Laboratory Studies

See the list below:

The diagnosis of aphthous ulcers (canker sores) is usually based on the history and clinical presentation. No laboratory procedures are available for definitive diagnosis.
- In patients with severe recurrent aphthous ulcers (RAUs), or canker sores, the clinical picture should guide laboratory testing. CBC count, a chemistry panel, and nutritional workup may be necessary.
- Patients with suspected malabsorption or a nutritional deficiency should undergo immediate screening. Consider screening in patients presenting with a history of recurrent aphthous ulcers (canker sores) lasting 6 months or longer.
CBC counts may be within the reference range in patients with recurrent aphthous ulcers (canker sores), although some have found anemia in 21%.^[3]Findings of neutropenia suggest Sweet syndrome or cyclic neutropenia; findings of leukocytosis suggest periodic fever, aphthous pharyngitis, and adenopathy (PFAPA) syndrome.
Serum iron levels may be low in 20% of those with recurrent aphthous ulcers (canker sores).^[3]
If a patient is dehydrated and catabolic, urinalysis may reveal an elevated specific gravity and ketone levels. In small children, serum chemistry testing may be performed to exclude hypoglycemia and metabolic acidosis (low serum bicarbonate levels and elevated anion gap [see the Anion Gap calculator]).

Imaging Studies

See the list below:

No imaging studies are indicated.

Other Tests

See the list below:

Histopathologic examination of biopsy specimens does not reveal unique findings and is rarely indicated, except to exclude other diagnoses, such as pemphigus, cicatricial pemphigoid, carcinoma, and Behçet disease.
Persistent ulceration in a patient with human immunodeficiency virus (HIV) should be biopsied to exclude carcinoma.^[31]

Treatment & Management

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Media Gallery

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
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