Pediatric Aphthous Ulcers Follow-up

Updated: Feb 25, 2019
  • Author: Michael C Plewa, MD; Chief Editor: Russell W Steele, MD  more...
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  • Dietary supplementation with vitamins, zinc, [92] or iron may prevent recurrence of aphthous ulcers (canker sores) in some individuals. Studies of lysine supplementation are preliminary and equivocal. [83]

  • Vitamin B12 supplementation may prevent ulcer recurrence even when B12 values are normal. [79, 80, 81]

  • A gluten-free diet is unlikely to improve recurrent aphthous ulcers (RAUs), or canker sores, [93] 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). [26, 27]

  • Use of a low-intensity ultrasound toothbrush may decrease recurrent aphthous ulcers (canker sores) activity. [94]

  • Regular use of a mouthguard while sleeping may also decrease recurrent aphthous ulcers (canker sores). [85]

  • Use of mouthwash or toothpaste with triclosan [95] or amyloglucosidase and glucose oxidase (Zendium) may decrease recurrent aphthous ulcers (canker sores). [96]

  • 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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  • 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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  • 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.


Patient Education

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  • 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 patient education resources, see the Teeth and Mouth Center, as well as Canker Sores.