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Fever Blisters:
In ancient Rome, and epidemic of fever blisters prompted Emperor Tiberius to ban kissing in public ceremonies.  Today fever blisters still occur in epidemic proportions.  About 100 million epidodes of recurrent fever blisters occur yearly in the United States alone.  An estimated 45 to 80 percent of adults and children in this country have had at least one bout with the blisters.

What causes fever blisters?
Fever blisters are caused by a contagious virus called herpes simplex.  There are two types of herpes simplex virus. Type 1 usually causes oral herpes, or fever blisters.  Type 2 usually causes genital herpes,  Although both type 1 and type 2 viruses can infect oral tissues, more than 95 percent of recurrent fever blister outbreaks are caused by the type 1 virus.

Herpes simplex virus is highly contagious when fever blisters are present, and the virus frequently is spread by kissing.  Children often become infected by contact with parents, siblings or other close relatives who have fever blisters.  A child can spread the virus by rubbing his or her cold sore and then touching other children.  About 10 percent of oral herpes infections in adults result from oral-genital sex with a person who has active genital herpes (type 2).  These infections, however, usually do not result in repeat bouts of fever blisters.

Most people infected with the type 1 herpes simplex virus became infected before the were 10 years old.  The virus usually invades the moist membrane cells of the lips, throat or mouth.  In most people, the initial infection causes no symptoms.  About 15 percent of patients, however, develop many fluid-filled blisters inside and outside the mouth 3 to 5 days after they are infected with the virus.  These may be accompanied by fever, swollen neck glands and general aches.  The blisters tend to merge and then collapse. Often a yellowish crust forms over the sores, which usually heal without scarring within 2 weeks.

The herpes virus, however, stays in the body.  Once a person is  infected with oral herpes, the virus remains in a nerve located near the cheek-bone.  It may stay permanently inactive in this site, or it may occasionally travel down the nerve to the skin surface, causing a a recurrence of fever blisters.  Recurring blisters usually erupt at the outside edge of the lip or the edge of the nostril, but can also occur on the chin, cheeks, or inside the mouth.

The symptoms of recurrent fever blister attacks usually are less severe than those experienced by some people after an initial infection.  Recurrences appear to be less frequent after age 35.  Many people who have recurring fever blisters feel itching, tingling or burning in the lip 1 to 3 days before the blister appears.

What causes a recurrence of fever blisters?
Several factors weaken the body's defenses and trigger an outbreak of herpes.  These include emotional stress, fever, illness, injury and exposure to sunlight.  Many women have recurrences only during menstruation.  One study indicates that susceptibility to herpes recurrences is inherited.  Research is under way to discover exactly how the triggering factors interact with the immune system and the virus to prompt a recurrence of fever blisters.

What are the treatments for fever blisters?
Currently there is no cure for fever blisters.  Some medications can relieve some of the pain and discomfort associated with the sores, however.  These include ointments that numb the blisters, antibiotics that control secondary bacterial infections, and ointments that soften the crusts of the sores.

What Can the patient do?
If fever blisters erupt, keep them clean and dry to prevent bacterial infection.  Eat a soft bland diet to avoid irritating the sores and surrounding sensitive areas.  Be careful not to touch the sores and spread the virus to new sites, such as the eyes or genitals.  To make sure you do not infect others, avoid kissing them or touching the sores and then touching another person.

Canker Sores:
Recurrent canker sores afflict about 20 percent of the general population.  The medical term for the sores is aphthous stomatitis.

Canker sores are usually found on the movable parts of the mouth such as the tongue or the inside  linings of the lips and cheeks.  They begin as small oval or round reddish swellings, which usually burst within a day.  The ruptured sores are covered by a thin white or yellow membrane and edged by a red halo.  Generally, they heal within 2 weeks.  Canker sores range in size from an eighth of an inch wide in mild cases to more than an inch wide in severe cases.  Severe canker sores may leave scars. Fever is rare, and the sores are rarely associated with other diseases.  Usually a person will have only one or a few canker sores at a time.  Most people have their first bout with canker sores between the ages of 10 and 20.  Children as young as 2, however, may develop the condition.  The frequency of canker sore recurrences varies considerably.  Some people have only one or two episodes a year, while others may have a continuous series of canker sores.

What causes canker sores?
The cause of canker sores is not well understood.  More than one cause is likely, even for individual patients,.  Canker sores do not appear to be caused by viruses or bacteria, although an allergy to a type of bacterium commonly found in the mouth may trigger them in some people.  The sores may be an allergic reaction to certain foods.  In addition, there is research suggesting that canker sores may be caused by a faulty immune system that uses the body's defenses against disease to attack and destroy the normal cells of the mouth or tongue.

In a small percentage of patients, canker sores occur with gastrointestinal problems, such as an inability  to digest certain cereals.  In these patients, canker sores appear to be part of a generalized disorder of the digestive tract.

Female sex hormones apparently play a role in causing canker sores.  many women have bouts of the sores only during certain phases of their menstrual cycles.  Most women experience improvement or remission of their canker sores during pregnancy.  Researchers have used hormone therapy successfully in clinical studies to treat some women. 

Both emotional stress and injury to the mouth can trigger outbreaks of canker sores, but these factors probably do not cause the disorder.

Who is susceptible?
Women are more likely than men to have recurrent canker sores.  Genetic studies show that susceptibility to recurrent outbreaks of the sores is inherited in some patients.  This partially explains why the disorder is often shared by family members.

What are the treatments for canker sores?
There are several treatments for reducing the pain and duration of canker sores for patients whose outbreaks cannot be prevented.  These include numbing ointments such as benzocaine, which are available in drug stores without a prescription.  Anti-inflammatory steroid mouthrinses or gels can be prescribed for patients with severe sores.  Mouthrinses containing the antibiotic tetracycline may reduce the unpleasant symptoms of canker sores and speed healing by preventing bacterial infections in the sores.  clinical studies at the National Institute of Dental Research have shown that rinsing the mouth with tetracycline several times a day usually relieves pain in 24 hours and allows complete healing in 5 to 7 days.  The U.S. Food and Drug Administration warns, however, that tetracycline given to pregnant women and young children can permanently stain youngsters teeth.  Both steroid and tetracycline treatments require a prescription and care of a dentist or physician.

Patients with severe recurrent canker sores may need to take steroid or other immuno-suppressant drugs orally.  These potent drugs can cause many undesirable side effects, and should be used only under the close supervision of a dentist or physician

What can the patient do?
If you have canker sores, avoid abrasive foods such as potato chips that can stick in the cheek or gum and aggravate the sores.  Take care when brushing your teeth not to stab the gums or cheek with a toothbrush bristle.  Avoid acidic and spicy foods.  Canker sores are not contagious, so patients do not have a worry about spreading them to other people.