Children's Hospital Colorado

Mouth Ulcers

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  • Painful, shallow ulcers (sores) on the lining of the mouth
  • Found on the gums, inner lips, inner cheeks, or tongue
  • Sores only on the outer lips (such as cold sores) are not covered

Causes of Mouth Ulcers or Sores

  • Canker Sores. The main cause of 1 or 2 mouth ulcers after age 5.
  • Hand-Foot-Mouth Disease. The most common cause of multiple ulcers in the mouth. These ulcers are mainly on the tongue and sides of the mouth. Most children also have small deep blisters on the palms and soles. Due to the Coxsackie virus. It is common between ages 1 to 5 years.
  • Herpes Simplex Virus (Cold sore virus). The first infection can be severe. It can cause 10 or more ulcers on the gums, tongue and lips. Key findings are additional ulcers on the outer lips or skin around the mouth. Also, fever and difficulty swallowing. Usually occurs age 1 to 3. It usually follows contact with an adult who has active cold sores (fever blisters). Often they have kissed the child.
  • Cold Sores (Fever Blisters). Sores are only found outside the mouth on the outer lip. They recur 2 or 3 times a year in the same place. There are no ulcers inside the mouth. Adult cold sores are the cause of Herpes Simplex infections in young children. Occurs in 20% of teens and adults.
  • Mouth Injury. Common mouth injuries are biting the tongue or inside of the cheek. Others can be caused by a toothbrush. The lining of the mouth always looks white when it heals. So forgotten injuries can look like a canker sore.
  • Mouth Burns. Hot foods (such as pizza) can cause mouth sores. They also turn white as they heal.

Causes of Canker Sores

  • Canker sores have many causes.
  • Minor injuries to the mouth can trigger a canker sore. Examples are from a rough food or a hard toothbrush. Biting oneself while chewing can start one.
  • Food allergies or irritants may also be a trigger.
  • Vitamin deficiencies can also be a cause. A vitamin deficiency can occur if your child is a picky eater.
  • Canker sores can run in families (genetic).
  • Often, the cause is unknown.

Symptoms of Canker Sores

  • Small ulcers have a white center with a red border around them
  • Size is usually less than ¼ inch (6 mm)
  • Found on the inner lips and inner cheeks
  • The sores are very painful, even when not eating
  • Usually get 1 canker sore at a time. Sometimes get 2 or 3.
  • No fever or other symptoms

Call 911 Now

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

  • Chemical in the mouth could have caused ulcers
  • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • 4 or more ulcers
  • Bloody crusts on the lips
  • Red, swollen and tender gums
  • Ulcers and sores also on the outer lips
  • 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
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Cold sores suspected
  • Mouth ulcers last more than 2 weeks
  • You have other questions or concerns

Self Care at Home

  • Canker sores suspected

Care Advice for Mouth Ulcers

  1. What You Should Know About Mouth Ulcers:
    • Canker sores are the most common cause of mouth ulcers.
    • They are 1 - 3 painful, white ulcers of inner cheeks, inner lip or gums (no fever).
    • Causes include injuries from rough food, tooth brushes, biting, or food irritants.
    • Here is some care advice that should help.
  2. Liquid Antacid for Mouth Pain (Age 1 Year and Older):
    • For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.
    • Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
    • Age over 6 years. Use 1 teaspoon (5 ml) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
    • Caution: Do not use regular mouth washes, because they sting.
  3. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  4. Fluids and Soft Diet :
    • Try to get your child to drink adequate fluids.
    • Goal: keep your child well hydrated.
    • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
    • Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
    • For infants, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
  5. Return to School:
    • Canker sores cannot be spread to others. Children with canker sores do not need to miss any school.
    • Children with fever need to be checked before going back to school.
    • Also, children with many mouth ulcers should be checked before going back.
  6. What to Expect:
    • They heal up in 1 to 2 weeks on their own.
    • Once they occur, no treatment can shorten the illness.
    • Treatment can help with the pain.
  7. Call Your Doctor If:
    • Mouth ulcers last more than 2 weeks
    • You think your child needs to be seen
    • Your child becomes worse

Care Advice for Mouth Ulcers

Cold Sore of Lower Lip

Herpes simplex lesion of lower lip, second day after onset.

This is also called a "Cold Sore."

Canker Sore on Inner Lower Lip

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

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