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Three common types of mouth sores are canker sores, cold sores, and mouth sores from dentures, called denture stomatitis. CANKER SORES Canker sores develop inside the mouth on the lining of the lip or cheeks or on the tongue. These sores are painful, shallow breakouts that have a red border and a yellowish center. They can last anywhere from 1 to 2 weeks. It is uncertain what causes canker sores. Some say they are caused by trauma (like when you bite down on your tongue or cheek) some digestive diseases such as Crohn disease, ulcerative colitis, or celiac disease a reaction to sodium lauryl sulfate—the chemical in toothpaste that makes it foamy. To help heal the sore and reduce the pain and size, your dentist might recommend a gel or cream that you apply directly on the sore. If you have a serious problem with frequent or large canker sores, the dentist may prescribe a medication or mouthrinse to control outbreaks. COLD SORES It is estimated that more than 60% of people worldwide have the virus that causes cold sores (human herpesvirus 1). Cold sores can develop near your nostrils and eyes, but they are most common on the border of your lips. Before the cold sore develops, you may have a tingling, itching, or burning sensation at the site where the sore will emerge. Within about 24 hours, a painful blister will develop that may be runny. Like canker sores, cold sores can last 1 to 2 weeks. Cold sore outbreaks can sometimes be triggered by emotional stress illness sun exposure without sunscreen. Cold sores can be passed easily from one person to another. The virus can survive on hard surfaces, which puts you at risk of spreading it by touching your sore and then coming into contact with another person by touching them or handling objects they may use or touch. To shorten the outbreak and help reduce discomfort, your dentist may suggest a cream that you can put on the sore (wash your hands carefully after use to avoid spreading the virus). In severe cases, your dentist may prescribe a medication that attacks the virus that causes the sores. MOUTH SORES FROM DENTURES Mouth sores known as denture stomatitis affect people who wear dentures. They can develop on any moist soft-tissue surface in your mouth but most often develop under your dentures, on the roof of your mouth, or under the tongue. The red patches that form may have no symptoms or may burn, sting, or itch. They may also affect your senses of taste and smell. Denture stomatitis normally arises from wearing your dentures too long or not cleaning your dentures properly. Although your dentist may prescribe an antifungal medicine, properly caring for your dentures may be more helpful. Do not wear your dentures when you sleep. Clean your dentures with a nonabrasive cleaner (not toothpaste, which can scratch your dentures). Brush your mouth thoroughly, including your gums, cheeks, roof of your mouth, and tongue. CONCLUSION Mouth sores such as canker sores, cold sores, or irritations from dentures are common. Luckily, your dentist may be able to help you control these outbreaks, reduce pain, limit the size and spread of the sores, and shorten the outbreak itself. https://doi.org/10.1016/j.adaj.2022.07.010 Prepared by Anita M. Mark, senior scientific content specialist, ADA Science and Research Institute, Chicago, IL. Disclosure. Ms. Mark did not report any disclosures. Copyright 2022 American Dental Association. Unlike other portions of JADA, the print and online versions of this page may be reproduced as a handout for patients without reprint permission from the ADA Publishing Division. Any other use, copying, or distribution of this material, whether in printed or electronic form, including the copying and posting of this material on a website, is prohibited without prior written consent of the ADA Publishing Division. “For the Patient” provides general information on dental treatments. It is designed to prompt discussion between dentist and patient about treatment options and does not substitute for the dentist’s professional assessment based on the individual patient’s needs and desires. You can find more information for patients at ADAcatalog.org or at MouthHealthy.org.

