Cold Sores, Fever Blisters

"Cold sores," also known as “fever blisters” are actually oral diseases caused by a group of viruses called herpes viruses. The more common “fever blister” type that is reoccurring and more persistent is called herpes labialis (lips). This type of the herpes simplex virus is usually asymptomatic (no symptoms) and lies dormant (sleeps) in nerve endings. But certain stimuli, such as sunlight, fatigue, fever, emotional stress, or menstruation can cause the virus to “wake up” and trigger an outbreak.

Everyone is at risk for herpes, including children, many of whom are already infected by three years of age. Studies suggest that by adolescence 62% of Americans are infected with HSV-1, and by the time one is in their 40s, 90% have been infected. Primary herpetic gingivostomatitis is the initial or first outbreak of herpes labialis, and most commonly occurs in children between the ages of 6 weeks to 6 years, although it can occur in anyone who has not been previously exposed to the herpes virus. Usually, a person coming down with this type of herpetic infection has fever, discomfort, headache, swollen lymph nodes in the neck, and may have a sore throat. These early symptoms are followed by very red, swollen gums and lips, and the appearance of blister-looking sores inside the mouth or on the lips. These ulcers are very painful, and often a child with primary herpes will not eat or drink. These deficiencies can become critical in small children and infants, and can lead to hospitalization (for dehydration), if not careful. These ulcers will spontaneously heal in 1-2 weeks, and only 20%-40% of the population will have recurring outbreaks.

The most important thing to remember is that the herpes virus is contagious! It can be transmitted from mother to child, person to person, or it can spread from the mouth to other body parts, such as genitals, fingers (herpes whitlow) and eyes (ocular herpes). It can also spread from kissing, shared eating utencils, lip balm, razors, and towels. It is important not to touch an active sore, and then someone else or another part of the body. After touching a sore, wash your hands! It is also recommended that dental appointments be postponed after an outbreak, and rescheduled for when the ulcers have healed.

Sources: Esther M. Wilkins, Oral Pathology for the Dental Hygienist, ed. 9, Boston, MA., 2005, Lippincott Williams & Wilkins.

Michele L. Darby & Margaret M. Walsh, Dental Hygiene Theory and Practice, ed. 2, St. Louis, MO, 2003, Saunders.

Links:
http://www.mayoclinic.com
www.aocd.org
www.thenakedscientists.com
www.medlineplus.org
www.healthcite.com
www.aad.org

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