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Cold sores (also called fever blisters) – are a group of fluid filled blisters which usually appear at the edge of the lips, in and around the mouth (can also be seen on the face,Cold Sores Marielaina Perrone DDS inside the nose, or even the genital area). Cold sores are caused by a viral infection. Cold sores are uncomfortable and unattractive. They usually heal in several days to 2 weeks.

Most cold sores are caused by a herpes simplex virus infection (HSV-1). The skin around the blisters is often red, swollen, and sore. The blisters may break open, leak a clear fluid, and then scab over after a few days. There are also cold sores manifested by the virus that causes genital herpes. These cold sores are caused by another type of the herpes simplex virus called herpes simplex virus-2 (HSV-2) and are spread by sexual contact. Either virus, ( HSV-1 or HSV-2) can cause cold sores on lips, inside the mouth, throat, and genitalia.

Is Oral Herpes Common?

Oral herpes is quite common. Over 60% of Americans have had cold sores, and approximately 25% of those infected experience recurrent outbreaks. Most people became infected before the age of 10. Anyone can be infected and once infected the virus remains latent for life.

The Herpes virus is spread from person to person via direct skin to skin contact. The most obvious time for transmission of virus is during the active phase. This phase begins with the appearance of the blister and ends with the scab formation. The herpes simplex virus usually enters the body through a skin break around or inside the mouth. It is generally spread when a person touches the cold sores or touches infected fluid. This can happen through sharing eating utensils or razors, kissing an infected person. A parent who has cold sores often spreads the infection to his or her child in this way. However, studies have shown that infected persons can also transmit the virus via saliva without the presence of oral lesions. This is because the virus may be present in the saliva. Cold sores can also be spread to other areas of the body.

Viruses are different from bacteria. While bacteria are independent and can reproduce on their own, viruses enter human cells and force them to make more virus. The infected human cell is usually killed and releases thousands of new viruses. The cell death and resulting tissue damage causes the actual cold sores. In addition, the herpes virus can infect a cell and, instead of making the cell produce new viruses, it hides inside the cell and waits. The herpes virus hides in the nervous system. This is called “latency.” A latent virus can wait inside the nervous system for days, months, or even years. At some future time, the virus “awakens” and causes the cell to produce thousands of new viruses that cause an active infection.

 

This process of latency and active infection is best understood by considering the cold sores cycle. An active infection is obvious because cold sores are present. The first infection is called the “primary” infection. This active infection is then controlled by the body’s immune system and the sores heal. In between active infections, the virus is latent. At some point in the future, latent viruses become activated and once again cause cold sores. These are called “recurrent” infections. Although it is unknown what triggers latent virus to activate, several conditions seem to bring on infections. These include stress, illness, tiredness, exposure to sunlight, menstruation, fever, and diet.

 

Cold Sores Marielaina Perrone DDSHerpes Symptoms

Not everyone shows symptoms from herpes. The first symptoms of herpes generally occur between two to 20 days following contact with the virus. Symptoms of the initial infection are usually far more severe than those of recurrent infections. The primary infection can cause symptoms like other viral infections including tiredness, headache, fever, and swollen lymph nodes in the neck.

 

Typically, 50 to 80% of persons with oral herpes experience a prodrome (symptoms of oncoming active disease) of pain, burning, itching, or tingling at the site where blisters will form. This prodrome stage may last anywhere from a few hours to one to two days. The herpes infection prodrome occurs in both the primary infection and recurrent infections. Following the prodrome, the disease process is rapid. First, small red bumps appear that quickly form fluid-filled blisters. The painful blisters may either burst and form a scab or dry up and form a scab. Within two days of the first red bumps, all the blisters have formed scabs. The skin heals completely and without scarring within six to ten days.

 

Children can have a very serious primary herpes infection called gingivostomatitis. This can cause fever, swollen lymph glands, and numerous blisters inside the mouth and on the lips and tongue that may form large, open sores. These often painful cold sores can last 2-3 weeks and can make eating and drinking difficult. This needs to be monitored as dehydration can develop in the younger children.

