Canker sores, also known as mouth ulcers or aphthous ulcers, are small, noncontagious lesions on the oral mucosal layer. Most canker sores cure on their own, within a week or two (1). However, it can be painful and interfere with eating and drinking.
Although mouth ulcers may develop at any age, they are frequent among teens and children (2). Read this article to learn more about the causes, symptoms, diagnosis, treatment, and prevention of canker sores, and how to differentiate them from cold sores.
Causes Of Canker Sores In Children
The exact cause is not clear in most cases. Hereditary and environmental factors, such as certain food or allergens, can cause recurrent canker sores.
- Dietary deficiency of iron, folate (folic acid or vitamin B9), cobalamin (vitamin B12), or zinc
- Accidental cheek bite
- Mucosal damage from incorrect brushing of teeth
- Injuries due to orthodontic braces
- Food allergies or sensitivities, commonly to coffee, nuts, eggs, chocolates, and fruits, such as citrus fruits and strawberries
- Sensitivity to compounds, such as sodium lauryl sulfate and alcohol found in oral hygiene products
- Hormonal changes in puberty
- Emotional stress
- Constipation can be a possible reason.
The following diseases and conditions can also be the reason for canker sores (5).
- Autoimmune conditions, such as celiac disease, inflammatory bowel diseases (ulcerative colitis and Crohn’s disease), and Behcet’s disease
- Infection from certain pathogens, such as the Helicobacter pylori bacteriaImmunocompromised conditions, such as HIV/AIDS
Note: Canker sores are not seen in herpes virus infection, which may cause cold sores in the mouth and lips.
Signs And Symptoms Of Canker Sores In Children
Pain is the primary symptom of canker sores. The child may have a burning or tingling sensation associated with the sores. Sometimes, burning can be felt before the lesions appear on the oral mucosal layer (3).
Canker sores are round or oval-shaped lesions with yellow or white-colored center surrounded by red borders. They are seen under the tongue, inside the cheek, on the soft palate, or the gums.
Is It A Canker Sore Or A Cold Sore?
Cold sores or fever blisters can occur in clusters of many sores. These may merge to form large ulcers and lack proper borders and shapes. Cold sores are often seen on the lips, unlike canker sores, which mostly occur on the oral mucosal layer.
Cold sores due to herpes simplex virus type 1 are common among kids. These sores last for three weeks and heal without scarring. Fever, itching, sore throat, and swollen lymph nodes are often associated with herpetic cold sores (6).
Should Parents Worry About Canker Sores?
Occasional canker sores that heal within a week or two are not significant causes of concern in children.
Seek pediatric consultation in the following situations.
- Mouth sores lasting more than two weeks
- Recurrent or frequent canker sores
- Large canker sores
- Excessive pain
- Sores present on lips
- High fever and a feeling of sickness
- Sores interfere with eating and drinking
If you are unable to differentiate canker sores from cold sores, ask your child to avoid touching sores and teach them hand hygiene techniques since cold sores are contagious. Consult a pediatrician to determine the type of sores.
How Are Canker Sores Diagnosed?
Doctors can identify canker sores by visual inspection (3). If your child has severe and frequent sores, additional examinations are conducted to identify the underlying cause. Healthcare providers will choose the required tests based on other symptoms and individual factors.
If the canker sores are due to injuries caused by misaligned teeth or dental appliances, then the pediatrician may refer the child to a dentist.
Treatment For Canker Sores In Children
Minor canker sores are cured within a week or two without any treatment. Large sores may require medical care, which can include the following (7).
- Pain-relieving over-the-counter topical products such as creams, gels, mouthwash, or pastes could help minor sores. Topical products with active ingredients, such as benzocaine, fluocinonide, or hydrogen peroxide, may enhance healing.
- Mouth rinses containing corticosteroids are prescribed by a doctor to reduce pain and inflammation if multiple or more extensive sores are present.
- Vitamin and mineral supplementations are often prescribed if dietary deficiencies are the cause for canker sores.
- Oral medications such as Carafate (sucralfate) or colchicine are used to treat severe canker sores.
- Oral steroid medications are often given to control severe inflammation.
- Chemical or instrumental cautery is required for severe cases of canker sores.
Seek a pediatrician’s help to choose the best method to cure canker sores in your child. Treatment may vary if any underlying disease or condition is detected. The sores may heal by themselves during the treatment of the underlying condition.
Home Remedies For Canker Sores
The following home care measures and lifestyle changes may help heal canker sores in children.
- Apply ice to reduce pain and swelling
- Avoid acidic, hot, and spicy food that may increase pain
- Rinse mouth with saltwater or baking soda rinse
- Use a soft toothbrush with sodium lauryl free toothpaste
- Eat soft and non-abrasive foods to avoid pain
Prevention Of Canker Sore In Children
The following tips may help reduce the risk of canker sore in children (8).
- Follow a balanced diet that included mixed nutrients
- Follow healthy oral hygiene habits
- Seek dental care for misaligned teeth and follow dentist recommendations while using dental appliances
- Avoid foods that cause allergies
You may also give your kid vitamin and mineral supplements if it is recommended by the pediatrician.
Canker sores are usually not a significant cause of concern since they mostly heal within a couple of weeks. Sores that last for more than two weeks will require medical inspection. Relevant treatment and appropriate preventive steps can help avoid canker sores recurrence. If it occurs frequently without any significant health problems, then one should think of lifestyle modification i.e., healthy diet, good hydration and destressing. Do not hesitate to speak to your pediatrician about any doubts and ways your child can avoid canker sores.
2. Canker Sores (Aphthous Ulcers) in Children; Cedars-Sinai Medical Center
3. Canker sores (mouth ulcers): Overview; The United States National Library of Medicine
4. Zinc; University of Rochester
5. Mohamed Nasser Elsheikh and Magdy ElSayed Mahfouz, Prevalence of Helicobacter pylori DNA in Recurrent Aphthous Ulcerations in Mucosa-Associated Lymphoid Tissues of the Pharynx; JAMA Otolaryngology-Head & Neck Surgery
6. Herpes – oral; MedlinePlus; The United States National Library of Medicine
7. Canker sores (mouth ulcers): What can you do if you have a canker sore?; The United States National Library of Medicine
8. Mouth ulcers; Betterhealth; The Victoria State Government
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