Cold Sores - Herpes. Call them what you will. They're a nuisance.

cold sores, canker soresCold sores are the bane of many people's lives. They aren't there when it doesn't matter, then erupt at the most inopportune moments. What can you do to control them?

Most cold sores are cause by a virus called herpes simplex virus type 1 (HSV-1). In most cases, the virus is passed on in early childhood when a child is kissed by a person with a cold sore, such as a family member. The virus goes through the skin and travels up the nerves, where it lies dormant (inactive) until it is triggered at a later date. Classically, dentists were taught that we would see unwell children up to the age of five years old with a mouth full of ulcers and a high temperature - this initial infection is called Primary Herpes - and it can be very unpleasant.primary herpes, cold sores, canker sores I have to say that I used to see cases of primary herpes infections quite regularly in very young children, but in recent years the cases I've seen have tended to be older.

Look how sore this lip is, and note how the gum around the teeth is raw (this is called gingivo-stomatitis).

Once the initial infection is over, the virus "goes to ground". It lurks in the trigeminal nerve (the nerve that supplies, amongst other things, the teeth and lips). Later in life, it may, but not always rear its ugly head and revisit the nerve endings in the lips or nose - the cold sores that we are all familiar with.

There are several different factors thought to trigger outbreaks of cold sores. These vary from person to person. Essentially the virus waits until your immune system is busy dealing with something else and then takes the opportunity to party. If you're unfortunate to have a poor immune system (immunocompromised), then the severity of the cold sores may be much worse.

Here are some of the triggers:

  • Emotional upset or psychological stress
  • Fatigue and tiredness
  • Trauma to the affected area
  • Strong sunlight
  • Menstruation (periods)

If we're honest there's not a great deal we can do to avoid the triggers apart from avoiding being smacked in the mouth! We CAN, however, avoid strong sunlight to the lips. Time and again I've seen people return from a holiday ruined by a face full of cold sores. Ultraviolet light is irritant. That's why we go red after exposure to UV (sunburn). sun block, SPF50That's why we get skin cancer. That's why we age prematurely if we're exposed to too much sunlight. And that's why we should wear sunblock on our lips when on holiday. Stop the UV getting to your lips and you'll dramatically reduce your chance of cold sores.

In rare cases, cold sores can be caused by the herpes simplex virus type 2 (HSV-2), which usually causes genital herpes. This can happen if you have oral sex with someone who has genital herpes.

How do we treat cold sores?

The very fact that you're reading this means you need help. Noticed how many alleged cures for cold sores there are out there? Firstly, once you've acquired the virus, it stays with you.

zovirax, acyclovir, aciclovir, cold sore creamWe thought we'd cracked the cold sore problem a few years ago when Zovirax (aciclovir) arrived on the market. It soon became apparent that, if you didn't catch the cold sore at the itchy/burning stage you were wasting your time. So, if you use acyclovir you MUST start using it from the very first signs you are developing a cold sore. And then use the cream five times a day. Miss the start of the cold sore and you're "shutting the door after the horse has bolted". You can buy aciclovir over the counter at pharmacies without prescription. Aciclovir is also available in tablet form.

Next to arrive on the market was penciclovir. Same size tiny tube, same five applications per day, but only available on prescription. Penciclovir seems to work better if you miss the start of the sore. Let's face it, most cold sores develop overnight, or when you're miles away from your tube of cream.

MHRA guidelines on advertising mean that we can't "draw attention to specific prescription only medicines". So, we can't recommend a preferred option or name the product via a web page, so we'd encourage you to visit your dentist and discuss which treatment is best for you.


Implications for dental treatment

It's funny how cold sores have been in and out of fashion in dentistry! Back in the early 80s there was paranoia about the potential for spreading the infection to other people if a patient had a cold sore. So much so that, in the dental school where I trained, a dental chair would be cleaned down with the dental equivalent of Napalm and a large notice stuck on it, stating "HERPES"! Then genital herpes raised its ugly head and the notice was changed to a capital H with a circle around it (to avoid embarrassment for all concerned!)

If we use the concept of Universal Precautions for cross infection, where everyone is treated as though they have everything, this approach hardly fits! 

Slowly, herpes took a back stage as other conditions beginning with H took hold - HIV, Hepatitis B, then Hepatitis C, but increasingly the Profession have had to come to terms with how easily Herpes is spread. And the "circle has been squared" (For a very interesting article on Mercator's Projection, making the round earth square, so it can fit on a map, follow this link). A cold sore is a pool of infection - burst one and it pumps millions of viruses into the surrounding area - so we ask patients not to come for routine dental treatment if they have a cold sore.

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© Hesslewood Lodge Dental Practice, 16/11/15