Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Aphthous Ulcers Differential Diagnoses

  • Author: Michael C Plewa, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Oct 12, 2015
 
 
 
Contributor Information and Disclosures
Author

Michael C Plewa, MD Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Mercy Saint Vincent Medical Center

Michael C Plewa, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Physicians for Social Responsibility, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Halim Hennes, MD, MS Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Brett J Earl, MD, and Joseph Dobson to the writing and development of this article.

References
  1. Bachtiar EW, Cornain S, Siregar B, Raharjo TW. Decreased CD4+/CD8+ ratio in major type of recurrent aphthous ulcers: comparing major to minor types of ulcers. Asian Pac J Allergy Immunol. 1998 Jun-Sep. 16(2-3):75-9. [Medline].

  2. Buno IJ, Huff JC, Weston WL, et al. Elevated levels of interferon gamma, tumor necrosis factor alpha, interleukins 2, 4, and 5, but not interleukin 10, are present in recurrent aphthous stomatitis. Arch Dermatol. 1998 Jul. 134(7):827-31. [Medline].

  3. Healy CM, Thornhill MH. Induction of adhesion molecule expression on blood vessels and keratinocytes in recurrent oral ulceration. J Oral Pathol Med. 1999 Jan. 28(1):5-11. [Medline].

  4. Birek C, Grandhi R, McNeill K, et al. Detection of Helicobacter pylori in oral aphthous ulcers. J Oral Pathol Med. 1999 May. 28(5):197-203. [Medline].

  5. Maleki Z, Sayyari AA, Alavi K, Sayyari L, Baharvand M. A study of the relationship between Helicobacter pylori and recurrent aphthous stomatitis using a urea breath test. J Contemp Dent Pract. 2009 Jan 1. 10(1):9-16. [Medline].

  6. Gallo Cde B, Mimura MA, Sugaya NN. Psychological stress and recurrent aphthous stomatitis. Clinics (Sao Paulo). 2009. 64(7):645-8. [Medline]. [Full Text].

  7. Huling LB, Baccaglini L, Choquette L, Feinn RS, Lalla RV. Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis. J Oral Pathol Med. 2012 Feb. 41(2):149-52. [Medline].

  8. Haisraeli-Shalish M, Livneh A, Katz J, et al. Recurrent aphthous stomatitis and thiamine deficiency. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Dec. 82(6):634-6. [Medline].

  9. Besu I, Jankovic L, Magdu IU, Konic-Ristic A, Raskovic S, Juranic Z. Humoral immunity to cow's milk proteins and gliadin within the etiology of recurrent aphthous ulcers?. Oral Dis. 2009 Nov. 15(8):560-4. [Medline].

  10. Thomas KT, Feder HM Jr, Lawton AR, Edwards KM. Periodic fever syndrome in children. J Pediatr. 1999 Jul. 135(1):15-21. [Medline].

  11. Padeh S, Brezniak N, Zemer D, et al. Periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome: clinical characteristics and outcome. J Pediatr. 1999 Jul. 135(1):98-101. [Medline].

  12. Ghodratnama F, Wray D, Bagg J. Detection of serum antibodies against cytomegalovirus, varicella zoster virus and human herpesvirus 6 in patients with recurrent aphthous stomatitis. J Oral Pathol Med. 1999 Jan. 28(1):12-5. [Medline].

  13. Lin SS, Chou MY, Ho CC, et al. Study of the viral infections and cytokines associated with recurrent aphthous ulceration. Microbes Infect. 2005 Apr. 7(4):635-44. [Medline].

  14. Arikan S, Durusoy C, Akalin N, Haberal A, Seckin D. Oxidant/antioxidant status in recurrent aphthous stomatitis. Oral Dis. 2009 Oct. 15(7):512-5. [Medline].

  15. Gupta SK, Gupta RC, Seth AK, et al. Epidemiological evaluation of recurrent stomatitis, nitrates in drinking water, and cytochrome b5 reductase activity. Am J Gastroenterol. 1999 Jul. 94(7):1808-12. [Medline].

  16. Herlofson BB, Barkvoll P. Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. Acta Odontol Scand. 1994 Oct. 52(5):257-9. [Medline].

