Mouth Ulcers

Symptoms

DEFINITION

• Painful, shallow ulcers (sores) on the lining of the mouth
• The gums, the inner sides of the lips or cheeks are the usual sites.
• Sores on the outer lips (e.g., recurrent fever blisters) are excluded

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Causes

• Canker Sores: The main cause of 1 or 2 ulcers after age 5
• Hand-foot-mouth disease: The most common cause of multiple ulcers in the mouth, mainly on the tongue and sides of the mouth. It is common between ages 1 to 5 years.
• Herpes Virus (Cold sore virus): The first infection can be severe and cause 10 or more ulcers on the gums, tongue and lips. Also, fever and difficulty swallowing. Usually occurs age 1 to 3.

Return to School

• Canker sores are not contagious.  Children with fever or many mouth ulcers need to be examined before returning to day care or school.

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See More Appropriate Topic (instead of this one) If

• Have thick-walled, small-blisters on the palms or soles, in addition to mouth ulcers, see HAND-FOOT-MOUTH DISEASE

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

• Not moving or too weak to stand

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Chemical in the mouth could have caused ulcers
• Signs of dehydration (very dry mouth, no tears and no urine in more than 8 hours)

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think your child needs to be seen
• 4 or more ulcers
• Bloody crusts on lips
• Red, swollen gums
• One ulcer on the gum near a tooth with a toothache
• Fever or swollen face
• Large lymph node under the jaw
• Began after starting a medicine

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Mouth ulcers last over 2 weeks

Parent Care at Home If

• Probable canker sores and you don't think your child needs to be seen

Care at Home

HOME CARE ADVICE FOR CANKER SORES (HARMLESS MOUTH ULCERS)

1. Canker sores are the #1 cause of mouth ulcers:
   • 1 to 3 painful, white ulcers of the inner cheeks, inner lip or gums (no fever).
   • Causes include injuries from rough food, tooth brushes, biting, food irritants, etc.
2. Liquid Antacid for Pain Relief:  
   • Use a liquid antacid 4 times per day for pain relief. (Avoid regular mouth washes, because they sting). 
   • Children over age 4 can use 1 teaspoon as a mouth wash after meals
   • For younger children, put ½ teaspoon in the front of the mouth after meals.
3. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for severe pain (especially at bedtime).
4. Fluids :  
   • Offer a soft diet.  
   • Encourage favorite fluids to prevent dehydration. Cold drinks, milkshakes, and popsicles are especially good.  
   • Avoid salty foods, citrus fruits and foods that need much chewing.  
   • For infants, give fluids by cup, spoon or syringe rather than a bottle (Reason: The nipple can cause pain).
5. Contagiousness: Canker sores are not contagious. Children with fever or many mouth ulcers need to be examined before returning to day care or school.
6. Expected Course: They heal up in 1 to 2 weeks on their own. Once they occur, no treatment can shorten the course, but treatment can reduce the amount of pain.
7. Call Your Doctor If:
   • Mouth ulcers last over 2 weeks
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Photo Example

Canker Sore on Inner Lower Lip

Source: Wikimedia Commons, Permission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License.

This is a public domain image file from Wikimedia Commons. Wikimedia is a freely licensed media repository.

Chickenpox Sores in Mouth

Patients with Chickenpox commonly have small sores in the mouth. The sores can last up to one week.