Cold Sores

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Signs and symptoms

Herpes infections often show no symptoms; when symptoms do appear they typically resolve within two weeks. The main symptom of oral infection is inflammation of the mucosa of the cheek and gums—known as acute herpetic gingivostomatitis -- which occurs within 5–10 days of infection. Other symptoms may also develop, including headache, nausea, dizziness and painful ulcers—sometimes confused with canker sores—fever, and sore throat. Primary HSV infection in adolescents frequently manifests as severe pharyngitis with lesions developing on the cheek and gums. Some individuals develop difficulty in swallowing (dysphagia) and swollen lymph nodes (lymphadenopathy). Primary HSV infections in adults often results in pharyngitis similar to that observed in glandular fever (infectious mononucleosis), but gingivostomatitis is less likely.

Recurrent oral infection is more common with HSV-1 infections than with HSV-2. Symptoms typically progress in a series of eight stages:

• 1) Latent (weeks to months incident free): The remission period; After initial infection, the viruses move to sensory nerve ganglia (Trigeminal ganglion), where they reside as life-long, latent viruses. Asymptomatic shedding of contagious virus cells can occur during this stage.
• 2) Prodromal (day 0-1): symptoms often precede a recurrence. Symptoms typically begin with tingling (itching) and reddening of the skin around the infected site. This stage can last from a few days to a few hours preceding the physical manifestation of an infection and is the best time to start treatment.
• 3) Inflammation (day 1): Virus begins reproducing and infecting cells at the end of the nerve. The healthy cells react to the invasion with swelling and redness displayed as symptoms of infection.
• 4) Pre- Sore (day 2-3): This stage is defined by the appearance of tiny, hard, inflamed papules and vesicles which may itch and are painfully sensitive to touch. Eventually, these fluid-filled blisters form a cluster either on the lip (labial) tissue, the area between the lip and skin (vermilion border), and can occur on the nose, chin, and cheeks.
• 5) Open Lesion (day 4): This is the most painful and contagious of the stages. All the tiny vesicles break open and merge to create one big, open, weeping ulcer. Fluids are slowly discharged from blood vessels and inflamed tissue. This watery discharge is teeming with active viral particles and is highly contagious. Depending on the severity, one may develop a fever and swollen lymph glands under the jaw.
• 6) Crusting (day 5-8): A honey/golden crust starts to form from the syrupy exudate. This yellowish or brown crust or scab is not made of active virus but from blood serum containing useful proteins such as albumin and globulins. This appears as the healing process begins and should not be scraped or picked at. The sore is still painful at this stage but more painful, however, is the constant cracking of the scab as one moves or stretches their lips, as in smiling or eating. Virus filled fluid will still ooze out of the sore through any cracks.
• 7) Healing (day 9-14): New skin begins to form underneath the scab as the virus retreats back into latency. A series of scabs will form over the sore (Called Meier Complex), each one smaller than the last. During this phase irritation, itching, and some pain are common.
• 8) Post scab (2–14 days): A reddish area may linger at the site of viral infection as the destroyed cells are regenerated. Virus shedding can still occur during this stage.^[8]

The recurrent infection is thus often called herpes simplex labialis. Rare reinfections occur inside the mouth (intraoral HSV stomatitis) affecting the gums, alveolar ridge, hard palate, and the back of the tongue, possibly accompanied by herpes labialis.

Herpes labialis infection occurs when the herpes simplex virus comes into contact with oral mucosal tissue or abraded skin of the mouth. Infection by the type 1 strain of herpes simplex virus (HSV-1) is most common, though cases of oral infection by the type 2 strain are increasing. Cold sores are the result of the virus reactivating in the body. Once HSV-1 has entered the body, it never leaves. The virus moves from the mouth to quietly reside (“remain latent”) in the central nervous system. In approximately one third of people, the virus can “wake up” or reactivate to cause disease. When reactivation occurs, the virus travels down the nerves to the skin where it may cause blisters (cold sores) around the lips, in the mouth or, in about 10% of cases, on the nose, chin, or cheeks. Cold sore outbreaks may be influenced by stress, menstruation, sunlight, sunburn, fever, or local skin trauma. Surgical procedures such as dental or neural surgery, lip tattooing, or dermabrasion are also common triggers. HSV-1 can rarely be transmitted to newborn babies by family members or hospital staff who have cold sores; this can cause a severe disease called Neonatal herpes simplex. People can transfer the virus from their cold sores to other areas of the body, such as the eye, skin, or fingers; this is called “autoinoculation." Eye infection, in the form of conjunctivitis or keratitis, can happen when you rub the cold sore, then rub your eyes before washing your hands. Finger infection (herpetic whitlow) can occur when a child with cold sores or primary HSV-1 infection sucks his/her fingers. HSV-1 can infect the genital area by engaging in oral sex with a partner with a cold sore.

Treatment

Acidophilus and yogurt, full of lactobacillus, also helps get rid of cold sores more easily. Its cultures can halt a cold sore from growing if taken right when the sore begins to develop. Acyclovir and penciclovir are used, although the shortening of duration of healing, pain and www.wtnperio.comdetectable virus is, at maximum, one day. Both are nucleoside analogues, being purine analogues of guanine. Furthermore, Famciclovir and Docosanol are in use for treatment against Herpes labialis. Laser therapy is a new option: A single 5 minute 1072 nm narrow waveband light application treatment has been shown to significantly reduce cold sore healing time by 4 days.

Lysine has been found to be effective for decreasing the frequency of outbreaks.

Zinc oxide/glycine cream is an effective treatment for facial and circumoral herpes infection. Zinc sulphate appeared to reduce both the number of episodes and the time to recovery of herpes labialis.

For more information on cold sores and how the PerioLase can help, contact Dr. Todd Welch at

West Tennessee Periodontics and Dental Implants at 731-215-2347.

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