  17. Herlofson BB, Barkvoll P. The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. Acta Odontol Scand. 1996 Jun. 54(3):150-3. [Medline].

  18. Hasan AA, Ciancio S. Association between ingestion of nonsteroidal anti-inflammatory drugs and the emergence of aphthous-like ulcers. J Int Acad Periodontol. 2009 Jan. 11(1):155-9. [Medline].

  19. Koridze Kh. Definition of risk of the aphthous stomatitis by hygienic indices [in Russian]. Georgian Med News. 2005 Apr. 25-8. [Medline].

  20. Ficarra G. Oral ulcers in HIV-infected patients: an update on epidemiology and diagnosis. Oral Dis. 1997 May. 3 Suppl 1:S183-9. [Medline].

  21. Liu C, Zhou Z, Liu G, Wang Q, Chen J, Wang L. Efficacy and safety of dexamethasone ointment on recurrent aphthous ulceration. Am J Med. 2012 Mar. 125(3):292-301. [Medline].

  22. Vincent SD, Lilly GE. Clinical, historic, and therapeutic features of aphthous stomatitis. Literature review and open clinical trial employing steroids. Oral Surg Oral Med Oral Pathol. 1992 Jul. 74(1):79-86. [Medline].

  23. Holbrook WP, Kristmundsdottir T, Loftsson T. Aqueous hydrocortisone mouthwash solution: clinical evaluation. Acta Odontol Scand. 1998 Jun. 56(3):157-60. [Medline].

  24. Pakfetrat A, Mansourian A, Momen-Heravi F, Delavarian Z, Momen-Beitollahi J, Khalilzadeh O, et al. Comparison of colchicine versus prednisolone in recurrent aphthous stomatitis: A double-blind randomized clinical trial. Clin Invest Med. 2010 Jun 1. 33(3):E189-95. [Medline].

  25. Bell J. Amlexanox for the treatment of recurrent aphthous ulcers. Clin Drug Investig. 2005. 25(9):555-66. [Medline].

  26. Binnie WH, Curro FA, Khandwala A, Van Inwegan RG. Amlexanox oral paste: a novel treatment that accelerates the healing of aphthous ulcers. Compend Contin Educ Dent. 1997 Nov. 18(11):1116-8, 1120-2, 1124 passim. [Medline].

  27. Greer RO Jr, Lindenmuth JE, Juarez T, Khandwala A. A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers. J Oral Maxillofac Surg. 1993 Mar. 51(3):243-8; discussion 248-9. [Medline].

  28. Khandwala A, Van Inwegen RG, Alfano MC. 5% amlexanox oral paste, a new treatment for recurrent minor aphthous ulcers: I. Clinical demonstration of acceleration of healing and resolution of pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Feb. 83(2):222-30. [Medline].

  29. Murray B, McGuinness N, Biagioni P, et al. A comparative study of the efficacy of Aphtheal in the management of recurrent minor aphthous ulceration. J Oral Pathol Med. 2005 Aug. 34(7):413-9. [Medline].

  30. Gorsky M, Epstein J, Raviv A, Yaniv R, Truelove E. Topical minocycline for managing symptoms of recurrent aphthous stomatitis. Spec Care Dentist. 2008 Jan-Feb. 28(1):27-31. [Medline].

  31. Skulason S, Holbrook WP, Kristmundsdottir T. Clinical assessment of the effect of a matrix metalloproteinase inhibitor on aphthous ulcers. Acta Odontol Scand. 2009 Feb. 67(1):25-9. [Medline].

  32. Gorsky M, Epstein J, Rabenstein S, Elishoov H, Yarom N. Topical minocycline and tetracycline rinses in treatment of recurrent aphthous stomatitis: a randomized cross-over study. Dermatol Online J. 2007. 13(2):1. [Medline].

  33. Rattan J, Schneider M, Arber N, et al. Sucralfate suspension as a treatment of recurrent aphthous stomatitis. J Intern Med. 1994 Sep. 236(3):341-3. [Medline].

  34. Jasmin JR, Muller-Giamarchi M, Jonesco-Benaiche N. Local treatment of minor aphthous ulceration in children. ASDC J Dent Child. 1993 Jan-Feb. 60(1):26-8. [Medline].

