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Deviations from the normal appearance of pale, pink and healthy mucosa require close monitoring or intervention and may be a sign of an underlying systemic disorder. Therefore, it is important that there is timely identification of abnormalities, appropriate management in primary care and onward referral for investigation to specialist services when required. Oral ulceration is the most common soft tissue abnormality in children, with recurrent aphthous stomatitis being the most common type of ulceration. This article discusses the various causes of oral ulceration in addition to vesiculobullous conditions, which may affect the paediatric patient.
CPD/Clinical Relevance: It is important that GDPs are aware of the range of causes of ulcers and blisters presenting in children and are aware of when to refer.
Article
Oral ulceration is a common condition affecting the oral mucosa and can be described as a full-thickness loss of the epithelium.1 There are many causes of oral ulceration and both local factors and the presence of any underlying systemic conditions need to be considered to reach a working diagnosis. The most common causes of oral ulceration can be found in Table 1.2
A structured and concise history is important when considering oral ulceration in the paediatric patient. The following points should be explored with both the child and parent:3
Ulceration as a result of oral mucosal trauma is frequently reported in children. Similarly to adult patients, traumatic ulceration can be categorized into physical or chemical causes, with the former being the most common.4 Physical trauma is often caused by sharp teeth, mamelons, orthodontic wires or appliances, with the most common site of traumatic ulceration being the non-keratinized mucosa. Traumatic ulceration can often present following accidental biting of the tissues after local anaesthetic has been administered (Figure 1).5 Therefore, it is important to provide optimal post-operative instructions to the child and parent/carer.
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