause bleeding gums. You might see herpes in your child from two years or even younger and on through the teen years.

Treating herpes ulcers:

Your child should drink plenty of fluids. Herpes is of viral origin and antibiotics will not provide a cure. Use of anti-inflammatory oral rinses may help heal the sore. One popular rinse is chlorhexidine, brand name Peridex (which is given by prescription and is not for young children).

To reduce pain use a topical benzocaine ointment. Benzocaine is an anesthetic that reduces discomfort. A popular brand that provides temporary relief is Orabase Baby Gel, (see also under aphthous ulcer).

Anti-viral medications such as acyclovir, should only be considered in severe cases and when the patient has signs of dehydration. Medications containing steroids are not recommended. It is important to note that many of the treatments mentioned here are not approved for young children. Let your dentist provide guidance on this.

Pyogenic granuloma

Pyogenic granuloma:

It is not an ulcer but may be confused with one. Pyogenic granuloma is a rapidly growing, deep red, mushroom shaped, swelling of the gums. The color is due to the great number of blood vessels present underneath the swelling. It is not cancer. The cause of these growths may be from trauma (a bump to the face, a cut in the gum), hormonal changes, or possibly bacterial infection. Some drugs have been known to contribute to pyogenic granuloma including anti-viral drugs, cancer fighting therapies and immunosuppressive drugs.

Treating pyogenic granuloma:

Treatment begins with a deep cleaning using local anesthesia (a shot). Sometimes cauterization (burning) such as with laser is applied to eliminate the swelling. This also is done after a shot and is not painful

Aphthous ulcer

Aphthous ulcers:

This common ulcer, (known as a canker sore), usually occurs in late pre-teen through the teen years. The origin of these ulcers is unknown. It is thought that perhaps genetic, infective, allergic, or nutritional factors play a role. It is also suspected that stress might be another factor. When aphthous ulcers appear later in life the dentist may consider systemic disease as a cause. This includes immunological disease or blood conditions including cancer.

One more note: check out the images above and see the similarity between the herpes sore and the aphthous ulcer. Often very different ulcers will look very much alike.

Treating aphthous ulcers:

There are no cures, however, topical ointments containing the anesthetic benzocaine can provide temporary relief. Examples include Zilactin-B, Orabase, Orabase with Kenalog (an anti-inflammatory), Orajel or Anbesol. Apply these products sparingly since irritation may result. Oral rinses include chlorhexidine (Peridex, which has anti-inflammatory properties) and the antibiotic rinses by prescription such as minocycline or tetracycline (studies suggest minocycline may be a bit more effective and like all antibiotic rinses is not used under eight years of age). One final note. Peridex may not be recommended in early teen years - consult your dentist.

Traumatic ulcer:

Most commonly these appear due to a burn such as a hot piece of pizza. A simple paste (Orabase baby gel) is enough to keep a child comfortable until healing occurs. The human mouth has efficient healing abilities and most traumatic ulcers heal quickly.

A swelling is not an ulcer:

Do not confuse swelling with ulcer. Swelling is a visible enlargement of the face. Any swelling is a cause for concern and you should contact your dentist immediately. Some swellings, particularly near the nose or below the jaw, are particularly threatening and may result in hospitalization.

An early upper swelling around the patient’s right eye is distinctly different then the ulcers pictured above.