Cold sores, fever blisters, and yes, even the dreaded “herpes” word—they’re all one and the same. They’re also some of the most abhorred types of oral and perioral lesions we have to manage. Why? Because they hurt. They’re unsightly. They make eating, drinking, and talking challenging. And by the time they’ve run their 7- to 10-day course, every remedy in the book has been tried and let us down. That’s the tricky part about viruses—there really isn’t a cure. It makes it challenging for both patient and provider alike.
I can’t count how many times I’ve had patients come in for limited exams and say there’s a red, painful bump on the gums, and they think it’s an abscessed tooth. Lo and behold, it’s a cold sore. Or there’s this one: A patient calls in expressing concern over a large cold sore, and therefore needs to cancel his dental appointment because it hurts and the patient is “concerned about the infection spreading.” Then there are all the times I do recare exams and get requests for scripts for cold sore medicines because these patients routinely get painful and annoying lesions. What’s the bottom line? The presence of these infections affect patient care and scheduling. Unless it’s an emergency or they come in for an assessment/treatment of the lesion, it’s best to see them after everything is healed up.
Let’s face it: oral herpes is common, and it isn’t going anywhere. In fact, herpes simplex virus type 1 (HSV-1) infects more than half of the US population by the time they reach their twenties.1 That’s a lot of people. What does that mean for us? When these lesions rear their ugly heads, we are the go-to practitioners for treatment.
The popularity of this topic demands that we—and all our staff members—be well versed on HSV-1. We must have the capacity to engage in candid discussions with our patients and educate them on HSV-1 etiology and treatment modalities. This includes palliative, over-the-counter, and prescription options.
Given the overall nasty nature of these lesions, I would submit that patients overwhelmingly want relief sooner rather than later. (Yesterday, in fact.) The inconvenience and pain caused by these sores are famous, and patients want a solution to their problem. The classic remedy is the antiviral drug acyclovir, which is the well-known generic name for the brand Zovirax. This medication is prescribed as a tablet, cream, or ointment, and while it doesn’t cure cold sores (because there really is no cure for this virus), it does help control the duration, frequency, and severity of lesions and their symptoms.
One of the most frequent scripts I write for oral herpes is a prolonged systemic dose of acyclovir followed by an oral cream for direct application. There are pros and cons to each of these remedies. But what if there was another option that placed the medication directly in the mouth on the side of the infection that resulted in improved lesion management andbetter patient compliance? Well, guess what—Sitavig is the new drug on the block that does just this. Since its approval by the FDA in 2013, it has become a favorite for a growing number of dentists in their arsenals for cold sore management.
As a whole, we as dentists are a curious, albeit skeptical, group of people. We don’t like to randomly prescribe something just because we read about it. That’s a given. So, naturally we’ll ask, “What is Sitavig, how does it work, and why should I prescribe it?”
In a nutshell, here’s the 101 on Sitavig and how it works2:
• At the immediate onset of prodromal herpetic symptoms, a single-dose, small, tasteless, odorless, white-colored, 8 mm tablet (approximately 2.5 mm in thickness) is applied directly to the upper gum region at the canine fossa on the side where the lesion is beginning to fester. The slow release of the active ingredient, acyclovir, from these tablets subsequently interferes with the replication process of the virus in the basal layer of the oral mucosa, where the HSV-1 replication takes place.
• Due to the drug’s unique delivery system (termed “Lauriad”), it adheres to the tissue and dissolves in 6–14 hours, which is the magic window when the virus has maximum replication activity. Eating and drinking can occur normally a few minutes after application.
• The medication can oftentimes delay subsequent outbreaks.
• The sustained release of the active ingredient (acyclovir) prevents the virus from reaching its full potential. This is due to the increased concentration of the drug where it is needed most.
• In general, decreased plasma concentrations of acyclovir mean fewer side effects for patients.
Convinced you should give it a go? You should be. I’m the type of person who likes to try new things in my practice. My philosophy is that if I’m getting too comfortable or bored with the status quo, it’s time to investigate what’s new in the ever-changing world of dentistry and health care—drugs and prescriptions included.
So tomorrow, when a frequent-flyer cold-sore patient comes to your office (and needs to be rescheduled), or when a patient calls to cancel an appointment because of a lesion, or requests a refill of an entire bottle of acyclovir tablets, you and your staff can offer a new medication to aid them in their healing process. Chances are the patient will do almost anything to prevent those unruly lesions from manifesting. When Sitavig delivers those desired results, you just made a new friend and a slew of referrals. It’s a win-win for all, and that’s what medicine is all about.
1. Cold sores. MedlinePlus website. https://medlineplus.gov/coldsores.html. Accessed November 13, 2018.
2. Targeted prescription cold sore treatment. Sitavig website. http://sitavig.com/. Accessed November 13, 2018.