Mouth Ulcers (Canker Sores)

MOUTH ULCERS


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DEFINITION

  • Painful, shallow ulcers (sores) on the lining of the mouth
  • The gums, the inner sides of the lips or cheeks are the usual sites.
  • Sores on the outer lips (e.g., recurrent fever blisters) are excluded

Causes

  • Canker Sores: The main cause of 1 or 2 ulcers after age 5
  • Hand-foot-mouth disease: The most common cause of multiple ulcers in the mouth, mainly on the tongue and sides of the mouth. It is common between ages 1 to 5 years.
  • Herpes Virus (Cold sore virus): The first infection can be severe and cause 10 or more ulcers on the gums, tongue and lips. Also, fever and difficulty swallowing. Usually occurs age 1 to 3.

Return to School

  • Canker sores are not contagious. Children with fever or many mouth ulcers need to be examined before returning to day care or school.

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WHEN TO CALL YOUR DOCTOR

Call 911 now (your child may need an ambulance) if:

  • Not moving or too weak to stand

Call your doctor now (night or day) if:

  • Your child looks or acts very sick.
  • Chemical in the mouth could have caused ulcers.  
  • Signs of dehydration (very dry mouth, no tears and no urine in more than 8 hours).

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think your child needs to be seen.
  • 4 or more ulcers.  
  • Bloody crusts on lips
  • Red, swollen gums.  
  • One ulcer on the gum near a tooth with a toothache.  
  • Fever or swollen face.  
  • Large lymph node under the jaw.  
  • Began after starting a medicine.

Call your doctor during weekday office hours if:

  • You have other questions or concerns.
  • Mouth Ulcers last over 2 weeks.

Parent care at home if:

  • Probable canker sores and you don't think your child needs to be seen.
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HOME CARE ADVICE

  1. Canker sores are the #1 cause of mouth ulcers:
    • 1 to 3 painful, white ulcers of the inner cheeks or gums (no fever).
    • Causes include injuries from rough food, tooth brushes, biting, food irritants, etc.
  2. Liquid Antacid for Pain Relief:
    • Use a liquid antacid 4 times per day for pain relief. (Some parents prefer regular mouth washes, but they may sting). 
    • Children over age 4 can use 1 teaspoon as a mouth wash after meals
    • For younger children, put 1/2 teaspoon in the front of the mouth after meals.
  3. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for severe pain (especially at bedtime).
  4. Fluids:
    5.  
    • Offer a soft diet.
    • Encourage favorite fluids to prevent dehydration. Cold drinks, milkshakes, and popsicles are especially good. 
    • Avoid salty foods, citrus fruits and foods that need much chewing.
    • For infants, give fluids by cup, spoon or syringe rather than a bottle (Reason: The nipple can cause pain).
  5. Contagiousness: Canker sores are not contagious. Children with fever or many mouth ulcers need to be examined before returning to day care or school.
  6. Expected Course: They heal up in 1 to 2 weeks. Once they occur, no treatment can shorten the course, but treatment can reduce the amount of pain.
  7. Call Your Doctor If:
    • Mouth ulcers last over 2 weeks
    • Your child becomes worse

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. American Academy of Pediatrics: Committee on Infectious Diseases. Herpes simplex. In Pickering L, ed. 2006 Red Book. 27th ed. Elk Grove Village, IL: 2006.
  2. Annunziato PW and Gershon A. Herpes simplex virus infections. Pediatr Rev. 1996;17:415-423.
  3. Armon K, Elliott EJ. Acute gastroenteritis. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health.London, England: BMJ Publishing Group; 2000. p. 273-286.
  4. Dilley DC, et al. Diagnosing and treating common oral pathologies. Pediatr Clin North Am. 1991;38:1227-1264.
  5. Dunlap CL, et al. Ten oral lesions you should know. Contemp Pediatr. 1991 Dec;8:16-28.
  6. Krol D, Keels M. Oral conditions. Pediatr Rev. 2007;28(1):15-22.
  7. Peter JR and Haney HM. Infections of the oral cavity. Pediatr Ann. 1996; 25:572-576.
  8. Rees TD and Binnie WH. Recurrent aphthous stomatitis. Dermatol Clin. 1996;14:243-256.
  9. Slavin KA, Frieden IJ. Hand-foot-mouth disease. Arch Pediatr Adolesc Med. 1998;152: 505-506.
  10. Waggoner-Fountain LA, Grossman LB. Herpes simplex virus. Pediatr Rev. 2004; 25(3):86-93.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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