Oral ulceration can occur in children and young people for the following reasons:
- Viral infections; herpetic stomatitis, Varicella Zoster (Chicken pox or Shingles), hand, foot and mouth disease, herpangina, glandular fever, HIV
- Recurrent Aphthous (oral) Stomatitis (RAS)
- Trauma
- Bacterial infections; necrotising gingivitis, syphilis, TB
- Fungal infection
- Cutaneous disease: lichen planus, pemphigus, pemphigoid, erythema multiforme, dermatitis herpetiformis, linear IgA disease, epidermolysis bullosa.
Recurrent Aphthous Stomatitis (RAS)
RAS is very common in childhood and usually not associated with other conditions. It is a clinical diagnosis of exclusion and can present in three forms:
- minor (most common, affecting the non-keratinised mucosa only)
- major
- herpetiform.
The ulcers can range in size (0.5 to >10mm) and duration (1-12 weeks).
Assessment
- Ask about location/site of ulcers, size, duration, symptom free periods, exacerbating and relieving factors, bowel problems, skin/genital blisters/ulceration.
- Dietary triggers: tomatoes, spicy food, carbonated drinks. Ask the patient to complete a diet/ulcer diary for 4 weeks
- Physical triggers: trauma, recent viral illness, lethargy/energy levels, height and weight disruption.
- Stress: any recent major life events, problems at school.
- Family history: parents, carers or siblings with similar oral ulceration history.
- Clinical photographs, if appropriate, are useful (include a sizer if available) and can be attached if an onward referral is necessary.
PLEASE SEE PRIMARY CARE MANAGEMENT FOR DETAILS OF INVESTIGATION AND TREATMENT.
C.M & P.G, H.C 22-01-24