From the Guidelines
White tongue and mouth ulcers in children can have several causes, including poor oral hygiene, thrush, minor injuries, food sensitivities, vitamin deficiencies, and viral infections, and the most recent evidence suggests that a comprehensive diagnostic approach is necessary to determine the underlying cause. According to the expert consensus guideline for diagnosis of difficult and complicated oral ulceration 1, the causes of oral ulcers are related to traumatic, infectious, allergic factors, and may be associated with skin disease, autoimmune disease, tumor, inflammatory bowel disease, and so on. The guideline emphasizes the importance of a detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening to improve diagnostic efficiency and avoid misdiagnosis.
Some possible causes of white tongue and mouth ulcers in children include:
- Poor oral hygiene, which can lead to a buildup of debris, bacteria, and dead cells on the tongue's surface
- Thrush, a fungal infection caused by Candida albicans, which can appear as white patches on the tongue and inside the mouth
- Minor injuries to the mouth, such as biting the tongue or cheek
- Food sensitivities or allergies
- Vitamin deficiencies, particularly B12, folate, or iron
- Viral infections, such as herpes simplex or hand-foot-mouth disease
- Conditions like celiac disease or inflammatory bowel disease
For white tongue, improving oral hygiene with regular brushing and gentle tongue cleaning is recommended. For thrush, antifungal medications like nystatin oral suspension may be prescribed. Mouth ulcers often heal on their own within 1-2 weeks, but pain can be managed with over-the-counter benzocaine gels or acetaminophen/ibuprofen for pain relief. If symptoms persist beyond two weeks, are severe, or are accompanied by fever or difficulty eating or drinking, medical evaluation is necessary as these could indicate more serious conditions requiring specific treatment. The expert opinion recommendations for targeted therapy-associated stomatitis also suggest the use of sodium bicarbonate containing mouthwash, chewing gum, candy, salivary substitutes or sialogogues, and analgesics to prevent and treat stomatitis 1.
It is essential to note that the diagnosis and treatment of oral ulcers in various types are tasks of oral specialists, and a comprehensive diagnostic approach is necessary to determine the underlying cause of white tongue and mouth ulcers in children. The recent study on difficult and complicated oral ulceration 1 provides a standardized procedure for oral ulceration diagnosis, which can improve diagnostic efficiency and avoid misdiagnosis.
From the Research
Causes of Leukoplakia (White Tongue) and Oral Ulcers in Pediatric Patients
- The causes of oral ulcers in pediatric patients can be diverse, ranging from infectious diseases such as herpangina and hand-foot-and-mouth disease, to nutritional deficiencies, gastrointestinal disorders, and side effects of medications 2, 3, 4.
- Aphthous ulcers, which are painful ulcerations located on the mucous membrane, can be mistaken for other conditions presenting with oral bullous or vesiculous lesions or ulcerations and erosions 3.
- Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year and can be associated with gastro-intestinal diseases, nutritional deficiencies, immune disorders, and rare syndromes 3.
- Oral ulcers can be classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers, and chronic ulcers with slow onset and insidious progression 3.
- Acute oral ulcers can be due to trauma, bacterial infections, deep fungal infection, gastro-intestinal or systemic diseases, while chronic oral ulcers may be drug-induced or due to benign or malignant tumors 3.
- In pediatric patients, aphthous stomatitis, infections, and trauma are the most frequent causes of oral ulcerations or erosions of the mucous membranes 4.
- Leukoplakia, or white tongue, is not directly addressed in the provided studies, but oral health problems such as coated tongue/dirty mouth and stomatitis are discussed in the context of palliative care for children and young people 5.