Cold sores – everyone needs to know about!

 In the dental setting, we need to be very aware of cold sore infection (Herpes simplex virus (HSV)) and practice infection control measures to prevent the spread of this disease in the dental environment. Cold sore, is a disease that few people want to talk about or simply does not think that it is important but everyone needs to know about.

What is a cold sore?

A cold sore is a small, painful, raised area of small, fluid-filled blisters. They usually happen where the lip joins the surrounding skin. Cold sores are usually found on the lips but you can get them in other places, such as in the nostrils, on the nose or around the outside of the mouth.

How do I get them?

The cold sore virus is very common and is carried by up to 80% of the population. It is caused by a virus called herpes simplex(HSV). Once you have been infected, the virus lies dormant in the nerves that supply feeling to the face and mouth.

What brings on the cold sores?

The virus can subsequently be reactivated, and it is the reactivation that presents as cold sores on the lips. Triggers are important in managing this condition to identify what triggers an outbreak of cold sores. Identifying the trigger is the first step to take towards managing cold sores. These triggers can vary between individuals. Common trigger factors include:

      • Ultraviolet (UV) light exposure.
      • Emotional stress or exhaustion.
      • Common cold, flu or feverish illness.
      • Weakened immune system.
      • Menstruation.
      • Exposure to extreme temperatures or weather conditions.
      • Pregnancy.
      • An injury to the mouth, surgical operation or dental treatment.

The cold sore cycle

There are five different stages:

      • Tingle: This stage normally lasts between a few hours and a day. The cold sore is invisible at this stage but a tingling or burning sensation may be felt.
      • Blister: This stage is characterised by a small group of painful, fluid-filled blisters. These are normally seen on the second day of the cold sore cycle
      • Ulcer: Once the small blisters have burst, a weeping ulcer is seen that may last for several days. This stage is also very painful. The clear liquid that is released from the ulcer contains a high number of viral particles and as such is highly contagious.
      • Scab: After about 4 days a thin scab will form, acting as a protective covering for the new skin that is forming beneath.
      •  Healing: After 9 – 12 days the cold sore will have healed.

Are they infectious?

Yes. Cold sores are infectious and the virus can be passed to other people by close contact or aerosol. A cold sore is most infectious when it is blistering. Reduce the risk of spreading the virus:

      • Try not to break the blisters or pick the scabs.
      • Always wash hands after touching the cold sore or applying medication.
      • Avoid kissing.
      • Do not touch the eyes and take extra care when applying or removing make-up.
      • Do not wet contact lenses with saliva while suffering a cold sore and always wash the hands before touching your lenses.
      • Sharing eating or drinking utensils, such as cutlery and cups, should be avoided, especially with children.

Cold sore and dental visit?

A cold sore is a pool of infection – burst one and it pumps millions of viruses into the surrounding area – so we ask patients not to come for routine dental treatment if they have a cold sore.

At our practice, elective dental treatments are deferred for patients with active lesions as aerosolization of the virus may occur during dental procedures, placing both the patient and oral health care provider at risk for possible infection or re-infection. Elective treatment should be postponed until the lesion has healed completely

Each of us has to keep patient safety and staff safety a priority.

 Can Cold Sores be treated?

 Yes. Antiviral creams, such as aciclovir and penciclovir, ease the pain and blistering and help the sores heal more quickly. You can buy aciclovir from a chemist, but penciclovir(Vectavir) has to be prescribed by your doctor. Both these creams should be applied as early as possible when the cold sore starts to develop and should be applied regularly. Vectavir 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. The antiviral properties of Vectavir should help control the virus. Then another antiviral medicament that can be used is Zovirax.