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Posted on August 15, 2014
Ulcers, Cold Sores, and Bumps

Oral pathology was a subject I loved in dental school, so abstract, so much to remember. I don’t like it so much now; now it happens to real people. For my patient population, I can thankfully say that almost everything I see falls into the category of nuisance, but curable. Since I see a few oral lesions frequently, I thought brief review of them would be a good topic for a blog. With that should come a warning. Nothing having to do with us humans ever presents as black and white, easily categorized or easily described. The internet is a good place to get general health information, but a lousy place to get good health advice. If you have questions, as always call me. If I can’t answer something I know the right person in Fort Collins who can.

Aphthous Ulcer, common name Canker Sore. These very distinct sores are a surface ulcer that is round or oval, white and surrounded by a very red border. The little sores , 1x1mm are often unnoticed, but the usual sized sore, 3x5mm, are extremely painful for about a week after onset. They happen almost exclusively on the moveable tissues of the inside of the mouth: bottom of inside lip, soft palate, underside of tongue or cheek in that order of likelihood. They are thought to be an over-response of the immune system to some irritation or insult to the mouth. Sometimes the cause if obvious like new braces, but most often the irritating agent is unknown. Because they are immune related, they do not respond to any antibacterial or antiviral medicine. Identifying them and treating them palletively, with Tylenol or ambesol, will help in the short term. Some over the counter products that cover the lesions will help for 24-48 hours. Zylactin is one over the counter product, but it stings on application. Older folks may remember cauterizing them with silver nitrate, but that causes excess tissue damage that may scar. Our immune systems are funny things, but one thing usually predictable is getting one Aphthous Ulcer will mean you get them repeatedly. They tend to peak in frequency around puberty. In extreme cases, a steroid rinse ( that suppresses the immune response in your mouth) can be prescribed to lessen the severity and prevent more from occurring. More or less, these bueaties are a bummer but not cause for concern.

Recurrent Oral Herpes Simplex, common name Cold Sore. These sores usually happen on the OUTSIDE border of the lip, start as fluid filled vesicles (tiny blister) that rapidly appear and crust over. They are often preceded by an itchy prodrome on the lip by those who can recognize the feeling. These lesions are from a type of herpes virus that lives inside the nerve cells of the face. Just like herpetic chicken pox infect the nerves of the trunk and comes out later in life as shingles or herpes zoster, once infected with the virus, it stays in your cells forever. There is currently a vaccine for chicken pox, but none for oral herpes. Almost 90% of the population is exposed/ infected by the virus by about age 3-4 (preschool!) and about half the population converts the virus to the chronic condition of infected nerve cells. Most initial infections are like a common cold, but sometimes children can get vesicles all over the inside of their mouth and throat resulting in a very painful week. A variety of antiviral medications have been developed which will lessen symptoms and speed healing from cold sores, but nothing cures the disease, because we can’t get the virus out of the nerve cells. The most common drug, Acyclovir, is generic and comes in a cream (best for young children), liquid (older children), or tablets for adults. A combination of cream and pills can be used and the drug does not cross react with other medications.