  35. Kutcher M. Evaluating the efficacy of 2-octyl cyanoacrylate bioadhesive for treatment of oral ulcerations. Compend Contin Educ Dent Suppl. 2001. 12-6; quiz 22. [Medline].

  36. Kutcher MJ, Ludlow JB, Samuelson AD, Campbell T, Pusek SN. Evaluation of a bioadhesive device for the management of aphthous ulcers. J Am Dent Assoc. 2001 Mar. 132(3):368-76. [Medline].

  37. Shemer A, Amichai B, Trau H, Nathansohn N, Mizrahi B, Domb AJ. Efficacy of a mucoadhesive patch compared with an oral solution for treatment of aphthous stomatitis. Drugs R D. 2008. 9(1):29-35. [Medline].

  38. Mizrahi B, Golenser J, Wolnerman JS, Domb AJ. Adhesive tablet effective for treating canker sores in humans. J Pharm Sci. 2004 Dec. 93(12):2927-35. [Medline].

  39. Rhodus NL, Bereuter J. An evaluation of a chemical cautery agent and an anti-inflammatory ointment for the treatment of recurrent aphthous stomatitis: a pilot study. Quintessence Int. 1998 Dec. 29(12):769-73. [Medline].

  40. Porter SR, Al-Johani K, Fedele S, Moles DR. Randomised controlled trial of the efficacy of HybenX in the symptomatic treatment of recurrent aphthous stomatitis. Oral Dis. 2009 Mar. 15(2):155-61. [Medline].

  41. Moghadamnia AA, Motallebnejad M, Khanian M. The efficacy of the bioadhesive patches containing licorice extract in the management of recurrent aphthous stomatitis. Phytother Res. 2009 Feb. 23(2):246-50. [Medline].

  42. Burgess JA, van der Ven PF, Martin M, Sherman J, Haley J. Review of over-the-counter treatments for aphthous ulceration and results from use of a dissolving oral patch containing glycyrrhiza complex herbal extract. J Contemp Dent Pract. 2008 Mar 1. 9(3):88-98. [Medline].

  43. Martin MD, Sherman J, van der Ven P, Burgess J. A controlled trial of a dissolving oral patch concerning glycyrrhiza (licorice) herbal extract for the treatment of aphthous ulcers. Gen Dent. 2008 Mar-Apr. 56(2):206-10; quiz 211-2, 224. [Medline].

  44. Buchsel PC. Polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair): a bioadherent oral gel for the treatment of oral mucositis and other painful oral lesions. Expert Opin Drug Metab Toxicol. 2008 Nov. 4(11):1449-54. [Medline].

  45. Katz J, Langevitz P, Shemer J, et al. Prevention of recurrent aphthous stomatitis with colchicine: an open trial. J Am Acad Dermatol. 1994 Sep. 31(3 Pt 1):459-61. [Medline].

  46. Mimura MA, Hirota SK, Sugaya NN, Sanches Jr JA, Migliari DA. Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial. Clinics (Sao Paulo). 2009. 64(3):193-8. [Medline]. [Full Text].

  47. de Abreu MA, Hirata CH, Pimentel DR, Weckx LL. Treatment of recurrent aphthous stomatitis with clofazimine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Nov. 108(5):714-21. [Medline].

  48. Revuz J, Guillaume JC, Janier M, et al. Crossover study of thalidomide vs placebo in severe recurrent aphthous stomatitis. Arch Dermatol. 1990 Jul. 126(7):923-7. [Medline].

  49. Jacobson JM, Greenspan JS, Spritzler J, et al. Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. N Engl J Med. 1997 May 22. 336(21):1487-93. [Medline].

  50. Wu JJ, Huang DB, Pang KR, et al. Thalidomide: dermatological indications, mechanisms of action and side-effects. Br J Dermatol. 2005 Aug. 153(2):254-73. [Medline].

  51. Altenburg A, Zouboulis CC. Current concepts in the treatment of recurrent aphthous stomatitis. Skin Therapy Lett. 2008 Sep. 13(7):1-4. [Medline].

  52. O'Neill ID. Off-label use of biologicals in the management of inflammatory oral mucosal disease. J Oral Pathol Med. 2008 Nov. 37(10):575-81. [Medline].

