dental pediatric disease/infection dentistry
Mouth Ulcers in Children Temitope T. Omolehinwa, B.D.S., DScD; Eric T. Stoopler, D.M.D., FDSRCS, FDSRCPS
ABSTRACT In this article, we discuss mouth ulcers, which are common in the pediatric population, though rendering a specific diagnosis may present a challenge. Evaluation of patients with mouth ulcers includes obtaining a thorough medical history and conducting an appropriate physical examination. Establishing a differential diagnosis will aid in determining if additional diagnostic studies are warranted, as well as initiation of appropriate management strategies. This article reviews the pertinent clinical aspects of mouth ulcers in children in order to provide optimal patient care. A mouth ulcer can be defined as any open sore caused by a breach in the epithelial lining of the oral mucous membrane(s);[1] it may, occasionally, involve tissues around the mouth. In children, this can be concerning due to possible decreased nutritional intake[2] associated with discomfort and pain related to the ulcers. Mouth ulcers may be of infectious or non-infectious origins. Recurrent aphthous ulcers and traumatic ulcers are examples of two commonly reported non-infectious conditions that cause oral ulcers in children, with a prevalence of 0.9% to 10.8% and
0.09% to 22.15%, respectively.[3] Herpes simplex virus (HSV) infection, also commonly reported in children and caused by a DNA virus, has a prevalence of 4.52% to 9.28%.[4] Most mouth ulcers have similar clinical appearances, making diagnosis challenging for the untrained eye.[5] A systematic approach, which includes a thorough medical history, review of systems, careful and detailed physical examination and, possibly, biopsy, as discussed in detail below, are important in arriving at an accurate diagnosis. Evaluation of Mouth Ulcer(s) in Pediatric Population Medical History The role of a detailed history, including history of present illness, cannot be overemphasized in establishing the etiology of mouth ulcers. One of the factors to consider is age of onset of these ulcers. For example, primary herpetic gingivostomatitis is common between the ages of 6 months to 5 years, while recurrent herpetic lesions are found in children older than age 5. On the other hand, recurrent aphthous ulcers have an onset of between 10 to 19 years of age.[5,6] Other important specific questions to ask patients/caregivers are listed below (adapted from Stoopler ET 2014).[7,8] • Is this the first time you are having ulcers, or have you had ulcers like these before? • How long has/have the ulcer(s) been present in your mouth? • Did the ulcers appear suddenly, or did you notice them over time?
The New York State Dental Journal NOVEMBER 2020 13 ●
