Cold Sores

Aug. 1, 2001
New developments in remedies help patients cope with the discomfort resulting from the recurrence of oral infections.

New developments in remedies help patients cope with the discomfort resulting from the recurrence of oral infections.

by Connie L. Sidder, RDH

I have practiced dental hygiene long enough to remember when gloves were not worn. Then came HIV-positive and AIDS, and we now are gloved all of the time. During the early days, though, the scariest patients I treated presented with active cold sores. (Fever blisters, by any other name, are still cold sores.) I would check my hands thoroughly for any skin lesions or cuts before proceeding. I would reschedule if at all possible. Also, the appointment was uncomfortable for the patient if the sore cracked or bled, thereby lengthening the healing time.

Everyone is at risk for the herpes simplex virus, the medical term given to cold sores. The virus enters through broken skin or the mouth. Children are often infected before the age of four or five. It can be transmitted by kissing or simply by sharing eating utensils or water bottles with a person experiencing a cold sore outbreak.

Cold sores (or HSV-1, for herpes simplex virus-1) are a common cause of infections of the skin around the lips and mucous membranes. The word 'herpes" is derived from the Greek word 'herpein," which means 'to creep." Herpes lesions characteristically are formed by tiny blisters grouped together on an inflamed base. HSV is one of the most difficult viruses to control and has plagued mankind for thousands of years. There is no known vaccine. The viral particles are carried by nerve cells, and they can remain inactive for long periods of time.

It is not known how the virus is triggered, but a number of factors may be involved, such as sunlight, wind, fever, local physical injury, menstruation, suppression of the immune system, or even emotional stress. Looking at this list, one might surmise that there is a constant threat for developing an HSV-1 outbreak. In other words, if you harbor the virus, you will get a cold sore again eventually.

Our office used to recommend l-lysine tablets, an amino acid, which are easily obtained in any grocer's vitamin section. Many people, who used to have monthly episodes, found l-lysine helpful in reducing the number of outbreaks annually.

Symptoms of the infections vary during the three stages: the primary outbreak, latency, and recurrence. The primary infection is usually more severe than recurrent episodes and may last up to two or three weeks. It begins as a swelling of fluid accumulation, which often is accompanied by a tingling sensation. This is followed by small, grouped blisters, which can break open and cause more discomfort. Over the course of the outbreak, the blisters dry up and heal. The scab is shed, and healing takes place with no scarring. The virus is not transmissible during the latency period, before the scab comes off.

So, how can we help our patients affected with HSV-1? Most people have tried everything, right?

The first antiviral cream to be approved for cold sores was Denavir, which is available by prescription only. It has been shown to heal HSV-1 sores an average of one day faster than without treatment. For that, it needs to be applied during the first hour of symptoms and every two hours for four days. One could also apply a lubricant, such as Campho-Phenique, Orabase-B, Orabase-Gel, or Zilactin. Zilactin also adds an anesthetic. An active ingredient of 10 percent alcohol is for a drying effect. The difference is that the antiviral properties of Denavir should help control the virus.

Then another antiviral, Zovirax, was introduced (and only approved for HSV-2, genital herpes). The problem with antivirals, as with antibiotics, is that they may result in viral resistance to the medications. Zilactin, with its anesthetic effect, helps lessen the pain involved with a cold sore. It is comforting, but it does not shorten the duration of the infection.

In addition, I recently discussed cold sore medications with a pharmacist, and he alerted me to a new over-the-counter remedy that has gained in popularity. Abreva is the first FDA-approved cold sore medication to actually speed healing. Instead of attacking the virus, as Denavir does, Abreva contains 10 percent docosanol cream which blocks the virus from entering adjoining cells (remember, herpes was once defined as 'creeping"). The medication offers hope of effectively lessening the severity as well as the duration of the HSV-1 sore.

We should feel empowered to offer patients information about over-the-counter and prescription products that really help. For example, I recently suggested the possibility of Abreva to a patient who complained of frequent cold sores. As it turned out, she, too, had heard of Abreva, but the pharmacy she visited was sold out — a positive sign for a remedy.

Although we still need to take precautions when treating patients with active HSV-1 lesions and take care not to open the sore, at least we can offer help by informing them of new developments. There is always something new on the horizon. I'll keep you posted.

Connie L. Sidder, RDH, is based in Fort Collins, Colo. She can be reached at (970) 482-4649 or consider@home. com.