  53. El-Haddad SA, Asiri FY, Al-Qahtani HH, Al-Ghmlas AS. Efficacy of honey in comparison to topical corticosteroid for treatment of recurrent minor aphthous ulceration: a randomized, blind, controlled, parallel, double-center clinical trial. Quintessence Int. 2014 Sep. 45(8):691-701. [Medline].

  54. Tezel A, Kara C, Balkaya V, Orbak R. An Evaluation of Different Treatments for Recurrent Aphthous Stomatitis and Patient Perceptions: Nd:YAG Laser versus Medication. Photomed Laser Surg. 2009 Feb. 27(1):101-6. [Medline].

  55. Zand N, Ataie-Fashtami L, Djavid GE, Fateh M, Alinaghizadeh MR, Fatemi SM, et al. Relieving pain in minor aphthous stomatitis by a single session of non-thermal carbon dioxide laser irradiation. Lasers Med Sci. 2008 Apr 12. [Medline].

  56. Sharon-Buller A, Sela M. CO2-laser treatment of ulcerative lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Mar. 97(3):332-4. [Medline].

  57. De Souza TO, Martins MA, Bussadori SK, Fernandes KP, Tanji EY, Mesquita-Ferrari RA, et al. Clinical evaluation of low-level laser treatment for recurring aphthous stomatitis. Photomed Laser Surg. 2010 Oct. 28 Suppl 2:S85-8. [Medline].

  58. Alidaee MR, Taheri A, Mansoori P, Ghodsi SZ. Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial. Br J Dermatol. 2005 Sep. 153(3):521-5. [Medline].

  59. Volkov I, Rudoy I, Freud T, et al. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled trial. J Am Board Fam Med. 2009 Jan-Feb. 22(1):9-16. [Medline].

  60. Gulcan E, Toker S, Hatipoglu H, Gulcan A, Toker A. Cyanocobalamin may be beneficial in the treatment of recurrent aphthous ulcers even when vitamin B12 levels are normal. Am J Med Sci. 2008 Nov. 336(5):379-82. [Medline].

  61. Carrozzo M. Vitamin B12 for the treatment of recurrent aphthous stomatitis. Evid Based Dent. 2009. 10(4):114-5. [Medline].

  62. Yasui K, Kurata T, Yashiro M, Tsuge M, Ohtsuki S, Morishima T. The effect of ascorbate on minor recurrent aphthous stomatitis. Acta Paediatr. 2010 Mar. 99(3):442-5. [Medline].

  63. Wright EF. Clinical effectiveness of lysine in treating recurrent aphthous ulcers and herpes labialis. Gen Dent. 1994 Jan-Feb. 42(1):40-2; quiz 51-2. [Medline].

  64. Liu HL, Chiu SC. The Effectiveness of Vitamin B12 for Relieving Pain in Aphthous Ulcers: A Randomized, Double-blind, Placebo-controlled Trial. Pain Manag Nurs. 2015 Jun. 16 (3):182-7. [Medline].

  65. Zhou Y, Chen Q, Meng W, Jiang L, Wang Z, Liu J, et al. Evaluation of penicillin G potassium troches in the treatment of minor recurrent aphthous ulceration in a Chinese cohort: a randomized, double-blinded, placebo and no-treatment-controlled, multicenter clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Apr. 109(4):561-6. [Medline].

  66. Hamdy AA, Ibrahem MA. Management of aphthous ulceration with topical quercetin: a randomized clinical trial. J Contemp Dent Pract. 2010. 11(4):E009-16. [Medline].

  67. Samet N, Laurent C, Susarla SM, Samet-Rubinsteen N. The effect of bee propolis on recurrent aphthous stomatitis: a pilot study. Clin Oral Investig. 2007 Jun. 11(2):143-7. [Medline].

  68. Shrivastava R, John GW. Treatment of Aphthous Stomatitis with topical Alchemilla vulgaris in glycerine. Clin Drug Investig. 2006. 26(10):567-73.

  69. Thornhill MH, Baccaglini L, Theaker E, Pemberton MN. A randomized, double-blind, placebo-controlled trial of pentoxifylline for the treatment of recurrent aphthous stomatitis. Arch Dermatol. 2007 Apr. 143(4):463-70. [Medline].

