American Medical Association Family Medical Guide - American Medical Association [480]
Symptoms
Some people have a slight tingling sensation of the skin around the mouth before they get a cold sore. The gums may become swollen and red. Once the cold sore appears, the blisters burst and develop into painful sores (see page 126). See your doctor about any sore or swelling in your mouth that recurs or that doesn’t heal in 2 weeks.
Diagnosis and Treatment
Doctors diagnose cold sores by their appearance. Mild cases of cold sores usually need no treatment. Applying an ice pack to cold sores for a few minutes at a time often relieves pain. Your doctor may prescribe an antiviral medication such as acyclovir, valacyclovir, or famciclovir for you to take by mouth before the blisters are fully formed. These drugs reduce the rate at which the herpes virus multiplies. For people who have frequent outbreaks, a doctor may prescribe small doses of these medications to take daily to prevent or reduce the frequency of outbreaks.
Oral Thrush
Oral thrush is infection of the mouth with a yeast called Candida albicans. The yeast is one of many microbes that are normally present in the mouth but that are usually kept in check by the helpful bacteria in the mouth. The yeast can multiply to above-normal levels if you have a weakened immune system, if you are taking antibiotics (which kill beneficial bacteria as well as harmful bacteria), or if you are taking inhaled corticosteroids (which can suppress the immune system) for an inflammatory respiratory disorder such as asthma. If a woman has a vaginal yeast infection, her newborn can be exposed during birth and develop oral thrush within a week after birth. Some women who are nursing develop thrush in their nipples (see page 539) and can transmit it to their baby during breastfeeding.
Symptoms
The main symptom of oral thrush is sore, creamy, yellow-white, slightly raised patches in the mouth (and sometimes in the throat). If the patches are rubbed, they become raw and painful. Thrush can also cause denture problems. See your doctor about any sore in your mouth that recurs or that doesn’t heal within 2 weeks.
Diagnosis and Treatment
Doctors can diagnose oral thrush by its appearance. Oral thrush is usually treated with a topical antifungal medication or an oral medication such as fluconazole. Your doctor will recommend maintaining good oral hygiene with regular brushing, flossing, and using antiseptic mouth rinses, which may help prevent another infection.
Leukoplakia
Leukoplakia is a disorder in which a portion of the normally soft lining of the mouth thickens, hardens, and turns white, usually over a few weeks. The thickening may be a protective response to repeated injury to the area caused by a rough tooth or a poorly fitting denture or by irritation from tobacco smoke or smokeless tobacco. Some leukoplakia patches can eventually become cancerous. About 5 percent of what are thought to be patches of leukoplakia are actually cancerous tumors (tumors of the mouth and tongue; see page 747). Leukoplakia is especially common in older men who smoke.
Symptoms
A leukoplakia patch can be any size, can be white or gray (see page 126), and is usually painless at first. Later it may become rough and stiff. In advanced stages, the rough patches may develop sores that eventually crack. The open cracks can be sensitive to hot, spicy, or acidic foods. See your doctor about any sore in your mouth that recurs or that doesn’t heal within 2 weeks.
Diagnosis
If you have symptoms of leukoplakia, your doctor will first recommend that you stop using tobacco and may recommend that you have a biopsy (in which samples of cells are taken from the affected area and examined under a microscope). He or she may also recommend that you see a dentist