Both of these conditions
cause small sores to develop in or around the mouth, and often are confused with
sores occur inside the mouth.............. cold sores usually occur
outside the mouth!
occur only INSIDE the mouth-on the tongue and the inside linings of the
cheeks, lips and throat. They are small ulcers with a white or gray
base and red border. They are common and often recur. They are NOT
CONTAGIOUS and are caused by bacteria.
Fever blisters are painful
fluid filled blisters or "cold sores"
that usually occur
OUTSIDE the mouth-on the lips, chin, cheeks or in
and on the nostrils. If they do occur
inside the mouth, it is usually on the gums or the roof of the mouth.
Inside the mouth, fever blisters are smaller than canker sores, heal more
quickly and often begin as a blister. About 50%**80% of the population have the virus
(HSV1), which hides in the nerve cells of our face.
They are VERY contagious. Cold sore virus
infects up to 90% of those older than 50**. Only
20-40% of those infected develop the sores. The others
can transmit the virus but never experience symptoms. They usually do not
last longer than two weeks. If a cold sore appear
inside the mouth, usually it appears on the non-movable
parts such as the roof, rather than the tongue or soft
Fever Blisters or Cold Sores
caused by a
contagious virus called herpes simplex. There are two types of herpes
Type 1-95% of recurrent fever blister
outbreaks are caused by this virus
80% of the population
carry HSV-I infection
Type 2-genital herpes 5-10% of the cases
Most people get infected
during infancy or childhood from an infected family member
or friend. This is when the worst symptoms are
experienced.** After the sores heal the virus slips
into nerve cells in the skin and lie dormant until something
weakens the immune defenses and awakens the virus.
Due to the societal
revolutions both virus are found in the mouth.++
Herpes simplex virus is highly
contagious when fever blisters are present and is frequently spread by
kissing. Most people with type 1 virus become infected before the age of
10. It is not caused by exposure to germs but results of a reactivation of
dormant viruses in the body.
of a Cold Sore:
Day 1: Tingle (itching or
burning sensation beneath the skin) Stage-occurs BEFORE the cold
sore has formed, usually around the mouth or base of the
nose. Applying anti-viral medication during this stage can
help alleviate cold sore symptoms.
Day 2: Blister Stage-a day
or two after the warning signal of tingling an outbreak of fluid filled blisters
Day 3: Ulcer or weeping
stage-is the most contagious and painful stage when the blister
rupture, leaving a shallow reddish open sore.
Day 5-8: Crusting
Stage-blisters dry up and form a yellow or brownish crust and eventually
fall off. During this stage it is important to care for the scab
so it will not crack or break.
Day 9-12: Healing Stage-a series
of scabs will form on the lesion and eventually flake off.
Each new scab will be smaller than the one before until the cold
sore heals, usually without scarring.
In initial infection for
most people have no symptoms. 15-30%, however, develop:
Fluid-filled blisters inside and outside
their mouth 3-5 days after they are infected (this fluid is full of viral
Swollen neck glands
Blisters merge than collapse
A yellowish crust forms over the
Healing occurs within 2 weeks without scaring
This virus stays in the body
Recurring blister tend to erupt at the
outside edge of the lip/edge of nostril
Recurrent fever blister attacks are less
sever than the initial infection
Recurrences appear less after age 35
a person has a primary herpes
infection the virus stays in the
body and may cause recurrent
Cause for a
of fever blister:
Injury to the mouth
Exposure to sunlight
Menstruation or pregnancy
Skin trauma around lips due to shaving
Some medication will
relieve some of the pain and discomfort associated with the sores. There
is no cure.
