From the Guidelines
Frequent mouth ulcers in a 16-year-old are most commonly caused by recurrent aphthous stomatitis (canker sores), which typically results from minor trauma, stress, or certain foods, as suggested by the expert consensus guideline for diagnosis 1.
Potential Causes
Other potential causes of frequent mouth ulcers in a 16-year-old include:
- Nutritional deficiencies (particularly vitamin B12, folate, iron, or zinc) 1
- Hormonal changes during puberty
- Viral infections like herpes simplex
- Food allergies
- Inflammatory conditions such as Crohn's disease or celiac disease, as seen in a 13-year-old boy with recurrent oral ulcers who was later diagnosed with Crohn's disease 1
Diagnostic Approach
For oral ulceration that cannot be diagnosed after collection of clinical medical history and oral examination, especially those with the course over 2 weeks, or cases which do not respond to 1–2 weeks of treatments, a biopsy should be considered, along with blood tests to exclude contraindications and provide clues for further clinical examination and diagnosis 1
Management
For immediate relief, the teen can use over-the-counter topical treatments like benzocaine gel (Orajel), apply a paste of baking soda and water to neutralize acid, or rinse with salt water or alcohol-free mouthwash. Avoiding spicy, acidic, or rough foods during outbreaks can prevent further irritation. If ulcers are large (>1 cm), extremely painful, last longer than two weeks, occur with fever, or appear frequently, medical evaluation is necessary as they could indicate a more serious underlying condition, such as invasive fungal infection in patients with high blood glucose levels 1. Good oral hygiene, adequate hydration, and stress management techniques may help prevent recurrences. Some teenagers benefit from identifying and avoiding personal trigger foods or using a soft toothbrush to minimize trauma to the delicate oral tissues.
From the Research
Possible Causes of Frequent Ulcers in the Mouth
- Chronic trauma 2
- Underlying systemic conditions such as:
- Infectious diseases 2
- Recurrent aphthous stomatitis (RAS) 4
- Recurrent oral ulceration (ROU) secondary to known or unknown systemic disease 4
- Ulcerative oral lichen planus (OLP) 5, 6
- Oral chronic graft-versus-host disease 6
- Traumatic oral ulcers 6
Diagnosis and Management
- Correctly establishing a definitive diagnosis is crucial for effective management 2, 4
- Treatment and management require an understanding of the immunopathologic nature of the lesion 2
- Intralesional steroid therapy (IST) may be an effective treatment for inflammatory and immune-mediated oral ulcers 5, 6
- Topical steroid therapy may be used in conjunction with IST 6