ORAL MEDICINE : How to manage a pediatric patient with oral ulcers

Oral ulcers are a common clinical problem in the pediatric population. 

Generally, an ulcer is defined as a well-circumscribed lesion with an epithelial defect covered by a fibrin clot (a pseudomembrane), giving the ulcer a yellow-white appearance. 

Oral-Ulcers

Presentation 

Population 
  • Any segment of the pediatric population, from infancy through adolescence 
  • Children of parents with recurrent oral ulcers due to genetic predisposition (i.e., recurrent aphthous stomatitis) 
  • Young children in group settings (e.g., daycare, shared play areas) developing oral ulcers secondary to an infectious (i.e., bacterial and/or viral) etiology due to the increased risk of oral fluid transfer in those settings 
Signs  
  • Well-circumscribed lesions, often depressed, with an epithelial defect covered by a yellow-white pseudomembrane 
  • Single or multiple ulcers; may present in clusters (herpetiform) 
  • Intraoral/perioral location: nonkeratinized and/or keratinized oral mucosa, oropharynx, lips, perioral skin 
  • Variable size (most commonly measured in millimetres, but may be larger)
  • General location: oral/perioral lesion(s) only or with involvement of other affected surfaces (i.e., skin, genitals, other mucous membranes) 

Symptoms 
  • Pain severity: Can range from asymptomatic to severe discomfort 
  • Burning 
  • Irritation 
  • Pruritis (itching sensation) 
  • Systemic symptoms, such as fever, malaise, lymphadenopathy, difficulty swallowing and general irritability 



jcda.ca 
Canadian Dental Association 
Eric T. Stoopler, DMD, FDS RCSEd / Ghada Al Zamel, DDS