America's Least Wanted

Feb. 1, 2001
Here's the rap sheet on the dreadful ways and means of canker and cold sores.
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Canker Sore
aka: Mouth Ulcer
Clinical terminology: Aphthous stomatitis

  • Modus operandi: Canker sores are loners. They prefer to run their course in the absence of other lesions although, infrequently, small groupings of two or three sores have been known to strike at the same time. Shy by nature, they keep themselves well inside the mouth and out of the limelight.
  • Last seen: On the inside linings of the cheeks and lips, as well as any part of the tongue - most often the sides, the tip, or the underside. Infrequently makes an appearance on the back of the throat. Any nonkeratinized oral mucosa is fair game.
  • Clinical appearance: Canker sores often begin as small oval or round reddish swellings that burst within a day. The ruptured sores are covered by a thin grayish-yellow membrane and edged by a red halo. They range in size from one- eighth of an inch in mild cases to nearly an inch in diameter in severe cases. They generally heal within seven to 10 days. Canker sores are not contagious, and their cause is unknown.
  • Symptoms: Persistent, nagging pain localized at the lesion site. Pain intensifies in the presence of salty, spicy, and abrasive foods. Acidic drinks such as lemonade or orange juice can also aggravate the sore and intensify the pain.
  • Triggers: Numerous factors can trigger an outbreak of canker sores. Trauma is one. Eating certain abrasive foods such as chips, French bread, hard candies, etc., can irritate the oral tissue and create a condition that is conducive to canker sore formation. Overzealous tooth brushing can invite the same trauma. Chewing and biting the insides of the cheeks and lips can also create conditions that predispose canker sore manifestation. Allergies to certain foods, as well as underlying systemic disorders, may contribute to their outbreak, hence the importance of an accurate differential diagnosis. Recent studies suggest that the use of toothpastes containing sodium lauryl sulfate may contribute to frequent canker sore recurrences. Finally, stress has also been linked to canker sore formation.
  • Proven remedies: While there are no cures for canker sores, treatments such as certain over-the-counter medications help reduce the symptoms and reinforce the body's natural healing processes. Because canker sores are essentially open wounds (ulcers) in the oral mucosa, they are extremely susceptible to aggravation by certain foods and beverages. Treatments produce a protective film or barrier to cover the sore and provide relief, as do some gels containing benzocaine for strong discomfort.
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Cold Sore
aka: Fever Blister
Clinical terminology: Herpes simplex labialis

  • Modus operandi: Unlike its partner-in-crime, the canker sore, cold sores like to travel in packs. And they're not shy like canker sores, as they often choose to appear outside the mouth for the world to see and stare, stare, stare.
  • Last seen: On the lips and corners of the mouth - and anywhere in this general vicinity. They can also manifest themselves on intraoral keratinized tissues, such as the hard palate, gingiva, and alveolar ridge - places where canker sores rarely, if ever, roam. That is an important point to remember because intraoral lesions could be canker sores or cold sores. They are both diagnosed by the location and type of mucosa they are infecting. As Herpetiform lesions, cold sores are viral in nature and are highly contagious. They are known to hide in the nerve ganglions when latent, only to reappear at the least opportune times (see Triggers).
  • Clinical appearance: Cold sores begin as small, clear fluid-filled vesicles, accompanied by a little rednesss around the edges. They quickly rupture and become crusted, yellow-brown, and "raw" in appearance. They heal, usually without scarring, within two weeks.
  • Symptoms: Most patients report a slight tingling sensation in the area of the lesion even before any outward signs become apparent. Then, during the vesicle phase, there is rarely any pain. Once the blister breaks and the lesion becomes "open," it is often sore and very painful.
  • Triggers: Once a person is infected with the Herpes Simplex Labialis (Type 1) virus and has suffered through a primary cold sore episode, it is thought that sunlight, hormones, fever, injury and stress can cause future eruptions. Once infected, the virus never leaves the body. It resides in the nerve ganglions, where it remains dormant until triggered into recurrence.
  • Proven remedies: Just like its kissin' cousin, the canker sore, cold sores have no cure. However, the same over-the-counter medications used to treat canker sores can also be used to effectively treat the symptoms of cold sores. Because cold sores are viral, there are also several prescription medications available to treat them at the systemic level. If a patient presents with cold sores, you may suggest an over-the-counter topical medication. You could also suggest that patients see their doctor or ask their dentist, either of whom can prescribe an appropriate antiviral prescription medication that works by inhibiting viral replication.

In a recent survey of more than 65,000 pharmacists, Pharmacy Times rated the top OTC products for:

Canker sores - Zilactin, Herpcin L, OraBase, Anbesol, Campho-Phenique, Gly-Oxide, Kanka, Tanac, and Cank Aid

Cold Sores - Zilactin, CarmEx, Herpecin, Anbesol, Campho-Phenique, Blistex, and Tanac.