PERSONS often consult their dentist, physician or even pharmacist, complaining of having small cold sores in or around their mouth from time to time. They usually recur on the lips, the hard palate, and the gingiva.

The lesion begins as multiple vesicular eruptions that soon disintegrate to form ulcers, varying in size from a few millimeters to a centimeter in width. When large numbers crop up simultaneously and spread throughout the mouth, the condition is called acute herpetic gingivostomatitis. These profuse attacks occur more frequently in infants, and in children under six years of age.
When the lesion occurs on the lips, it is called a cold sore or herpes labialis. Small transparent blisters (vesicles) form, and soon coalesce and rupture, yielding a yellowish fluid that then hardens to form a crust that eventually heals.
Herpes simplex lesions are distinguished from apthous ulcers, which are more likely to occur singly, and are not preceded by vesicular eruptions.
Cold sores are caused by the herpes simplex virus that takes up permanent residence in our mouths shortly after birth. It is most likely passed on to us by our mothers. Thus, the ulcers result, not from a new invasion but from some trauma or change in the tissue that lowers resistance.
Cold sores are so called because the common cold is often the agent that lowers resistance, and brings on the acute attack. Sunburn of the lips is also a frequent precursor to herpes labialis.
Herpes simplex ulcers on the lips are usually preceded by an itching, tingling, or burning sensation. Once formed, they are particularly painful, because of the constant movement of the cheeks and lips containing the sores against the teeth. Even smiling stretches the lips and, likewise, the sore. Eating and toothbrushing hurt, the more so with greater numbers, or larger size of the lesions inside the mouth.
Regardless of the extent of the disease, the lesions become less painful after a few days, and complete healing takes place within two weeks, leaving no residual scarring.
Topical anesthetics in an adhesive base can be applied to the ulcer for temporary relief, but it is difficult to treat any lesions inside the mouth, because of the diluting and washing action of saliva.
Spicy and irritating foods and beverages should be avoided. Soft foods and careful toothbrushing will prevent injury to the healing sores. At present, there are no preventive measures. Cold sores are not known to affect babies.
On the other hand, what certainly affects only babies and children is the emergence of teeth through the gums, called teething. Teething begins at about six months of age, when the baby incisors erupt, and continue until all the permanent teeth have taken their normal place in the mouth.
The pain and discomfort of teething is caused, not by infection but by teeth pushing through the gums. Indeed, the gum becomes inflamed and extremely irritated, not only during infancy teething but even when teeth erupt later in life, such as during the eruption of wisdom teeth.
Infants can chew on teething rings and biscuits to help relieve the symptoms. Baby “gum drops,” available in the local pharmacy, may provide some relief, but all that is usually required is time and patience for the teeth to erupt fully.
Parents should look out for thrush or candidiasis or moniliasis, which is more likely to occur in infants under six months old and the elderly, but will occur in anyone with lowered resistance.
White or grayish-white patches appear on the mucous membranes of the entire mouth — the tongue, lips, cheeks, gums, and throat. Thrush is caused by an overgrowth of the fungus (yeast), Candida albicans, which is normally present in the mouth.
Infant thrush may derive from improperly sterilized bottle nipples or infected breast nipples. It may be a side effect of antibiotics or corticosteroids (oral or nasal/oral inhalants) taken at any age that destroy normal oral bacteria, which feed on the fungus, allowing its proliferation.
Multiple white patches, appearing as curdled milk throughout the mouth, easily identify thrush. If they are scraped off, the raw surface bleeds and is painful. Infants may develop fever and cough, and have difficulty feeding.
Mild cases of thrush are likely to disappear without treatment. The pediatrician or family physician should be consulted for infant thrush, because he or she has more experience treating the disease than most dentists.
Severe cases may require topical application of nystatin, an antibiotic that destroys fungi. If thrush occurs as a consequence of a systemic antibiotic, it usually disappears on cessation of the drug, as the oral flora and fauna return to their normal, symbiotic balance.
More resistant cases require treatment with nystatin or other topical antifungicides. People suffering from xerostomia (dry mouth) are also at greater risk of candidiasis.