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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 59212
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Customer: replied 18 days ago.
My daughter who is 7 keeps getting little ulcers on the tip of her tongue.
Why would this be? Is it serious like it could be with an adult?

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Thank you.

This is termed Recurrent aphthous stomatitis, which is not an uncommon condition in her age group. The cause is usually not determinable and the following are the predisposing factors;

1) Deficiency of iron, folic acid (folate), or vitamin B.

2) Stress

3) Food allergies

4) Helicobacter pylori which cause stomach ulcer may be associated.

5) Decreased body resistance (immunity).

6) Foods, particularly chocolate, coffee, peanuts, eggs, cereals, almonds, strawberries, cheese, and tomatoes

Treatment of it is following;

The treatment consists of a multi-point approach, consisting of the following:

1. Tetracyclin in the form of mouth swish or expectorate. This is effective for its antibacterial action.

2. Topical anesthetic in the form of a Benzocaine paste. This helps to numb the pain temporarily.

3. A topical steroid gel containing Triamcinolone Acetonide. This helps to reduce inflammation.

4. A 2-3 weeks course of vitamin B complex capsules. This helps to correct any nutritional deficiencies.

Hematinic (iron, folic acid, vitamins B-6 and B-12) deficiencies are twice as common in patients with recurrent aphthous ulcers. At present, no single theory of the immunopathogenesis of recurrent aphthous ulcers exists, but immune dysregulation may play a significant role. Thus you may ask his doctor to get the following work up too;

1) Determination of iron, ferritin, folate, and vitamin B-6 and B-12 levels.
2) Antinuclear antibody.
3) Patch or sensitivity testing.
4) Biopsy with hematoxylin and eosin stain and cultures.

These should be able to point to the cause and will be able to prevent the episodes and chalk out the right treatment. Meanwhile, the following also would be advised;

1) Avoidance of salt and hot spices to prevent pain.
2) Some people may correlate the appearance of ulcers after exposure to walnuts, pineapple, cinnamon, or other agents. In such cases, remission may be achieved by avoiding the inciting agent. If food exposure is thought to be the culprit, a food diary can be helpful.
3) Medications like Colchicine and Montelukast sodium are efficacious (prescription medicines).
4) Gelclair can provide a protective coating to reduce pain.

I hope your symptoms resolve soon.

I would be happy to assist you further if you need any more information.
Thanks for using Just Answer.

Customer: replied 18 days ago.
Thank you. That all sounds alarming. can it be due to a serious underlying cause?

Very welcome.

It is not alarming.

The majority of kids outgrow it.

Customer: replied 18 days ago.
but you mentioned immune problems. I wondered if it is a sign of cancer or something awful
Customer: replied 18 days ago.
also helicobactor and stomach ulcers don't sound good

Immune problems are related to reacting to some food allergen etc.

Customer: replied 18 days ago.
how about the fact that they are always right at the tip of her tongue?

I gave you a possibility. It is not necessarily to be the problem in her case.

H pylori is easily treatable

It does not matter (tip of the tongue).

Customer: replied 18 days ago.
I wondered if it was just something simple like pushing her tongue up against her teeth

It is difficult to know without a physical exam and the treatment is to ask her not to do it. Though this does not seem to be the cause.

Dr. Arun Phophalia and 4 other Medical Specialists are ready to help you
Customer: replied 18 days ago.
okay. thank you.

You are very welcome.

Wishing her a speedy resolution and all the very best in life.

It was a pleasure to assist you.

I sincerely hope that I have helped you and that I have earned my 5-star rating today!

Thank you.

Stay blessed.

Customer: replied 18 days ago.
sorry. she just woke up and I managed to get a picture. does that change the diagnosis? it's 2 white patches

These are typical aphthous ulcers.

Customer: replied 18 days ago.
not thrush?

In kids, thrush is extremely rare and does not look like it.

Customer: replied 18 days ago.
thank you