what you can do:
Antibiotics to control secondary bacterial
Ointments to soften the crusts of the sores
Keep blisters clean and dry to prevent
Eat a soft, bland diet to avoid irritating
Do not touch the sores and spread the virus
to new sites
Avoid kissing others
or touching the blisters
and touching others, this will infect others
Sunscreen on lips can prevent sun-induced
recurrences of herpes
factor of 15 or higher
frequently during sun exposure
Reduce stress in life
Avoid sexual contact
including oral sex which can transmit the virus to the
A diet that is high in
lysine and low in arginine has been found to be helpful. In vitro studies indicate that the amino acid arginine
is required by the herpes virus to replicate. Since
lysine competes with arginine for intestinal transport, a diet rich in
lysine (brewers yeast, legumes, dairy, wheat germ, fish and meat)
and low in arginine may have an antiviral effect. Chocolate,
peanuts and almonds are high in arginine and should be avoided. Herpetic
ulcers outbreaks may be lessened or prevented by
antivirals or by taking Lysine.
using Tooth and Gum
Toothpaste and/or Squigle - Both are sodium lauryl
Try over-the-counter products such as
anesthetic skin creams containing benzocaine like Nupercainal.*
Try pain relievers such as
acetaminophen or ibuprofen. They will ease the discomfort but
will not help healing the sores.
Replace your toothbrush.
Shave with a
disposable razor during outbreak.
If the sores do not heal in 14 days
contact your doctor.
If you have more than 6 outbreaks a
year, ask your doctor about taking Acyclovir regularly. It can
reduce the number of episodes by up to 80%*
~ Use Viroxyn. Click here to get
information about Viroxyn, the single dose one application cold sore
medicine: Viroxyn, cold sore
treatment. It stops the pain in minutes and stops the swelling and
destroys the growth of the virus.
Orajel Mouth Aid orajel.com; Phenol.
Herpecin-L chatteminc.com; Pure Lip
Solution Pack (Zinc); Tannic Acid.
Abreva (Allotonin) it is docosanol cream to
accelerate healing smithklinebeecham.com; Carmex
Bees.com (zinc oxide)
Herbal Remedies Tea
liquid medication ~
Supplemental: Herpetrol Tablets; Lysine, an over the counter
supplement, may reduce outbreaks in some people.
Remedies: Ice, tea bags, or petroleum jelly
Medications: Famvir (famcyclovir) Valtrex (valcyclovir)-
500mgm; 4 tabs stat then 4
tabs 12 hrs later
Drugs for Cold Sores
(faster healing in days)
||Twice a day for 1
||Twice a day for 7
||Most expensive, with no
||Twice a day
indefinitely for prevention
||Use for prevention, not
recommended for treatment
||Every 2 hours
while awake for 4 days
||Lease expensive of drugs that
may work best. May be more effective than
others when started late.
||Five times a day
until sore heal
||Least expensive but may be
slightly less effective
Reports on Health Pg 10 10/05
that these lesions are contagious and you must practice good
hygiene during attacks.
Click here to learn
about Canker sores....
is a unique approach to treating cold sores/fever blisters.
For most people, Viroxyn is a single-application treatment, and
has been proven to shorten the duration of outbreaks from 10 days
to three to four days. Many patients report pain relief within
minutes of application.
The active ingredient in Viroxyn is
considered by the FDA to be safe and effective when used as a
germicidal treatment of open skin wounds. Viroxyn is applied
topically, and works by acting directly on the mature virus.
Emotional stress (60
percent) was reported by patients to be the most common
trigger, and pain or discomfort (81 percent) was their primary
concern. Acyclovir ointment was the most common antiviral drug
recommended or prescribed by health care professionals (60
Treatment Modalities and Medication
Recommended by Health Care Professionals for Treating Recurrent
Herpes Labialis - Raborn G.W., Chan K.S., Grace M. JADA January
Herpes simplex and aphthous ulcerations: presentation,
diagnosis and management; Dr. Sciubba ; General Dentistry pg 510-515 January
Ulcer Management; Ms McManus, Ms Pittman, Dentistry Today pg 47-51 January
Cold Sore, AGD Impact Fact Sheet, pg 26
*Source: Consumer Reports on Health
Feb 2001 and National Institute of Dental Research.
** Academy of General Dentistry, Plant Aloe Vera: Relieve a Cold.
~Common Mouth Sores, JADA, Vol. 132, November 2001
~~We have NO financial interest
in this product.
February 06, 2008
Services Patient Education