Recurrent aphthous stomatitis is a chronic inflammatory disease characterized by recurrent painful mouth ulcers with varying frequency. In children, the disease is often associated with dehydration, as a result of the pain caused by canker sores and the inability to consume solid and liquid foods. Under these conditions, the correct therapy of recurrent aphthous ulcers is particularly important.
Canker sores may initially appear as erythematous papules (red bumps) that erode to form sharp, circumscribed necrotic ulcers.
There are 3 categories of recurrent aphthous ulcers:
• Minor aphthous ulcers. They account for 80-85% of recurrent aphthous ulcers, are between 1 and 10 mm in diameter, and heal spontaneously in 7-10 days.
• Major aphthous ulcers. It constitutes 10-15% of recurrent aphthous ulcers. These lesions are larger than 10 mm in diameter, heal over a period of 10-30 days or even longer, and may leave scars.
• Herpetiform ulcers. It accounts for 5-10% of recurrent aphthous ulcers and presents as multiple, clustered lesions of 1 mm to 3 mm. These canker sores usually heal in 7-10 days.
Causes of canker sores in children
Risk factors for canker sores in both children and adults include local traumatic injuries, chemical exposure, local infections, salivary gland dysfunction, nutritional deficiencies, gastrointestinal disorders, systemic disorders, food allergies or hypersensitivity, hormonal fluctuations, stress, depression and genetic predisposition.
The main symptoms of aphthous stomatitis in children
Usually, older children describe burning or stinging sensations in the oral mucosa 1-2 days before the appearance of canker sores. Patients with recurrent aphthous ulcers often mention, in the early stages of the condition, local trauma or food hypersensitivity. The following symptoms can also be associated with canker sores: cough, fever, headache (headache), joint or muscle pain, nausea, especially when canker sores appear in the context of a general illness (acute pharyngitis, tonsillitis or in the context of a recurrent febrile syndrome ).
Children often refuse to eat because of the pain they feel in the oral cavity. This is precisely why there is a risk of dehydration, especially among young children. Clinical signs of dehydration include: dry mucous membranes, depressed fontanel, absence of urination, apathy, lethargy. If the child continues to refuse fluids and, implicitly, oral rehydration solutions, hospitalization may be required. Bacterial superinfection of stomatitis lesions is relatively common, and high fever may be one of the first clinical signs.
Treatment of aphthous ulcers in children
The main goals of medical therapy in people with canker sores, including children, are: pain relief, maintenance of adequate fluid intake, a normal diet, early resolution, and prevention of recurrence.
Treatment of aphthous ulcers usually includes anti-inflammatory and/or symptomatic therapy, while immunomodulators are rarely used except in severe, difficult-to-heal cases.
Symptomatic therapy includes anesthetic and occlusive agents, which are commonly used when ulcers are small and few, to reduce pain and improve oral intake. Some anesthetic and occlusive agents have also been found to speed the healing of canker sores. If bacterial superinfections occur, oral or injectable antibiotic therapy is needed, depending on the patient’s digestive tolerance.
In situations where dehydration is important, the child is hospitalized for intravenous hydroelectrolytic rebalancing.
