Cold Sores (Herpes Simplex I)

Overview

This is a Cold Sore or Herpes Simplex I; note the fluid filled vesicles. This is a highly contagious stage of the outbreak.

This is a Cold Sore or Herpes Simplex I; note the fluid filled vesicles. This is a highly contagious stage of the outbreak.

Cold sores are a recurring viral infection (meaning they come back periodically throughout your lifetime) that appear as fluid-filled blisters (called vesicles) on the outside of the mouth.

How Do Patients Get Cold Sores?

The Primary or Initial Infection

The initial or primary infection is caused by the Herpes Type 1 virus. The virus is highly contagious, and occurs when an infected individual transfers the virus to a mucous membrane or break in the skin. The primary infection usually occurs in childhood or infancy, but it can occur at any time throughout your life. As a primary infection, it can occur without symptoms or present as severe flu-like symptoms of primary herpetic gingivostomatitis such as:

  • Swollen lymph nodes, or lymphadenopathy (limf-ad-en-ah-pah-thee)
  • Fever
  • Severely inflamed gum tissue followed by eruption of fluid-filled vesicles throughout the mouth
  • Foul breath odor
  • Extreme pain and discomfort/difficulty eating
This stage of the Cold Sore appears to be crusting and is less contagious.

This stage of the Cold Sore appears to be crusting and is less contagious.

Recurrent Cold Sores

Following the primary infection, the virus remains in the body and can cause symptoms to recur throughout your lifetime. There is usually a period of time when you are aware that a cold sore is about to erupt called the “prodromal period.” The skin itches and burns with no sign of vesicles.

30% – 40% of all dental patients have recurrent cold sores 3-4 times a year depending on what triggers their outbreaks.1  It appears that stress, excitement, wind, cold, sunburn, the flu, or a cold are all triggers for a recurrence of the cold sores.

It should be noted that cold sores can occur anywhere on your body, although they can more easily occur in mucous membranes (mouth, genitalia). They recur wherever they enter your body. For example, if you scratch a cold sore and your finger has an opening in the skin, the virus could potentially enter the body at this point and recur there in the future. This virus is highly contagious, so care should be taken to avoid touching it until well after a scab has formed. Cold sores are not precancerous.

How Long Does a Cold Sore Last?

Cold sores usually heal in 7-10 days and have the potential to leave a scar that may take months disappear. There are a number of systemic antiviral medications on the market that may help control the recurrent outbreaks. Topical medications may be applied  which may or may not stop the progression of an outbreak. The ingestion of the essential amino acid lysine has also shown to be effective in stopping and/or lessening the severity of an outbreak.

Dental lasers can be used to shorten the duration by stopping the fluid filled blisters from erupting and spreading, creating faster healing.

Cold Sores Misunderstood

The common perception of the cold sore is that they are trivial in nature. These recurrent lesions are highly contagious due to the fluid filled vesicles saturated with the virus.1  Touching the cold sore and transmitting the virus to hands can spread the virus to oneself or others. The cold sore virus is the leading cause of non-impact blindness in the U.S. called Herpes Whitlow; 1.5 million cases are reported each year resulting in 40,000 cases of blindness.2

1. Embil J, Stephens R, Manual R, Prevalence od Recurrent Herpes Labialis and apthous lesions among young adults on six continents, Journal of the Canadian Medical Association, October 4, 1975, Vol 113, p627-630

2. Browning W, McCarthy J, A Case Series, Herpes Simplex Vitus as an Occupational Hazard, J Est. Rest. Dent, 2012 24(1) p. 61-66