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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Acquired Oral Findings, continued
There are 3 types of ulcers:
Traumatic: Typically result from mechanical or thermal injury. Usually seen on the buccal mucosa, tongue, lips, or palate.
Infectious: Usually caused by HSV (primary or recurrent) or Coxsackie infections. HSV ulcers can be seen on the gingiva, lips, tongue, buccal mucosa, palate, pharynx, tonsils and skin. Coxsackie ulcers are typically prominent over the posterior soft palate. (Refer to Chapter 9: Common Oral Pathology for more information).
Aphthous: Disintegration and necrosis of epithelial tissue on a mucous membrane; usually painful.
Aphthous: Known as stomatitis (“canker sores�), these ulcers are round, yellowish-grey ulcers with surrounding erythema (halo) usually located on mucous membranes.

Primary Herpetic Gingivostomatitis
Primary Herpetic Gingivostomatitis is caused primarily by herpes simplex virus type 1. The primary infection is most severe and usually seen in children under age 6. Due to painful vesicles and ulcers, children often refuse to drink and are at risk for dehydration.

Treatment is mainly supportive with hydration maintenance and pain control. The acyclovir family of antiviral medications may be used, especially for immunosuppressed patients. The infection is life-long, and recurrences occur as “cold soresâ€� (herpes labialis), usually at times of stress or infection. 

Aphthous Ulcers
Divided into 3 categories:

Aphthous Minor Ulcers: Characterized by small (usually 1-5 mm) lesions that heal without scarring
Aphthous Major Ulcers: Recurrent major aphthae may take up to 4 weeks to heal and may scar.
Aphthae: A speck or blister on the mucous membranes characteristic of some diseases.
Herpetiform Ulcers: Grouped 1-2 mm papules, vesicles, or ulcers. Often very painful.

The etiology of aphthous ulcers is unknown, but they may be infectious, autoimmune, allergic, nutritional, or traumatic in nature.

Treatment includes supportive care, bland diet (avoid spicy and citrus), and topical anesthetic creams or mouthrinses. Recurrence is likely.

Fast Facts
There are 3 types of oral ulcers: traumatic, infectious, and aphthous.
Aphthous ulcers are the most common type of oral ulcer in the United States.
The etiology of aphthous ulcers is unknown.
The 3 subtypes of aphthous ulcers can be distinguished clinically.
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