 

Most people experience less than two cold sore outbreaks each year. Some people never experience cold sores outbreaks, while some have very frequent outbreaks. In most people, the blisters form in the same area each time and are triggered by the same factors.

 

Treatment of Cold Sores

Pharmaceutical Treatment

Cold sores will usually start to heal on their own within a few days. If they become painful or make you feel embarrassed, they can be treated.Prescription  treatment may be used during the prodrome stage to stop or markedly decrease size and duration of colds sores. These treatments  include skin creams, ointments, or sometimes pills. Other over the counter treatments may get rid of the cold sores only 1 to 2 days faster, dry them out, or help ease painful blisters or other uncomfortable symptoms. Prescription treatment consists of the use of antiviral drugs such as Acyclovir (Zovirax), Famciclovir (Famvir) and Valacyclovir (Valtrex). Acyclovir is the drug of choice and can be

Cold Sores Marielaina Perrone DDS

given as an injectable, by mouth, in pill form, or as an ointment. Acyclovir is effective in treating both the primary infection and recurrent outbreaks. When taken by mouth to prevent an outbreak, acyclovir reduces the frequency of herpes outbreaks.

Other treatments include topical antiviral creams and ointments, such as penciclovir (Denavir) cream. Some research demonstrates that penciclovir appears to reduce the
average size and duration of cold sores.

Penciclovir reportedly is best used as quickly as possible after symptoms (pain, tingling, itching, burning or blisters) begin to appear. Although the recommended dose varies with the individual, the average adult dose calls for applying the cream to the affected areas every two hours, while awake, for four days.

Alternative Treatments

Diet

Eating a healthy well balanced diet is believed to keep cold sores at bay.

-Imbalance of Amino acids Lysine and Arginine. A diet rich in amino acids may help prevent recurrences of cold sores. Herpes sufferers want to increase intake of lysine and decrease intake of arginine. Lysine is found in most vegetables, legumes, fish, and turkey. Arginine rich foods that should be avoided include chocolate, peanuts, almonds, as well as other nuts and seeds.

-Avoid alcohol, caffeine, and sugar.

Vitamins

Vitamins helpful in reduction of cold sore outbreaks:

-Vitamin C and bioflavonoids have been shown to reduce the duration of a cold sore outbreak as well as reduce the number of sores produced.

-Vitamin B complex can give support to the nervous system where viruses can hide out. B complex vitamins can also help manage stress, an important contributing factor to the outbreak of herpes viruses.

-Vitamin E. Applying the oil in vitamin E capsules directly to cold sores may provide relief of symptoms.

-Zinc lozenges are known to enhance the immune system as well as affect the reproduction of the herpes simplex virus.

-Ointments containing lemon balm or licorice and peppermint have been shown to help cold sores heal faster.

Newer Treatments

Cold Sores Marielaina Perrone DDS-Xerese. This is the only FDA approved pharmaceutical agent that can prevent the progression of cold sores.  It has been proven to reduce the likelihood of ulceration along with faster healing and improved symptom relief. It is also the only medication that is antiviral and anti-inflammatory(contains steroid). Only recommended for 12 years and older.

-Lip Clear Invisible Bandage. This is a clear bandage that is applied directly to the cold sores. This protects transmission of sore while active, can be used as a concealer, and promotes faster healing.

-Viroxyn Professional – This is a single application cold sore treatment available only thru dentists and physicians. Viroxyn contains 7.5% Benzocaine to numb the cold sores site along with an antiviral ointment. The dual action application will begin healing of the site almost immediately. Removing pain or discomfort as well as promoting faster healing. A typical cold sore last about 10-12 days but with proper use Viroxyn has been shown to reduce that time down to as little as 3 days.