Does your child have pain from a toothache or having a tooth removed by the dentist? Your child’s dentist or pediatrician may be able to help you comfort them. TOOTHACHES At some time in their childhood, children may develop a toothache. Research suggests that 1 of 4 infants and children up to age 5 years have a toothache at some point. That number jumps to one-half of all children by the time they reach age 6 through 9 years.1 Toothaches can result from infections in the tooth, such as tooth decay, or problems with the gums or other tissues around the tooth. Toothache is different from the tooth pain that occurs when a baby is teething or the tooth pain that occurs when a child has a loose baby tooth. TOOTH REMOVAL At some point, children may need to have 1 or more of their teeth removed by a dentist. Parents should be aware that pain after tooth removal is usually not very high to begin with and drops steadily after a few hours.2 USING MEDICINE TO MANAGE PAIN If your child has a toothache, make an appointment with their dentist or pediatrician as soon as possible. If the dentist or pediatrician cannot see your child quickly, he or she may suggest pain relievers that you can buy at the store to control the pain for a short time until they can see your child. If the pain continues or gets worse, or your child develops facial swelling or fever, contact your child’s dentist or pediatrician again. If your child cannot see a dentist or pediatrician, you can take your child to an urgent care clinic or hospital emergency department. If your child has a tooth removed, their dentist or pediatrician may also suggest using pain relievers. Some health organizations3-5 suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, which can be bought in the store, may help. NSAIDs can be taken alone or with acetaminophen. Do not be confused by these names— they are medical terms. In the store, the pain relievers go by names like Advil (Haleon group), Motrin (McNeil-PPC), or Tylenol (Johnson & Johnson). These medicines come in a number of forms, so it is important to follow your child’s dentist’s or pediatrician’s directions on which pain reliever to use and how to give it to your child. CONCLUSION It is not uncommon for infants and young children to experience a toothache. In many cases, this pain can be temporarily managed with pain-relieving medicines that can be bought in stores. If your child is experiencing a toothache, contact their dentist or pediatrician. If the dentist or pediatrician cannot see your child immediately, they may recommend a pain reliever for temporary use and explain how to use it. If your child has a tooth removed, pain-relieving medications may also be recommended by their dentist. https://doi.org/10.1016/j.adaj.2023.07.004 Prepared by Anita M. Mark, senior scientific content specialist, ADA Science and Research Institute, Chicago, IL. Disclosure. Ms. Mark did not report any disclosures. Copyright 2023© American Dental Association. Unlike other portions of JADA, the print and online versions of this page may be reproduced as a handout for patients without reprint permission from ADA Publishing. Any other use, copying, or distribution of this material, whether in printed or electronic form, including the copying and posting of this material on a website, is prohibited without prior written consent of ADA Publishing. “For the Patient” provides general information on dental treatments. It is designed to prompt discussion between dentist and patient about treatment options and does not substitute for the dentist’s professional assessment based on the individual patient’s needs and desires. You can find more information for patients at ADAstore.org or at MouthHealthy.org. 1. Santos PS, Barasuol JC, Moccelini BS, et al. Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis. Clin Oral Investig. 2022;26(2):1105-1119. 2. Akl N, Sommerfield A, Slevin L, et al. Anaesthesia, pain and recovery profiles in children following dental extractions. Anaesth Intensive Care. 2020;48(4):306-313. 3. WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children With Medical Illnesses. World Health Organization; 2012. 4. American Academy of Pediatric Dentistry. Pain management in infants, children, adolescents, and individuals with special health care needs. In: The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry; 2021:377-385. 5. Carrasco-Labra A, Polk DE, Urquhart O, et al. Evidence-based clinical practice guideline for the pharmacological management of acute dental pain in children: a report from the American Dental Association Science and Research Institute, the University of Pittsburgh School of Dental Medicine, and the Center for Integrative Global Oral Health at the University of Pennsylvania. JADA. 2023;154(9):814-825.

