Cold sores and canker sores, although they may look similar and cause comparable discomfort, are actually completely different conditions. Each has different origins and therefore particular ways they can be treated or prevented. 

One of the best ways to determine if a lesion is a canker or a cold sore is to see where it occurs. Cold sores tend to occur on keratinized tissue such as the outer lips, gums, palate and tongue; canker sores tend to favor areas of non-keratinized tissue such as inside the lips, the cheeks and underneath the tongue. Because they have different etiologies, each type of lesion needs to be treated differently.

Cold sores are ulcerations that are caused by the HSV-1 virus. The CDC reports that about half of the people in the USA aged 14-49 have this virus. It is very common and lays dormant in the body until an outbreak is triggered. Common triggers include stress, trauma, sickness or even sunlight. Some people who have the virus rarely, if ever, can experience outbreaks, while others can get them frequently. Some research has linked high levels of arginine, a common amino acid found in nuts, seeds, some meats, and legumes, with an increase in cold sore outbreaks. Limiting food with arginine may help decrease the occurrence of flare-ups. 

If severe or constant, cold sores can be treated by taking an antiviral medication prescribed by a doctor. The medication can be taken at the onset of symptoms or preventively if outbreaks occur often. If an antiviral is not an option, lysine, another amino acid has also shown to be helpful in preventing or lessening the occurrence of cold sores and can be taken as a supplement. One thing to remember is, the HSV-1 virus can be passed relatively easily via saliva, especially during an outbreak. Take care not to share cups or utensils or kiss others with cold sores as these are the common ways the virus is passed on. 

Canker sores, on the other hand, are not caused by a virus, however, the actual cause is not fully understood. Some research has shown it may be related to vitamin deficiency, particularly vitamin B-12. Stress and trauma to the oral tissue can also be associated. Treatments are usually palliative (pain reducing) in nature. Numbing agents such as Canker Cover can help desensitize the area while it heals. Warm salt water rinses may also help speed recovery. If a person is susceptible to frequent canker sores, taking a B-12 supplement may be helpful for prevention. Since canker sores are not due to a virus or bacteria, they cannot be passed between people.

Some people experience cold sores or canker sores to the point where they affect daily life. If you’ve never had either of them, consider yourself lucky. At least now you know options for treatment and prevention. 

Dr. Nick is with Palm Desert Smiles and can be reached at (760) 568.3602.

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