The National Institute of Dental and Craniofacial Research estimates that 500,000 Americans experience cold sores each year. Fewer than 5 percent, according to dermatologist Christina Cernik, M.D., in the June 9, 2008 edition of "Archives of Internal Medicine," develop on the tongue. Those that do typically involve the front two-thirds of the tongue.
Antiviral Drugs
Oral antiviral drugs such as acyclovir, valacyclovir and famciclovir can reduce the duration and severity of cold sores on the tongue and elsewhere. However, the effectiveness of antiviral drugs depends on how quickly the patient starts taking them. Cernik says they are maximally effective when started during the prodrome or premonitory phase of tingling, burning, soreness or sensitivity. They are still effective up to 48 hours after blisters or sores appear. After that, says Cernik, there is no evidence that they have any effect at all, although some doctors will still prescribe them. Topical antiviral drugs have no effect at all on the tongue, probably because they're washed away by saliva before they have a chance to absorb.
Pain Relief
Treating pain plays an important role in cold sore healing, since patients often play or poke at areas that cause pain, resulting in fresh injury to the damaged tissue. Although topical local anesthetics can relieve pain from cold sores on the lips and face, they don't work as well on the tongue. MayoClinic.com recommends over-the-counter oral medications such as acetaminophen or ibuprofen to relieve cold sore pain. MayoClinic.com also endorses cool or warm compresses. Since it's difficult to apply a compress to the tongue, sipping cool, nonacidic fluids such as ice water or apple juice provides an alternative. Food---especially spicy or hard foods---can also provoke pain. The American Academy of Pediatrics patient information website, HealthyChildren.org, recommends a soft, bland diet until symptoms resolve.
Oral Hygiene
Food particles and mouth bacteria can delay healing at best and cause cold sores to become secondarily infected with bacteria at worst. While oral hygiene plays an important role in treatment for fever blisters on the tongue, it can be difficult to perform. In the Feb 2008 edition of the "Journal of Oral Pathology and Oral Medicine," researchers Paolo G. Arduino, D.D.S., M.M.Sc., and Stephen R. Porter, D.D.S., Ph.D., note that tongue fever blisters often produce extreme sensitivity and a white or yellow coating that covers the entire tongue. Patients, the authors say, should only engage in tooth-brushing and flossing over unaffected areas only to avoid causing fresh injuries. Frequent rinses with antibacterial mouthwash non-traumatic cleansing to affected areas.
References
- "Archives of Internal Medicine"; "The Treatment of Herpes Simplex Infections; Christina Cernik, M.D., et al.; June 9, 2008
- "Journal of Oral Pathology and Oral Medicine"; Herpes Simplex Virus Type 1 Infection; Paolo G. Arduino, D.D.S., M.Sc. and Stephen R. Porter, D.D.S, Ph.D.; Feb. 2008
- MayoClinic.com: Cold Sores: Lifestyle and Home Remedies
- HealthyChildren.org: Oral Herpes
