It is very hard to figure out whether one has a cold sore or a canker sore, since these labels are often used interchangeably. However, there are enough significant differences between the two that a more precise definition of each is warranted. To start off, a cold sore, or a fever blister, has viral origins and therefore is highly contagious, whereas the canker sore, or an aphthous ulcer, is diet and stress-related, and therefore is not contagious. Secondly, a canker sore occurs inside your mouth, on moveable soft tissues of the gums and cheeks, the soft palate, or after one accidentally bites their tongue. A cold sore occurs around the mouth, most frequently on the lips or the corners of the mouth. If a cold sore appears inside the mouth, it can usually be found on the non-movable tissues, such as the roof of the mouth. Both types of sores may take between 10 to 14 days to heal. Therefore, knowing which one of these two is the cause of all the pain and discomfort is the first step to knowing how to treat the problem.

Cold cores are usually very painful, and they tend to recur. They are caused by the herpes simplex, type-1 virus (HSV-1) which lives inside the nerve tissues. Most people are infected with the HSV-1 virus in early childhood from an infected family member or a friend, from an exchange of a kiss, a shared glass or utensil, or other saliva-borne contact. Not all infections lead to an outbreak of the symptoms right away. Sometimes, the virus stays dormant until a trigger sets off an episode.

A cold sore outbreak progresses through several stages and the affected individual is highly infectious during the entire course. A primary infection (the first episode in an individual) can be accompanied by flu-like symptoms, such as a sore throat, high fever, swollen neck glands, and finally, the eruption of the painful mouth sores.

The Stages of a Cold Sore:

Day 1: The Prodromal (pre-outbreak) Stage: before the actual sore forms, a person may experience a tingling, itchy, burning sensation beneath the skin of the affected area. If these symptoms are recognized and an anti-viral medication is applied immediately to this area during this stage, then the actual outbreak of the cold sore symptoms can be minimized, or alleviated.

Days 2 -3: The Blister Stage: the emergence of fluid-filled blisters is the first visible appearance of the cold sore.

Day 4: The Ulcer or Weeping Stage: this is the most painful and most contagious period, when the ruptured blisters ooze, and leave a reddish open sore.

Days 5 -8: Crusting Stage: after the first few days, the blisters dry up and form a crust which falls off eventually. It is very important not to pick off these crusts, or to allow the neighboring areas to crack open, because this can lead to another round of painful new blistering, extending the total length of the cycle.

Days 9 -14: Healing Stage: The scabs that have formed gradually flake off as the tissue heals beneath them. There is usually no scarring of the affected areas from the cold sores.

Cold Sore Outbreak Triggers:

There may be long periods between these viral outbreaks. However, there are several factors which may trigger these episodes. An immunodeficiency, or a weakened immune system caused by an illness, a cold or a flu, menstruation or pregnancy, trauma, such as dental treatment, physical stress or fatigue, strong or prolonged sunlight exposure, or tanning salon ultraviolet lamps can all trigger an outbreak of cold sores.

How to Treat a Cold Sore:

Most outbreaks are mild, and only need topical relief. There are many over-the-counter (OTC) ointments that contain benzyl alcohol as a numbing agent, and other moisturizers to keep the lips moist and prevent further cracking of the lips. These are mostly effective to minimize the discomfort. Antivirals need to be prescribed by your dentist or physician, and are applied topically. They are most effective if applied at the onset of symptoms, when they can reduce the severity or length of the episodes.

How to Minimize Recurrences:

If you are prone to cold sore outbreaks, it is important to consider life-style modifications that may reduce the frequency of these unpleasant outbreaks. Among the most elusive recommendations is to reduce the stresses in one’s life as much as possible. Applying sunscreen to the face and lips and wearing a rimmed hat before outdoor activities in the sunshine will reduce the triggering effect of the sun. In the home, replace your toothbrush often, and especially after an episode, is essential. Avoid kissing, sharing drinks, utensils, or physical contact with others, especially if you see visible signs of sores on the person.

One important consideration for those prone to cold sores is their diet: foods rich in the amino acid lysine, such as red meats, fish and dairy products are recommended. Dietary supplements containing lysine can be substituted. Avoid chocolates (unfortunately), but you can substitute a wide assortment of nuts and raisins in your daily diet.

How to Treat Canker Sores:

The same dietetic considerations have to be made if canker sores recur frequently. The main goal of canker sore treatment is pain and discomfort relief through the application of moisturizing ointments containing numbing ingredients. Most of these can be selected from the wide range of OTC medications available on the market.

For help in properly diagnosing a particular outbreak, please call our office at Watergate Dental Associates and schedule a thorough examination with one of our doctors.