Mouth sores and patches are commonly found on careful oral examination of pediatric patients. Lesions may be asymptomatic or may lead to ulceration, pain, and decreased oral intake. Oral lesions may be categorized as anatomic, traumatic, or infectious. Many of these lesions are isolated to the oral cavity and mucosa, but certain systemic illnesses and conditions can present with oral sores or patches as part of a constellation of symptoms. Diagnosis is primarily clinical. Management is often limited to supportive care, including pain control and ensuring adequate hydration.

• Oral candidiasis is the most common oral fungal infection in infants and children, with Candida albicans being the most frequently identified species. When infections are persistent in children older than 6 months, the clinician should consider an underlying defect in the systemic immune system.

• Epstein pearls are asymptomatic and self-resolving, keratin-filled, epithelial-lined cysts that are extremely common in newborns.

• A sucking blister, also referred to as a sucking pad or callus, is a hyperkeratotic thickening at the closure line of the upper and lower lips caused by the mechanical effects of sucking, and may be white or pigmented. These lesions, found in newborns and young infants, usually disappear by 3 to 6 months of age.

• Traumatic oral lesions arise from mouthing objects in the period of infancy, and accidental biting or injury from objects placed in the oral cavity in older children. Pain is the predominant symptom, occurring 24 to 48 hours after the initial injury.

• Small gingival vesicles that progress into painful ulcerations following high fever, irritability, and malaise should prompt consideration of primary herpetic gingivostomatitis caused by herpes simplex virus (HSV) type 1 as a diagnosis.

• Herpangina also produces oral ulcerations and follows a prodrome that includes malaise, sore throat, and low-grade fever. It is caused by coxsackievirus group A, usually in the summer and early fall. The oral ulcerations are isolated in herpangina. When oral ulcerations occur in conjunction with palmar and plantar papulovesicles, hand, foot, and mouth disease should be strongly considered.

• Recurrent aphthous stomatitis (RAS) is the most common inflammatory ulcerative condition of the oral mucosa in patients in North America, with up to 20% of the population affected during childhood or early adulthood. Its cause is unknown. It is categorized into major and minor forms based on size and location of ulcers.

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