Cold Sores Conclusion

As of today there is no cure for the herpes simples virus. After you get infected, the virus stays in your body for the rest of your life. If you get cold sores often, treatment can reduce the number of cold sores you get and how severe they are. It is important to be aware of the symptoms so as not to infect your loved ones. With diligent care and treatment, cold sore numbers and events can be reduced in time so your life is not adversely affected.



Oral cancer affects approximately 40,000 people in the United States each year. Oral Cancer kills one person every hour, every day totaling about 8,000 deaths per year. Only a little more than half of those 40,000 diagnosed, will be alive in 5 years. This is a number that has stayed steady for quite a number of years. Around the world, the problem is even greater with about 640,000 new cases of oral cancer each year. Historically, the death rate for oral cancer is higher than in cancers such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, testicular cancer, and endocrine system cancers (thyroid).

While not all oral lesions become malignant, the majority are removed surgically. The key is to find lesions as early as possible. One of the more effective ways for early detection is screening with a velscope. The velscope is a quick painless way to find tumors in the mouth that are not yet visible to the eye.  As many as 1/3rd of patients with cancerous oral lesions experience a recurrence of their oral cancer. Researchers have been studying this issue for years in attempts to figure out why the oral cancer returns and how to either stop it or slow it down or to avoid surgery altogether.

Oral Cancer Study

After more than 30 years of research, scientists at Ohio State University College of Dentistry, might have found a key to give oral cancer survivors hope for the future. That hope lies in a combination of black raspberries and

Velscope oral cancer screening Marielaina Perrone DDS

Velscope oral cancer screening system for early detection

fenretinide (a drug that has been used to treat certain cancers, rheumatoid arthritis, acne, and psoriasis, has been found to also slow the production and accumulation of a toxin that leads to vision loss in Stargardt’s patients).

The study conducted consisted of using a topical gel application containing freeze dried black raspberries directly on precancerous lesions in the mouth. This gel application reduced clinical and microscopic premalignant features (Pharmaceutical Research, April 2010, Vol. 27:4, pp. 628-643). Early results have shown definite efficacy of the freeze dried black raspberry gel while the placebo showed no effect.

How Does It Work to Stop Oral Cancer?

The study believes that the berry compounds work at the cellular level by activating two related pathways in the premalignant cells. These pathways are:

-Apoptosis. A genetically determined process of cell self-destruction that  is a normal physiological process. Cells only live and reproduce new cells for a set amount of times until they die. Tumor cells, on the other hand continue to divide and produce without dying off. Normal cells have this ” programmed cell death”, to eliminate  DNA-damaged cells, uncontrolled cell growth, and tumor formation.

-Terminal Differentiation. Final stage of cell division, where the cell may stay in this phase and no longer proliferate (grow more cells).

The benefit of all this, is that damaged cells do not continue to divide and multiply and are therefore sloughed away by the body.

The goal of the research is for the raspberry compound (in a gel or mouthwash), to encourage the epithelium to differentiate, creating a barrier to ward off development of oral cancer. The data initially supports that the black raspberry gel is doing just that. It is thought to be re-educating the cells to differentiate away from the cancerous state.

While the black raspberry gel was quite effective in many of the patients involved in the study, not all of them responded equally well to the black raspberry gel treatment. The theory is that is a direct reflection of individual patient differences in metabolism. So, the researchers added the chemotherapy agent  fenretinide.  The black raspberry gel in combination with fenretinide was more effective, acting as a one-two punch in fighting the oral cancer lesions.

The fenretinide will be delivered as a patch whereas the black raspberry gel can be placed directly on the lesions in the mouth. The theory by the research team is that this will treat both visible lesions and lesions that are yet to develop.

Oral Cancer Conclusion

This could be potentially game changing oral cancer research if the results continue to stay strong throughout the research study. Until the study progresses further, our only hope is to diagnose oral cancer as early as possible. This can be achieved via the use of the Velscope Oral Cancer Screening System. This is a tool that gives the dentist the best chance of diagnosing oral cancer and precancerous tissue as early as possible. Very important to see a dentist using this system and to go for regular dental examinations.