Bednar’s ulcers occur due to feeding intolerance. Read the article to know the diagnosis, management, and preventive measures to avoid these ulcers.
The origin of any oral ulcer, especially in an infant, can be mainly of two sources:
A traumatic causative.
An underlying infection (infectious origin ulcers).
The occurrence rate in newborns regarding these ulcerative lesions is often elusive or somewhat unclear but is commonly found in a few cases during routine health check-ups. Also called Bednar’s aphthae, these ulcers are mainly attributed to feeding intolerance. As per research, the potential linkage to the exact cause is because the baby’s palate is exposed to trauma in such cases.
These neonatal ulcers' name is derived from the Austrian Physician or Pediatrician Alois Bednar, who first discovered it in 1950. Bednar’s ulcers' features are commonly confused by some physicians with the RAS group of lesions (Recurrent aphthous stomatitis), but they are different entirely and hence are not associated.
These mucosal lesions that appear ulcerative on the posterior borders of the hard palate or the soft palate usually are symmetrical, connecting both the maxilla and mandible (upper to lower jaw soft tissue region). They are pretty standard if diagnosed during a routine check-up, especially if the physician suspects the infant's response to trauma from its palate.
Also called “ulcera pterygoida,” Bednar ulcers commonly are referred to colloquially as the ulceration of palatine angles and hence the term. The ulcers are small and shallow with traumatic causative from the mother's breast nipple or the bottle nipple during feeding. A diagnosis is directly linked to the infant's palatal trauma, and subsequent examination reveals these ulcers specific at these locations.
Physicians' lack of awareness about these ulcers may complicate issues. These ulcers spontaneously regress without causing any form of a sequel, usually within a month, and no intervention is needed (as per retrospective case analysis studies and research). Bednar’s ulcers may not even be diagnosed at times because of a lack of concern. More often, however, it may be a source of stress during sucking to the infant causing discomfiture. The recent development of orthodontic bottles and nipples has positively impacted the reduced incidence reports of these ulcerative lesions in Newborn infants.
Amongst the causes, especially in developing and developed countries, the uneven temperatures of formula-based milk or even microwaving formula milk would be considered a possible source of thermal burns to the infant. Hence one of the preventive modalities for preventing oral ulcerations and burns, especially in an infant upto three months of age, would be to avoid uneven mixing, consistency, and temperatures, or microwaving formula milk as it can lead to burns in the oral mucosa.
Though the pathophysiologic cause of these ulcers is unclear, research attributes the formation of these shallow-edged ulcers on the palate to two types of reasons - traumatic and immunologic. Mechanical pressure caused by bottle nipples during feeding or only in a horizontal position has triggered the hypothesis for traumatic origin Bednar’s aphthae. Also, as these lesions seldom have any exudate or rough borders, this hypothesis linked to bottle feeding and feeding intolerance is thought of as a primary reason.
However, another immunologic hypothesis states that infants born through standard or spontaneous vaginal delivery are exposed to the vaginal flora (that may evidentially show why infants born through normal vaginal delivery have more incidence of ulcers than infants delivered through cesarean section). This hypothesis may lack evidence given that the mode of delivery may not be as impactful for causing ulcers compared to the local trauma and discomfort caused to the infant's mouth while bottle or nipple sucking.
The differential diagnosis for Bednar’s ulcers depends on the cause rather than the physical presentation of neonatal ulcers. Bohn’s nodules, Epstein pearls, and recurrent aphthous stomatitis (RAS) are other commonly occurring whitish-yellow opaque nodules also occurring at the junction of the hard palate or soft palate. However, the physician needs to confer with the dental surgeon to get an accurate diagnosis to differentiate it from the more severe conditions that involve an underlying infective etiology like herpetic stomatitis, coxsackievirus, and hand, foot, and mouth disease.
The differentiating factor always remains, however, that an infective etiology will also clinically present with fever, and the lesions do not always occur at the posterior palate region. The dentist or physician should also note that Bednar’s ulcers are relatively smooth and rounded with a shallow presentation specifically in the palate region while establishing a differential diagnosis for oral lesions. Also, as it is essential to wait and watch whether these lesions are self-limiting and will heal obviously within 6 to 8 weeks, neonatal ulcers should not be interfered with unless an infectious entity is involved in the infant. Hence establishing the cause of ulcers becomes essential.
The differential diagnosis conditions for Bednar’s ulcers are mainly being:
Coxsackie viral lesions.
Management mainly depends on treating the underlying cause of discomfort to the child either due to bottle or nipple feeding. A change in the feeding habits by the mother proved a source of faster healing of these self-healing ulcers. Usually, the time taken is 6 to 8 weeks for the ulcer to heal spontaneously.
The physician or dentist should cross-check any duration after eight weeks to establish a differential diagnosis and investigate any infectious cause of concern to the baby.
Physicians usually advise infant mothers to enlarge the orifice of the nipple (if the narrow nipple hole is creating an issue), and the position for nursing also should be corrected (horizontal position to be avoided then).
The possibility of light scars on the palate may exist and is not a cause of concern if the ulcers heal within a month on their own.
To conclude, the physician should not intervene with Bednar's ulcers discovered routinely during check-ups. Instead, the underlying cause and changes in feeding habits adopted to address the oral discomfort of the newborn should be investigated.
Last reviewed at:
29 Dec 2021 - 4 min read
Most Popular Articles
Do you have a question on Bednar's Ulcer or Feeding Intolerance?Ask a Doctor Online