What do you and your patients need to know about cold sores?

In Health by Erinne Kennedy, DMD, MPH

Everyone knows someone who suffers from cold sores. They are painful, embarrassing and, go figure, they typically arise just when you have a big event coming up … your daughter’s wedding, a family vacation in the Bahamas or when you start a new job. Link

The cause of cold sores is the herpes simplex virus 1 (HSV-1), a virus which is most likely contracted during childhood or adolescence by kissing, sharing utensils, or by some other form of physical contact with an infected person. Once a person had the virus they will have it for the rest of their life. The herpes virus travels along nerve endings which is why it reoccurs in the same areas. It is also very contagious, which is why it’s important to limit the spread of the virus. Many patients don’t realize how debilitating this virus can be if it is spread to the eye or to young children. The great news is as dental professionals, we can help to reduce outbreaks and keep from proliferate viral spread.

The symptoms of the first infection are flu-like and last for approximately seven days. (reference). The secondary infection can recur and causing flare-ups throughout life. Common triggers for recurrent episodes include sun, stress and trauma, and most patients are acutely aware of their specific triggers.

How can the dental team help? There are three steps to helping dental patients deal with herpes lesions.

1. ASK

During the initial comprehensive exam, I always ask, ”Do you ever develop any sores on your lips or in your mouth?

Gathering information to help your patient with their overall health is so important. It shows that you care, that you are informed and that you are your patient’s advocate. If they have a history of cold sores, be sure to ask some follow-up questions.

Do you know why you have these sores? This question gives you an opportunity to educate your patient and help determine etiology and make an accurate diagnosis.

How often do you have cold sores?

What treatment do you use?

Do you recognize the feeling or sensation in the affected are when you are about to get a cold sore?

What do you do to prevent cold sores?


Work with your patient to figure out WHY they get the cold sore. For many, it is the same reason over and over.

Do you know the common event that causes these sores?
• Fever or other illness: Even a cold or flu can be made even worse with a cold sore!
• Excessive sun exposure or sunburn: Watch out vacation!
• Stress skin abrasions: Dry, chapped, cracked or irritated skin can be a susceptible target.
• Surgery or other trauma, even including dental surgery: The pressure of the explorer or the trauma of the injection can be enough to trigger a cold sore.
• Menstrual periods
• Medications, such as corticosteroids, that weaken the immune system
• Life stress: Weddings, work/job changes, children, college etc. All of these can trigger an outbreak of the herpes virus.


The goal with cold sores is like anything in life: prevention, prevention, prevention. If you do have an outbreak, the sore will generally heal in 7-10 days. I try to encourage my patients to wear a lip balm with SPF 30 when they are in the sun (exercising, snow sports and beach time), to try to reduce stress and to replace their toothbrush after an outbreak! During an outbreak, I ask my patients to not share utensils, cups, kisses, ChapStick or anything that touches the sore with loved ones.

There are two ways to reduce recurrence: drugs and laser treatments. Many times, patients have the sore in the exact same spot, and the more times this spot is treated with either antiviral medication or a laser the less likely they are to have the sore recur in that spot. It’s great to bear in mind that sometimes this can take many treatments.

Most patients feel a sore coming on Friday night at midnight, when they land in Mexico for a vacation or right before a big holiday. For these occurrences, I tend to prescribe oral anti-viral drugs with a few refills. I tell the patient to keep one bottle either at home or in their travel case at all times so that when they feel the tingly sensation (prodrome), they can start the medication immediately (reference). The earlier they start the medication, the more effective it is. (reference)

For elderly patients, it is common to use laser treatment since there are minimal side effects. Research shows that the laser does not completely eradicate the virus or its recurrence, but is decreases the intensity of the pain and the length of the sore. (reference)

Prevention is the key in helping patients alleviate and reduce the presence of cold sores. Communicating and asking your patients will help educate them and their families. Working with your patients as a team will allow you to help them improve their health long term.