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

Causes

• Canker Sores: The main cause of 1 or 2 mouth ulcers after age 5. Not contagious. 
• Hand-foot-mouth disease: The most common cause of multiple ulcers in the mouth, mainly on the tongue and sides of the mouth. Due to the Coxsackie A-16 virus. 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. Key findings are ulcers on the outer lips or skin around the mouth. 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 child care or school.

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

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 (5 ml) as a mouth wash after meals
   • For younger children, put ½ teaspoon (2.5 ml) 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 child 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.

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Source: CDC PHIL

From the CDC's Public Health Image Library (http://phil.cdc.gov), ID#4492, in the public domain.