Research shows that a diet high in added sugar can increase the risk of cavities and gum disease.1,2 Left untreated, these dental diseases can lead to tooth loss. ADDED SUGAR IN DIETS Many foods that come in packages often have added sugar in them.3 This includes many snack foods like chips and pretzels. You might not expect that sugar is also added to other foods like frozen meals and ketchup or other sauces. Drinks also may be high in added sugar.4 Your oral health is especially at risk from foods that are sticky or gummy because they stick to your teeth. These not only include many candies but also many chewable over-the-counter medicines (like antacids), vitamins, and supplements. Flavored yogurts and many formulas, baby foods, and juices may be sweetened with added sugar as well. Juices are often used when weaning infants from formulas or breast milk. However, the American Academy of Pediatric Dentistry recommends that juice not be given to infants younger than 1 year. After that, juice should be limited.5 Talk to your child’s doctor about how much juice is okay for your child. They also suggest that infants and children should not suck on bottles or sippy cups filled with juice for long periods and should not go to sleep with a juice-filled bottle or sippy cup. READ THE LABEL The US Department of Agriculture and American Academy of Pediatrics suggest limits you should place on added sugar in

From the time your child gets their first tooth until the last permanent tooth comes in, your child’s mouth goes through a lot of changes. TEETHING Your child’s first teeth may start coming in around 6 through 8 months. This is a process called teething. Often, babies who are teething want something to chew on. When looking for a teething ring, choose one made of hard rubber and avoid fluid-filled or plastic rings that can leak or break. BUILDING A DENTAL HOME You child should have their first dental visit at some point between the time they get their first tooth to the age of 1 year. Ideally, the office you go to for that first visit will become your child’s dental home, the place they will continue to go during childhood. CAVITY PREVENTION From the minute your child’s first tooth comes in, it is at risk of developing a cavity. A cavity is a hole in the tooth caused by bacteria. Cavities might not be painful at first, but they can become painful and, left untreated, can cause an infection in other parts of the tooth or the body. There are several things you can do to help prevent cavities in your child: brush their teeth twice a day with a fluoride toothpaste clean between teeth that are side by side once daily limit sugary snacks and drinks ask your dentist about sealants. Brushing When your child is young, you will need to brush their teeth for them. Children need to be able to handle a child-sized toothbrush well enough to clean all surfaces of every tooth. Some say children are ready to brush their own teeth about the same time as they can tie their own shoes. Even after your child starts brushing for themselves, you might supervise to make sure they are doing a thorough job and using the right amount of toothpaste. Children younger than 3 years should use a smear of fluoride toothpaste (about the size of a grain of rice). Children 3 years and older should use a pea-sized amount of toothpaste. They should not swallow toothpaste. Swallowing too much fluoride may cause discolorations or pits to form on the permanent teeth that are developing beneath the gums. Clean between the teeth Cavity-causing bacteria can grow between the teeth. The space between teeth that are next to each other should be cleaned once per day. You or your older child can gently use dental floss, floss holders, or tiny brushes made for cleaning between the teeth. Limit sugary snacks and drinks For example, avoid letting your child suck on or chew sticky candies and limit the sugary beverages they drink. The American Academy of Pediatrics suggests avoiding juice for the first year and limiting the amount of juice after that to the following amounts per day1 : 4 oz for children 1 through 3 years old 4 through 6 oz for children 4 through 6 years old 8 oz for children 7 through 18 years old. The pediatrics group also says children should not sip on juice throughout the day or go to bed with juice. Sealants The chewing surfaces of the molars in the back of your child’s mouth have pits and grooves where cavities can form. Sealants are a plastic coating that can be painted on those tooth surfaces to seal those pits and grooves and protect molars from cavities. CONCLUSION From the time your child’s first tooth comes in, teeth need to be cared for. Your child may need help easing symptoms during teething. You also can do a lot to protect their teeth from cavities. Talk to your dentist about your child’s teeth and dental needs. https://doi.org/10.1016/j.adaj.2021.10.005 Prepared by Anita M. Mark, senior scientific content specialist, ADA Science and Research Institute, Chicago, IL. Disclosure. Ms. Mark did not report any disclosures. Copyright© 2022 American Dental Association. Unlike other portions of JADA, the print and online versions of this page may be reproduced as a handout for patients without reprint permission from ADA Publishing. Any other use, copying, or distribution of this material, whether in printed or electronic form, including the copying and posting of this material on a website, is prohibited without prior written consent of ADA Publishing. “For the Patient” provides general information on dental treatments. It is designed to prompt discussion between dentist and patient about treatment options and does not substitute for the dentist’s professional assessment based on the individual patient’s needs and desires. You can find more information for patients at ADAcatalog.org or at MouthHealthy.org .