80% of the population has been exposed to cold sores or fever blisters (clinically referred to as Recurrent Herpes Labialis), as discussed in a previous e-newsletter on canker sores. However 99% of these individuals don�t know when they had their initial exposure with the virus. Though rare (1% of cases), the first clinical appearance can be an extremely virulent, possibly leading to a hospital stay. This rare episode is known as a �Primary Herpetic Stomatitis�.

The virus otherwise lies dormant in a person for many years. Outbreaks, characterized by lesions, can be triggered by emotional stress, physical fatigue, colds, flu as well as severe lip chapping and exposure to sunlight or ultraviolet light. The lesions are usually found on the skin around or on the borders of the lips, on the roof of the mouth and on the gums. The lesions, though self-limiting, last as long as 14 days.

Unfortunately, there is no cure for these lesions, only palliative therapies. There are prescription medications (oral administration), i.e. Acyclovir and Valtrex* that if taken at the earliest signs of an episode (tingling and burning) will greatly diminish the intensity and duration of the outbreak.

However, if not caught early, there are two new topical over the counter creams Docosanol 10%, Viroxyn and one prescription cream Penciclover (Denavir), which will greatly reduce the pain and duration of these lesions. Denavir seems to be the drug of choice, as it appears to be most effective.

Warm wishes for warmer weather,

*After the initial writing of this newsletter we were advised of a change in protocol by the manufacturer of Valtrex. Previously it was give twice/day (500mg) for five days. The updated regimen calls for only 2 grams (2000mg) twice/day for only one day.

References:
*Nov./ Dec. 2003 General Dentistry Herpes simplex and aphthous ulcerations: Presentation, diagnosis and management�An update by James Sciubba, DMD,PhD
*Jan, .2004 Dentistry Today �Ulcer Management