Cold sores result from infection with one of two types of the herpes simplex virus, usually type one. In the 2008 edition of "Archives of Internal Medicine," internist Christina Cernik, M.D., reports that 95 percent of cold sores occur outside the mouth, mostly on the border of the lip. Cold sores in the mouth, says Cernik, usually occur during the first outbreak of the virus and rarely recur.
Appearance
Cold sores in the mouth appear as 1- to 2-mm shallow, pink abrasions that may become gray or yellow after three or four days, when they begin to heal. In the 2008 edition of "Harrison's Principles of Internal Medicine," University of Washington Professor of Infectious Diseases Lawrence Corey, M.D., explains that doctors often refer to them as "punch-out lesions" because they exhibit such symmetric, clearly-defined borders.
Location
The most common site for cold sores in the mouth, according to Cernik, is the roof of the mouth. Other sites include the gums, the lining of the cheeks, the tongue and the back of the throat. Cold sores on these sites usually develop after cold sores on the roof of the mouth.
Associated Symptoms
Cold sores are associated with pain described as soreness, burning or aching. Cold sores in the mouth, according to Corey, are often accompanied by fever, swollen lymph nodes in the neck, poor appetite, muscle pain and a generalized sense of malaise. A sore throat can make it difficult to swallow. Young children, in particular, require careful monitoring for dehydration.
Time Frame
The Academy of General Dentistry says cold sores usually appear two to 12 days after a person catches the virus from an infected family member or friend. They usually last between three days to two weeks, longer during the first episode. People with immune system problems and those who take immune-suppressing drugs such as prednisone may experience more severe outbreaks that last longer.
Recurrence
Corey says that 90 percent of people demonstrate evidence of exposure to the herpes simplex virus by the age of 50. Most experience symptoms that are so mild, they do not recognize them. About 30 percent, according to the Academy of General Dentistry, develop recognizable symptoms. These people usually average between one and six recurrences each year; however, most recurrences involve cold sores on the lips or on other sites outside of the mouth.
Treatment
Cernik recommends a one-week course of a prescription antiviral medication such as valacyclovir, acyclovir or famciclovir for cold sores in the mouth. According to Cernik, clinical trials show that these medications reduce the duration of symptoms from an average of nine days to four days in treated patients and produce interim improvements in symptom severity. However, Cernik cautions, the drugs work best when they're started soon after a cold sore appears. After four days, they may not confer any benefits at all.
References
- "Archives of Internal Medicine"; The Treatment of Herpes Simplex Infections: An Evidence-Based Review; Christina Cernik, M.D., et al.; June 2008
- "Harrison's Principles of Internal Medicine, 17th Edition"; A. S. Fauci et al.; 2008
- Academy of General Dentistry: What Are Cold Sores?
- MayoClinic.com: Cold Sore
