Can I have scale and polish dental procedure if I've got a cold sore?

January 08, 2023

A key aspect of maintaining on optimum oral heath is to have regular dental check-ups. Ideally, these procedures should be spaced every six months. A routine dental check-up will involve the dentist examining the teeth for any signs of decay, the soft tissues like gums for signs of any traumatic injuries or swellings, the tongue for any deformities and other structures that may directly affect the function or esthetic of an individual.

If needed, basic dental treatments may also be carried out in these visits. These include application of fluoride and basic scaling and polishing of the teeth in order to prevent the advent of caries. However, there are times when a dilemma arises whether or not a dental practitioner should opt for or whether a patient with certain conditions should even consider going to the dentist in the first place.

What is a cold sore?

One such condition that finds measurable prevalence is herpes simplex or cold sores. Cold sores occur due to viruses who target the oral cavities or the genital regions. HSV-1 virus usually targets the oral cavity and its surrounding structures. This condition often goes undiagnosed or ignored as it can be mistaken for a commonly occuring ulcer. However, blisters formed due to herpes have a vesicular stage wherein rupturing, redness or oozing of liquid is prominent.

Herpes virus that targets the oral cavity can manifest into a range of conditions. Once the virus enters the body, it enters a prodromal phase before it develops into a full blown lesion. The virus then occupies a nerve and remains latent until and unless it is triggered by an external factor. These triggers can be stress, UV radiation, temperature changes, etc. HSV can result in lesions like herpetic whitlow, herpes labialis and oral conditions like herpetic gingivostomatitis.

What does the scale and polish treatment consist of?

A scaling and polishing procedure is done with the help of devices called ultrasonic scalers. The electrical device houses an attachment which is called a scaler and is hand-held. Ultrasonic vibrations are transferred to the scaler once the device is powered on. These vibrations are transmitted to the tooth surface and subsequently onto the attached debris, plaque and calculus. A thin steam of water or coolant is also released from the scaler. The resulting microstreaming and vibrations result in detachment of the plaque and calculus from the tooth surface. A polishing procedure follows, wherein an oscillating rubber cup and a prophylaxis paste is used to smoothen the surface of the tooth.

Can I have a scale and polish if I currently have a cold sore?

A person suffering from cold sores should ideally refrain from scaling and polishing procedure until the active lesion succumbs. If an active lesion is present, then the patient puts the dentist in jeopardy of getting infected by HSV. In case the lesion is in its patent phase, then the heat generated by the scaler and the general anxiety of getting in a dental operatory add up to reactivate the lesion. There are studies where researchers have speculated that the pressure exerted at the peripheri of the lips and the angle of mouth during scaling in order to reach the back teeth is also one of the triggers of activating the HSV.

Poor oral hygiene status warrants for a longer treatment time. This also means that the dentist is also at a risk of getting infected due to the prolonged exposure. Herpetic whitlow is a form of herpetic infection which affects the fingers and thumbs of a dentist who operates on a patient with an active HSV lesion. There are also herpetic lesions involving the arms and eyes which a dentist may get infected with despite wearing gloves and full-sleeved gowns.

Compared to other treatment modalities like extractions and root canal treatments, scaling and polishing procedures are non-invasive. Scaling and polishing procedures are not emergency procedures and hence they can be deferred until the active lesion resolves. Guidelines issued by the Occupational Safety and Health Administration must be considered before electing to treat a patient with herpes. Even a dentist who is suffering from a herpetic lesion should not do any treatments till the lesion resolves.

It takes nearly two weeks for the herpes lesion to completely heal. Thus, since the time it was first detected, a patient suffering from cold sores must wait for at least two weeks before opting to under any dental treatment.

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