Deterrence/Prevention

See the list below:

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.

Complications

See the list below:

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.

Prognosis

See the list below:

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

See the list below:

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.

Questions

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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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Author

Michael C Plewa, MD Research Director, Department of Emergency Medicine, Mercy Emergency Care Services, Inc, and Mercy Health Saint Vincent Medical Center

Michael C Plewa, MD is a member of the following medical societies: American College of Emergency Physicians, American Academy of Emergency Medicine, 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.

Sections Pediatric Aphthous Ulcers
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

Pediatric Aphthous Ulcers Follow-up

Deterrence/Prevention

Complications

Prognosis

Patient Education

References

Tables

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