Pediatric Aphthous Ulcers Follow-up

  • Author: Michael C Plewa, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 5, 2010
 

Deterrence/Prevention

  • Dietary supplementation with vitamins, zinc,[63] or iron may prevent recurrence of aphthous ulcers (canker sores) in some individuals. Studies of lysine supplementation are preliminary and equivocal.[56]
  • Vitamin B12 supplementation may prevent ulcer recurrence even when B12 values are normal.[53, 54, 55]
  • A gluten-free diet is unlikely to improve recurrent aphthous ulcers (RAUs), or canker sores,[64] unless the patient has celiac disease (gluten-sensitive enteropathy), which may be present in as many as 5% of patients in whom recurrent aphthous ulcers (canker sores) are initially diagnosed.
  • Susceptible patients may benefit from avoiding toothpaste or mouthwash products containing sodium lauryl sulfate (SLS).[15, 16]
  • Use of a low-intensity ultrasound toothbrush may decrease recurrent aphthous ulcers (canker sores) activity.[65]
  • Use of mouthwash or toothpaste with triclosan[66] or amyloglucosidase and glucose oxidase (Zendium) may decrease recurrent aphthous ulcers (canker sores).[67]
  • Stress reduction may be useful, although evidence for this intervention is lacking.
  • Although numerous reasons abound for convincing a pediatric patient to quit smoking or chewing tobacco, cessation does not have a beneficial effect on recurrent aphthous ulcers (canker sores), which nicotine appears to prevent.
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Complications

  • Secondary bacterial infection is rare.
  • Patients with major recurrent aphthous ulcers (canker sores) can have clinically significant oral scarring.
  • Painful lesions can cause interruption in eating and drinking, leading to dehydration and perhaps nutritional deficiencies.
  • Patients with acquired immunodeficiency syndrome (AIDS) may have ulcerations that are resistant to topical steroid therapy. However, systemic steroids must be administered only with caution because of the possibility of adverse effects, especially the development of opportunistic infections.
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Prognosis

  • Herpetiform and minor recurrent aphthous ulcers (canker sores) have a self-limited course and tend to have few or no sequelae.
  • Major recurrent aphthous ulcers (canker sores) can cause scarring, dehydration, and malnutrition; however, if recognized early and treated effectively, major recurrent aphthous ulcers (canker sores) can be well controlled, with minimal sequelae.
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Patient Education

  • General therapeutic measures for active ulcers include good oral hygiene, nonirritating gargles, and increased fluid intake.
  • Cool bland beverages, such as milkshakes, are well tolerated. Patients should be advised to avoid salty or spicy foods.
  • Although efficacy for recurrent aphthous ulcers (canker sores) is unproven, stress control may benefit some patients.
  • For excellent patient education resources, visit eMedicine's Teeth and Mouth Center. Also, see eMedicine's patient education article Canker Sores.
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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, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Halim Hennes, MD  MS, Pediatric Emergency Medicine Research Director, Professor, Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin

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

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

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

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

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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.
 
 
 
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