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Cold Sores

What are Cold Sores?

Cold sores (also called fever blisters, herpetic lesions, and herpetic mouth ulcers) are caused by the virus Herpes Simplex. There are two variants which cause the initial infection with herpes labialis, HSV-1 and HSV-2. Initial infection can be asymptomatic or may present as areas of small sores on the attached gingival tissues. Afterward, the virus becomes dormant, inserting itself into nerve pathways (dermatomes) of the skin.

Reactivation of the virus may be caused by periods of stress, exposure of the skin to excess sunlight or other ultraviolet light sources such as tanning lamps; or by medical/dental procedures in or around the mouth. Generally HSV-1 is responsible for repeated outbreaks of Herpes labialis. Oral reinfection by HSV-2 is rare.

Outbreaks of herpes labialis are often preceded by a prodrome (early symptoms) that may include itching or tingling. If treated during the prodromal stages with appropriate antiviral medication, progression to the stage where blisters form can often be avoided. Once sores have begun to form, the condition is harder to treat. Herpes labialis can be a painful condition. Fortunately, it will resolve on its own, and the sores generally heal within ten days to two weeks, with the peak of blister ulceration occurring around one week.

Herpes labialis is very contagious, and is one of the most commonly occurring skin lesions. About 75% of adults have the condition, which is not curable. It is spread through direct skin contact, or through oral secretions. Transmission may occur even when no skin lesions are present.

How does the dentist diagnose Cold Sores?

Note: ToothIQ.com contains general information. Only a dentist can properly diagnose your specific condition.

The dentist performs an examination of the affected tissues, and arrives at a diagnosis on the basis of location, appearance and history of the lesion(s).

It is important to distinguish cold sores from canker sores which are not of viral origin (canker sores are believed to be auto-immune). Treating cold sores with steroid ointments or medications can cause the condition to worsen, as steroids inhibit the body’s immune response.

Cold sores may be distinguished from canker sores in several ways. Cold sores most commonly form outside the mouth—on the lips. When they occur in the mouth, they are usually found on the attached, keratinized (thick, durable) soft tissues on the hard palate and around the necks of the teeth. They are generally smaller in diameter than canker sores, and form blisters before ulcerating.

How are Cold Sores treated?

Cold sores can be treated in a variety of ways with oral medications such as valacyclovir, which is effective in many people if treatment is begun in the prodromal stages. Topical antiviral ointments such as penciclovir and acyclovir can reduce the duration of the lesions slightly, and help to reduce the pain.

The best way to manage herpes labialis is to avoid the type of contact that causes transmission, especially when active or healing lesions are present. Many children contract the condition from parents and grandparents, who show affection to the children by kissing them.

It is important to rule out canker sores, which may be treated with steroid medications (unlike cold sores). Viscous lidocaine gel, or benadryl elixir formulated in a bismuth subsalicylate base to help them adhere to affected tissue, can provide temporary pain relief during the most painful stages of outbreaks.

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Author: Thomas J. Greany, D.D.S. / Editor: Ken Lambrecht

This page was last updated on March 2, 2018.

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