From the Guidelines
For a 4-year-old with aphthous ulcers, the primary focus should be on pain relief and comfort measures, as most aphthous ulcers heal within 7-10 days without specific treatment. When managing aphthous ulcers in children, it's essential to prioritize their comfort and pain relief. According to the expert consensus guideline for diagnosis of difficult and complicated oral ulceration 1, oral ulcerations can be caused by various factors, including traumatic, infectious, allergic factors, and may be associated with skin disease, autoimmune disease, tumor, inflammatory bowel disease, and so on. For aphthous ulcers, some key considerations include:
- Gentle oral hygiene using a soft toothbrush and mild, SLS-free toothpaste
- Application of over-the-counter benzocaine gel directly to the ulcer using a cotton swab, up to 4 times daily for pain relief
- Use of acetaminophen liquid for pain at a dose of 15 mg/kg every 4-6 hours as needed
- Rinsing with warm salt water if the child can manage it
- Avoiding spicy, acidic, or rough foods that may irritate the ulcers and offering soft, bland foods instead
- Ensuring adequate hydration with cool liquids through a straw to bypass the sore. It's crucial to monitor the child's condition and consult a healthcare provider if the ulcers are large, extremely painful, last longer than two weeks, or if the child develops fever or difficulty eating or drinking.
From the Research
Treatment Options for Aphthous Ulcers in Children
- Topical treatments, such as topical anesthetics, topical steroids, and sucralfate, are considered the first line of therapy for aphthous ulcers 2.
- A systematic approach to the management of aphthous ulcerations in children includes nutritional and vitamin supplementation, topical anesthesia, and debriding, anti-inflammatory, and protective agents 3.
- For recurrent aphthous stomatitis (RAS), colchicine associated with topical treatments constitutes a suitable treatment, while thalidomide is the most effective treatment but its use is limited by frequent adverse effects 2.
Management of Recurrent Aphthous Ulcers
- The primary goals of therapy for recurrent aphthous ulcers (RAU) are relief of pain, reduction of ulcer duration, and restoration of normal oral function 4.
- Topical medications, such as antimicrobial mouthwashes and topical corticosteroids, can achieve the primary goals but have not been shown to alter recurrence or remission rates 4.
- Systemic medications, such as levamisole and oral corticosteroids, can be tried if topical therapy is ineffective, while thalidomide is effective but should be used only as an alternative to oral corticosteroids due to its toxicity and cost 4.
Considerations for Treatment
- A detailed history and thorough examination of systems can assist the physician or dermatologist in defining whether the aphthous ulcers are related to a systemic disease process or truly idiopathic 5.
- Topical corticosteroids are considered the first line of treatment for oral aphthous ulcers due to their minimum side effects 5.
- A multidisciplinary treatment approach may be necessary for major aphthous ulcers that are refractory and persist for several weeks to months 6.