tongue, cheek, or vestibule If the hard palate or gingival margins are affected, it is unlikely to be aphthous Aphthous-like ulcers are often confused with HSV infection In contrast, they are never preceded by vesicles and occur only on nonkeratinized oral mucosa Ulcers can also be seen in systemic illnesses (e.g., celiac disease, or inflammatory bowel disease such as Crohn’s), or in patients with neutropenia Recurrent aphthous ulcers often start in childhood or adolescence They peak in early adult life and then seem to spontaneously resolve Recurrent aphthae usually occur during periods of anxiety, such as during final examinations at school or during domestic disturbances The ulcerations may appear singly or in clusters They are usually painful and tender, have a clinical course of 10 to 14 days, and often cause difficulties with eating In young children, there is a syndrome of recurring aphthous ulcers and periodic fevers known as PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) Treatment of aphthous ulcers is largely empirical and also usually unsatisfactory Drugs used in the management of aphthae have included topical steroid elixirs, such as dexamethasone (0.5 mg/5 cc), or topical local analgesics, such as 2% viscous lidocaine or benzocaine oral emollient (Orabase with benzocaine), which allow the patient enough comfort to eat Due to the risk of methemoglobinemia secondary to benzocaine toxicity, these agents should not be used in children