Oral conditions - young children

It is a good idea to look inside your child’s mouth regularly. Look at the gums, the teeth and tongue. Also look at the cheeks, the roof of the mouth and lips. Oral thrush, mouth ulcers and cold sores are common problems. Also look out for the early signs of tooth decay (see Tooth decay – young children). Speak to your doctor or oral health professional if you are concerned about anything in your child’s mouth.

Oral thrush in young children

Oral thrush is a fungal infection that affects the soft tissue inside the mouth. It is quite common in young children. Oral thrush looks like milky white patches in the mouth. On the tongue it appears as a white coating which does not disappear after feeding. Your child may also have an infection in the nappy area at the same time. Very rarely a fever and abdominal irritation may show with an oral thrush infection; however, this may also indicate a more general infection.

Thrush is treated with antifungal medications applied directly to the affected areas. See your pharmacist, doctor or oral health professional.

Mouth ulcers in young children

Mouth ulcers are a type of sore inside the mouth. They can have several causes and are not contagious.

Traumatic ulcers are a common type of mouth ulcer that results from injury to the mouth; for example, after biting the cheek.

Aphthous ulcers are a painful type of ulcer that tends to come back again and again as one or many sores a few millimetres in size.

Mouth ulcers usually heal on their own in a week or two. If any ulcer does not heal after two weeks, it is important to see a doctor or oral health professional. While oral cancer is extremely rare in children, ulcers that don’t heal can be a sign of oral cancer.

There isn’t treatment for mouth ulcers, but you can help to reduce pain by:

• avoiding acidic foods and drinks, such as oranges and other citrus fruits. Salty, spicy or hot food can also sting the ulcer and make it worse.
• making sure children regularly drink water.
• using a protective gel on the affected area, especially before eating.

Take care with any anaesthetic gel or medication, as they can have ingredients which might not be suitable for young children. Ask your pharmacist, doctor or oral health professional.

Oral herpes (cold sores) in young children

Cold sores are blisters around the mouth and nose, caused by the Herpes Simplex Virus (HSV). Cold sores are very infectious and spread easily from one person to another. The most infectious time is in the first few days when the cold sore blister is forming. The virus may be spread by touching the sore directly or through saliva. Sometimes, people can pass the virus to others when they have no symptoms.

The first HSV infection

If your child has been infected with herpes simplex, they may show no symptoms. However, one in four children develop mouth ulcers If they do have symptoms. They may include:

• fever
• irritability and tiredness
• painful mouth ulcers and lip blisters
• sores (blisters and ulcers) in and around the mouth
• a sore throat
• swollen neck glands
• poor appetite or reluctance to drink.

Symptoms of cold sores in children

The ulcers/blisters usually take 10 to 14 days to go away. The blisters never leave scars.

Symptoms in children may include:

• tingling, burning or itchiness of the skin (these are early signs of a cold sore)
• small clusters of blisters that quickly break out inside the mouth, or on the gums or lips
• yellowish ulcers surrounded by a red circle, which develop after the blisters burst
• red, swollen gums that bleed when touched
• fever, feeling unwell, tiredness and irritability.

See your doctor or oral health professional if sores do not heal within two weeks or the child has a fever or is not drinking.

Treatment for cold sores in children

There is no cure for the HSV infection, but you can help to reduce pain by giving your child:

• lots of fluids, preferably water – dehydration is a risk in small children if it is painful to swallow
• bland foods such as plain natural yoghurt
• little or no salty, spicy or acidic foods.

Ask your pharmacist or doctor about pain relief medication and antiviral creams which may make it more comfortable for your child to drink and eat.

Preventing the spread of cold sores

HSV is transmitted easily. To reduce its spread:

• Avoid touching your child’s cold sores and try to keep them from touching them too. Wash your and their hands thoroughly, and as soon as possible, if a sore is touched.
• Keep your child’s utensils such as cups and forks, and items such as towels and face washers separate from everyone else’s and wash them thoroughly after use.
• Take extra care not to let your child touch anyone around the eyes, including themselves. A herpes infection in the eyes can be quite serious.
• You should keep them home from childcare or school until their cold sore blister stops weeping to prevent spreading the virus.

Hand, foot and mouth disease in young children

Hand, foot and mouth disease is a common viral infection in infants and children younger than 5 years old. Most children have mild symptoms for 7 to 10 days. It is characterised by painful ulcers in the front of the mouth and small blisters on the hands and feet. Your child may also have a sore throat or mouth and a minor fever.

