Oral ulcers in children- a clinical narrative overview

Abstract

The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. Differential diagnosis can range from classic infectious disease of childhood (e.g. herpangina, hand-foot-and-mouth-disease) over nutritional deficiencies, gastrointestinal disorders, inflammations (e.g. pemphigus vulgaris, lichen planus, mucous membrane pemphigoid) to side effects of medications (Stevens-Johnson Syndrome) or chronic dieseases (e.g. sarcoidosis, systemic Lupus erythematodes, familial Mediterrenean fever). Therefore, children with oral ulcers are treated by many different specialists such as dentists, family doctors, paediatricians, rheumatologists, haematologists, gastroenterologists and otorhinolaryngologists.A systematic literature search and a narrative literature review about the potential 48 diseases connected to oral ulcers were performed. According to the duration of symptoms and size of the lesions, a tabular overview was created to support the clinician in making a correct diagnosis, additionally different treatment options are presented.

Dental Emergencies in an Italian Pediatric Hospital during the COVID-19 Pandemic

“…In our analysis, stomatitis and aphthous stomatitis accounted for more than one-third of the oral issues group in 2019, compared to about 15% in 2020. We included stomatitis and aphthous stomatitis in the oral complaints group when a more specific diagnosis did not follow: such oral lesions are an unspecific manifestation of several diseases, mainly mild and self-limiting, whose differential diagnosis can be challenging [ 28 ]. When a specific diagnosis was made for the oral manifestation, for example hand-foot-and-mouth disease, the case was included in the systemic group.…”

Refractory oral ulcers

“…The differential diagnosis of refractory oral ulcers in children includes lichen planus, systemic lupus erythematosus, Behcet disease, candidiasis, herpes infection, hand‐foot‐mouth disease, herpangina, trauma, nutritional deficiency, and paraneoplastic pemphigus 1 . PNP is a mucocutaneous autoimmune bullous disease that is associated with an underlying neoplasm.…”

Desquamative Gingivitis in the Context of Autoimmune Bullous Dermatoses and Lichen Planus—Challenges in the Diagnosis and Treatment

“…DG is predominantly observed in women, with a female to male ratio of 4:1. It occurs more commonly in middle-aged and older adults, and only in rare cases in children [ 8 , 22 ].…”

“…Severe pain is associated with ulceration and large areas with missing epithelium, leading to the patients’ inability to feed. Dehydration is a severe complication as a result of pain with mastication and reduced oral food and fluid intake, requiring hospitalization [ 22 , 30 ].…”