Coronavirus Pandemic Notice
Posted 2/3/2021

Our Practice Updates General Covid-19 Information
The Coronavirus Pandemic safety protocols remain in place.

All persons 2 years and up who enter the office must wear a face mask that covers both the mouth AND the nose.

To maintain proper social distancing within the office, we continue to call you in from your car and to escort you out one family at a time.

Therefore, entering and exiting transitions take longer. Please be patient with us as we do our best to keep everyone as safe as possible.

Only one adult may accompany the patient(s) for the appointment(s) to limit in office capacity.

We continue to separate, by session, appointments for well/non-sick patients from appointments for sick/contagions concerns.

All entrants are screened for Covid-19 symptoms and exposure. (All non-urgent appointments are rescheduled if there is a positive screen.)

Our pandemic hours are the still Monday-Friday 8am-4pm and we continue to have Saturday hours 8am-12pm.

As usual, we are available for advice 24/7.

Telehealth visits are still available.

The office is not handling cash payments within the office space.

We are not doing in-office testing for Covid-19.

We are not yet offering Coronavirus vaccines.

**We are following the American Academy of Pediatrics guidelines (12/2020) to conduct in office cardiac screening for all children 5 years and older in order to determine clearance to resume exercise/gym/sports.


Continue to mask, social distance, and wash your hands frequently.

Avoid unnecessary gatherings with persons with whom you do not live.

Do not send your child to daycare, camp, nor school with any symptoms of Covid-19 nor if he has had close contact with someone who has or is under investigation for Covid-19.

Refer to the Erie County Dept. of Health website for a list of Covid testing locations.

If you get tested, isolate as if you are positive and quarantine your family until the results are reported as normal.

If there is a test-proven, positive Covid-19 case in your household refer to the Erie County Health Commissioner mandate (Health Alert Priority #355) for the proper quarantine procedure via this link: www.erie.gov/covid19. Note the quarantine time has been shortened from 14 to 10 days.

If you think your child has the Covid-19 virus he may be treated supportively at home. Regarding suspected Covid-19 illness, call if there is fever of 100.4 or higher longer than 72 hours or if there is shortness of breath, trouble breathing, difficulty keeping down fluids, or an extensive rash.

Presently available vaccines are approved for either 16 or 18 year-olds and up.


Stay safe!
Let’s Go Buffalo!
Crush this Virus!

Mouth Ulcers

Is this your child's symptom?

  • Painful, shallow ulcers (sores) on the lining of the mouth
  • Found on the gums, inner lips, inner cheeks, or tongue
  • Sores only on the outer lips (such as cold sores) are not covered

Causes of Mouth Ulcers or Sores

  • Canker Sores. The main cause of 1 or 2 mouth ulcers after age 5.
  • Hand-Foot-Mouth Disease. The most common cause of multiple ulcers in the mouth. These ulcers are mainly on the tongue and sides of the mouth. Most children also have small deep blisters on the palms and soles. Due to the Coxsackie virus. It is common between ages 1 to 5 years.
  • Herpes Simplex Virus (Cold sore virus). The first infection can be severe. It can cause 10 or more ulcers on the gums, tongue and lips. Key findings are additional ulcers on the outer lips or skin around the mouth. Also, fever and difficulty swallowing. Usually occurs age 1 to 3. It usually follows contact with an adult who has active cold sores (fever blisters). Often they have kissed the child.
  • Cold Sores (Fever Blisters). Sores are only found outside the mouth on the outer lip. They recur 2 or 3 times a year in the same place. There are no ulcers inside the mouth. Adult cold sores are the cause of Herpes Simplex infections in young children. Occurs in 20% of teens and adults.
  • Mouth Injury. Common mouth injuries are biting the tongue or inside of the cheek. Others can be caused by a toothbrush. The lining of the mouth always looks white when it heals. So forgotten injuries can look like a canker sore.
  • Mouth Burns. Hot foods (such as pizza) can cause mouth sores. They also turn white as they heal.

Causes of Canker Sores

  • Canker sores have many causes.
  • Minor injuries to the mouth can trigger a canker sore. Examples are from a rough food or a hard toothbrush. Biting oneself while chewing can start one.
  • Food allergies or irritants may also be a trigger.
  • Vitamin deficiencies can also be a cause. A vitamin deficiency can occur if your child is a picky eater.
  • Canker sores can run in families (genetic).
  • Often, the cause is unknown.

Symptoms of Canker Sores

  • Small ulcers have a white center with a red border around them
  • Size is usually less than ¼ inch (6 mm)
  • Found on the inner lips and inner cheeks
  • The sores are very painful, even when not eating
  • Usually get 1 canker sore at a time. Sometimes get 2 or 3.
  • No fever or other symptoms

When to Call Us for Mouth Ulcers

Call 911 Now

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Chemical in the mouth could have caused ulcers
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • 4 or more ulcers
  • Bloody crusts on the lips
  • Red, swollen and tender gums
  • Ulcers and sores also on the outer lip
  • One ulcer on the gum near a tooth with a toothache
  • Fever or swollen face
  • Large lymph node under the jaw
  • Began after starting a medicine
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Cold sores suspected
  • Mouth ulcers last more than 2 weeks
  • You have other questions or concerns

Self Care at Home

  • Canker sores suspected

Care Advice for Mouth Ulcers

  1. What You Should Know About Mouth Ulcers:
    • Canker sores are the most common cause of mouth ulcers.
    • They are 1 - 3 painful, white ulcers of inner cheeks, inner lip or gums (no fever).
    • Causes include injuries from rough food, tooth brushes, biting, or food irritants.
    • Here is some care advice that should help.
  2. Liquid Antacid for Mouth Pain (Age 1 Year and Older):
    • For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.
    • Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
    • Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
    • Caution: Do not use regular mouth washes, because they sting.
  3. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  4. Fluids and Soft Diet :
    • Try to get your child to drink adequate fluids.
    • Goal: keep your child well hydrated.
    • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
    • Solid Foods. Offer soft, bland foods like macaroni and cheese. Other good ones are mashed potatoes, cereals with milk and ice cream.
    • Avoid foods that need much chewing. Avoid citrus, salty, or spicy foods.
    • Note: Fluid intake is more important than eating any solids.
    • For infants, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
  5. Return to School:
    • Canker sores cannot be spread to others. Children with canker sores do not need to miss any school.
    • Children with fever need to be checked before going back to school.
    • Also, children with many mouth ulcers should be checked before going back.
  6. What to Expect:
    • They heal up in 1 to 2 weeks on their own.
    • Once they occur, no treatment can shorten the illness.
    • Treatment can help with the pain.
  7. Call Your Doctor If:
    • Mouth ulcers last more than 2 weeks
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Canker Sore on Inner Lower Lip

This is a picture of a canker sore on the inner lip. These sores are painful. They can be caused by many things including: injury to the tissue in the mouth, citrus fruits, acidic vegetables and allergic reactions. Some diseases can also cause a canker sore to form.



Cold Sore of Lower Lip

This shows a cold sore on the lip. Cold sores are caused by the Herpes simplex virus. This cold sore has been visible for two days.




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Transit Office Hours

4899 Transit Road Depew, NY 14043

Monday – Friday: 8am-4pm
Saturday: 8am-12pm

(716) 558-5437