This disease will heal by itself. Give fluids (mostly water) and soft foods to reduce discomfort. Keep your child at home until the sores have dried to prevent spreading the disease.

See your GP if:

• Your child is not drinking enough to stay hydrated
• Your child’s fever lasts longer than 3 days
• Your child has a weakened immune system (body’s ability to fight germs and sickness)
• Symptoms are severe
• Symptoms do not improve after 10 days
• Your child is very young, especially younger than 6 months

Tooth abscesses in young children

A tooth abscess is a pocket of pus caused by an infection and is normally associated with tooth decay. An abscess can also be caused by the gums directly on a healthy tooth. For example, when food keeps getting stuck and not cleaned out, or a sharp piece of food or tooth fragment gets lodged into the gums, or even an infection over a newly erupting tooth. The abscess appears as a pimple on the gum, swelling of the gum or swelling of the face on the side of the affected tooth.

Signs and symptoms may include:

• Your child complaining of a throbbing toothache that can go to the jaw
• Sensitivity to hot and cold temperatures
• Sensitivity to the pressure of chewing or biting
• Fever
• Your child’s face or cheek is swollen, and you feel swollen glands on the child’s jaw or neck.

See a doctor or oral health professional immediately if you think your child may have a tooth abscess.

Brushing teeth twice a day with low fluoride toothpaste (18 months - 6 years) or adult toothpaste (6 years and above) is an important preventative measure for tooth decay.

Cellulitis

Cellulitis is caused by bacteria that enters the body through broken skin. It can appear as redness of the skin, swelling and fever, and can spread very quickly to the rest of the body. If this infection is seen on the face, it can be related to a tooth or to gums, where the infection has spread deep.

The treatment for cellulitis is a course of antibiotics, so it is important for your child to see a doctor or oral health professional as soon as any swelling of the face appears. In severe cases you may need to go to the hospital emergency department.

Mucoceles in young children

A mucocele is a harmless, mucus-containing cyst of a small saliva gland. It looks like a soft, bluish-grey swelling, usually on the lower lip. It can be caused by trauma to the lip, often from lip biting.

Mucoceles will often burst and heal by themselves. If they don’t heal, or if they become a problem, see your doctor or oral health professional.

Eruption cysts in young children

An eruption cyst is a smooth, bluish, dome-shaped blister that appears on the gum where a tooth is coming through. Treatment is not usually required because the cyst bursts when the tooth breaks through.

Seek advice from a doctor or oral health professional if you think the area may be infected or if the cyst doesn’t go away when the tooth erupts, or within two weeks.

Measles in young children

Measles is a viral infection. The first symptoms of measles can include:

• Fever
• tiredness
• cough
• runny nose
• sore red eyes and
• lots of small white spots (Koplik spots) that look like grains of salt surrounded by inflammation (swelling and redness) on the inside the mouth on the cheeks. The white spots appear two to three days before the measles rash shows on the face and body.

Immunisation is the best protection against measles. It’s safe, effective and free for eligible people. Two doses are required for optimal protection and are usually given at 12 and 18 months of age. Catch up vaccines are available.

Measles can be a serious condition in young children and is highly contagious. See your doctor immediately if you think your child might have measles.

A number of other viral and bacterial infections can show signs in the mouth. It's always a good idea to check with an oral health professional, GP or paediatrician if you have any concerns.

Chalky teeth in young children

About one in six children have ‘chalky teeth’ (also known as hypomineralised enamel). This can look like creamy-brown or very white spots (like the colour of chalk), particularly on the molars (back teeth). Both the baby molars (which come through at around age two), and the permanent adult molars (which come through at around six years of age), can be affected.

Teeth can become ‘chalky’ if the enamel (tooth surface) doesn’t harden properly when the tooth is forming. Because these teeth are weaker, they have a much higher risk of tooth decay.

Taking your child for regular professional dental check-ups can help with early identification and care of this problem. It is recommended that children have an oral health assessment by one year of age.

Chalky teeth can sometimes be confused with tooth decay. If you notice anything unusual about your child’s teeth, always see your dentist or oral health professional as soon as possible.

Where to get help (key organisations with web links and phone numbers):

• Your GP (doctor)
• Your dentist or other dental practitioner
• Oral Health Victoria provide public dental services through the Royal Dental Hospital Of Melbourne and community dental clinics for eligible people. For information about public dental services call (03) 9341 1000, or 1800 833 039 outside Melbourne metro.
• Australian Dental Association ‘Find a Dentist’ or call (03) 8825 4600
• Your maternal and child health nurse