  70. Yang TY, Jang TY. The value of local botulinum toxin A injection in the treatment of the pain of aphthous ulcer. Eur Arch Otorhinolaryngol. 2009 Mar. 266(3):445-8. [Medline].

  71. Collier PM, Neill SM, Copeman PW. Topical 5-aminosalicylic acid: a treatment for aphthous ulcers. Br J Dermatol. 1992 Feb. 126(2):185-8. [Medline].

  72. Sharquie KE, Najim RA, Al-Hayani RK, Al-Nuaimy AA, Maroof DM. The therapeutic and prophylactic role of oral zinc sulfate in management of recurrent aphthous stomatitis (ras) in comparison with dapsone. Saudi Med J. 2008 May. 29(5):734-8. [Medline].

  73. Hunter IP, Ferguson MM, Scully C, et al. Effects of dietary gluten elimination in patients with recurrent minor aphthous stomatitis and no detectable gluten enteropathy. Oral Surg Oral Med Oral Pathol. 1993 May. 75(5):595-8. [Medline].

  74. Brice SL. Clinical evaluation of the use of low-intensity ultrasound in the treatment of recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Jan. 83(1):14-20. [Medline].

  75. Skaare AB, Herlofson BB, Barkvoll P. Mouthrinses containing triclosan reduce the incidence of recurrent aphthous ulcers (RAU). J Clin Periodontol. 1996 Aug. 23(8):778-81. [Medline].

  76. Fridh G, Koch G. Effect of a mouth rinse containing amyloglucosidase and glucose oxidase on recurrent aphthous ulcers in children and adolescents. Swed Dent J. 1999. 23(2-3):49-57. [Medline].

  77. Field EA, Brookes V, Tyldesley WR. Recurrent aphthous ulceration in children--a review. Int J Paediatr Dent. 1992 Apr. 2(1):1-10. [Medline].

  78. Hodosh M, Hodosh SH, Hodosh AJ. Treatment of aphthous stomatitis with saturated potassium nitrate/dimethyl isosorbide. Quintessence Int. 2004 Feb. 35(2):137-41. [Medline].

  79. Mahdi AB, Coulter WA, Woolfson AD, Lamey PJ. Efficacy of bioadhesive patches in the treatment of recurrent aphthous stomatitis. J Oral Pathol Med. 1996 Sep. 25(8):416-9. [Medline].

  80. Rogers RS. Recurrent aphthous stomatitis: clinical characteristics and associated systemic disorders. Semin Cutan Med Surg. 1997 Dec. 16(4):278-83. [Medline].

  81. Saxen MA, Ambrosius WT, Rehemtula al-KF AL, et al. Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan: a randomized, double-blind clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Oct. 84(4):356-61. [Medline].

  82. Scully C. Clinical practice. Aphthous ulceration. N Engl J Med. 2006 Jul 13. 355(2):165-72. [Medline].

  83. Ueta E, Osaki T, Yoneda K, et al. A clinical trial of Azelastine in recurrent aphthous ulceration, with an analysis of its actions on leukocytes. J Oral Pathol Med. 1994 Mar. 23(3):123-9. [Medline].

  84. Victoria JM, Correia-Silva Jde F, Pimenta FJ, et al. Serotonin transporter gene polymorphism (5-HTTLPR) in patients with recurrent aphthous stomatitis. J Oral Pathol Med. 2005 Sep. 34(8):494-7. [Medline].

  85. Wormser GP, Mack L, Lenox T, et al. Lack of effect of oral acyclovir on prevention of aphthous stomatitis. Otolaryngol Head Neck Surg. 1988 Jan. 98(1):14-7. [Medline].

  86. Ylikontiola L, Sorsa T, Hayrinen-Immonen R, Salo T. Doxymycine-cyanoacrylate treatment of recurrent aphthous ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Mar. 83(3):329-33. [Medline].

Previous
Next
 
Recurrent aphthae in floor of mouth, showing ovoid ulcer with inflammatory halo.
Typical aphthous ulcer in a common site, showing inflammatory halo surrounding a yellowish, round ulcer.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.