Table 3

Summary of some causes of ulceration in children and their associated factors3 4 5 9

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  • Often single ulcer in location of irritation

  • May be caused by removable appliance, sharp tooth with identified cause of irritation

  • Self-inflicted ulceration (Pica) can be associated with children with learning disabilities

Removing the cause should resolve the ulcer
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  • Often multiple painful ulcers

  • Systemic symptoms such as fever, malaise

  • May be associated with nursery/school outbreak

  • Includes: HSV-1, Coxackie virus

Ulcers are usually self-limiting
Bacterial Infection
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  • Pain and halitosis

  • Can coincide with poor oral hygiene and swelling/inflammation of gingiva

  • May have bleeding from the gums

  • Children with underlying immunosuppression are more likely to present with infections

May require antibiotics, support from dentist with oral health
Recurrent aphthous stomatitis
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  • Multiple recurring ulcers

  • May be family history of recurrent ulceration

  • Appearance of ulcers often follow a pattern

  • Triggers include hormonal changes, stress, anaemia/haematinic deficiencies and oral sensitivities

  • Present in major, minor and herpetiform types

Any underlying deficiencies should be corrected
Inflammatory conditions
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  • Associated cobbling of mucosa/lip swelling

  • Include orofacial granulomatosis and inflammatory bowel disease

  • Associated GI symptoms

  • Triggered by allergic reaction, that is, benzoates and cinnamon

Referral to appropriate specialty for further investigation of underlying cause