Mouth ulcers are a common presentation to the clinical practitioner. It is resulted from various causes. Cold sores are caused by viral infection, namely herpes simplex virus I. The distinction has to be made between these two conditions precisely as the management is entirely different. This article points out the differences between cold sore and other mouth ulcers with regard to etiology, clinical appearance, laboratory findings and management.
Ulcer
Mouth ulcers are resulted from a multitude of causes commonest being damage to the mouth, cheek or gums from a teeth or a sharp toothbrush or by an accidental bite. Other causes include chemical injuries, bacteria, viruses, fungal, protozoal infections, autoimmunity, oral manifestations of connective tissue disorders, allergy and lack of some dietary factors such as vitamin C, vitamin B12, iron and zinc.
Clinically they are reddish and yellowish in appearance and commonly occur in the mucosa inside the mouth. Most of them are self limiting, resolving within 1-2 days, unless secondary bacterial infection is supervened.
For simple oral ulcers, specific investigation is not needed. Culture from the vesicular fluid may reveal the causative organism. If the oral ulcers occurred in relation to a connective tissue disorder, other clinical features of the respective disease have to be identified.
Most of them are self-limiting, and others should be managed depending on their cause.
Cold Sore
Cold sores are caused by herpes simplex virus I, which causes mucocutaneous lesions predominantly of the head and neck region. The disease is transmitted by infected saliva so that the disease is contagious.
The ulcers mainly appear outside the mouth on the border of the lips, inside over the bone, on the roof of the mouth, on the gum tissue and insides of the nostrils. The lesions are red fluid filled, small and painful blisters. The prodromal hyperesthesia is followed by rapid vesiculation, pustulation and crusting. Usually they heal in 7-10 days.
The diagnosis is made by demonstration of the virus by PCR, electron microscopy or culture from vesicular fluid. Serology is of limited value because it helpful only in confirming the primary infection.
There is no cure for the disease. Antiviral therapy can be helpful to reduce the frequency and the duration of the occurrence. The treatment must be commenced within 48 hours of the clinically apparent disease. Thereafter, it is unlikely to influence the disease course or clinical outcome, although severe manifestations of the disease should be treated regardless of the time of the presentation.
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What is the difference between ulcer and cold sore? • Cold sore is resulted from Herpes simplex virus I while mouth ulcers are resulted by a magnitude of causes. • Cold sores are infectious while oral ulcers are not. • Oral ulcers occur in the mucosa inside the mouth while cold sores appear outside the mouth on the border of the lips, inside over the bone, on the roof of the mouth, on the gum tissue and insides of the nostrils. • Oral ulcers are reddish and yellowish in appearance, but cold sore are red fluid filled, small and painful blisters. • Simple oral ulcers heal in 1-2 days while cold sore takes 7-10 days to heal. • Simple oral ulcers are self-limiting, while there is no cure for HSV, antiviral therapy may be helpful to reduce disease frequency and limit the duration of the occurrence.
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