Colony Square Dental Associates

Is Flossing Helpful or Harmful?

Is Flossing Helpful or Harmful?


You can count on hearing, ‘don’t forget to brush and floss’ during visits to the dentist, on oral health educational videos and on TV. You may wonder why and when this refrain took hold and the reasons your dentist and hygienist stress the importance of this home healthcare routine.

Surprising though it may be, the practice of flossing isn’t new. There is evidence that even prehistoric man had a mechanism to remove foods from between their teeth. And while it’s been over two hundred years since an American dentist first introduced packaged flossing to the public, the toothpick was the #1 choice to remove those stubborn particles until the end of WW II. While the first flosses were made out of a silk thread, typically today’s floss is made from waxed or non-waxed nylon.

Why does the dental profession stress flossing along with brushing?

The majority of oral healthcare professionals began advising patients to floss for health reasons, not merely to remove a lodged popcorn kernel or a piece of lettuce from between our teeth. After years of research, dentists were provided scientific data to better understand the causes of decay, gum inflammation, periodontal disease, and bone loss. As our oral healthcare knowledge base grew, products, such as floss, were introduced to help prevent or mitigate the causes of dental disease. This became increasingly important as more recent research studies provided additional evidence showing the correlation between oral health and diabetes, heart disease and even cancers. Maintaining one’s oral health not only puts a happy, healthy smile on your face but also serves to enhance your general wellbeing.

Where does floss fit in the discussion of oral health? Brushing is important. It helps clean the surfaces of our teeth, but a toothbrush, even an electric, does not fully reach in between the teeth – spaces where it’s easier for these bacterial colonies to coalesce. This is where flossing comes into play. Bacteria live in our mouths. And that’s okay. In fact, there are hundreds upon hundreds of strains of bacteria; and each individual’s oral bacterial makeup is different. Most strains of oral bacteria do not pose a problem. But there are types that do. Sugars and starches, even found in many healthier foods, pose problems. It’s those carbohydrates. There is a type of oral bacteria that enjoys carbs as much or more than we do. The problem is that this bacterial strain, as it feeds on these substances, produces lactic acid that is known to dissolve the enamel of your tooth’s surface – one of the primary causes of dental decay. Other strains, though not as prevalent, are known to impact the health of the bone tissue of the jaw. With all these bacteria, our goal is to educate you on the techniques available to help prevent the ‘bad’ bacteria from forming colonies of harmful sticky substances. Floss breaks up the soft and sticky bacterial plaque. When our saliva does not wash it away and brushing does not reach all surfaces, this substance will adhere to the tooth’s surface. Left undisturbed, the production of lactic acid from the colonies of bacteria dissolve the enamel of the tooth surface. The result? The potential for tooth decay. Also, when plaque is not removed, in combination with products found in our saliva, it calcifies. This hard substance, calculus, if not removed regularly, cause gum tissue inflammation – leading to periodontal disease and potential bone loss. It’s the combination of brushing and flossing that disrupts the bacteria, stops the formation of the sticky substances and helps prevent the damaging build up. A good thing!

Why the recent hype about: ‘no need to floss’ or ‘flossing is harmful to your health’?

If flossing does all this hard work for us, why the recent articles? We don’t always have a definitive study that says that if you do ‘A’ you will be assured that ‘B’ will occur. There is not, as yet, fully definitive evidence-based research showing that if you floss you will not get cavities. But we do know that it makes sense as it removes harmful substances and reduces the buildup of cavity-causing plaque. And there is evidence-based research findings that flossing is beneficial in reducing the risk of gum diseases (and hence potential bone loss), which is a good enough reason in itself to floss. Just ask Drs. Hochberg and Diora. After years of practicing, they along with the preponderance of dentists and hygienists, have observed that the patients who brush AND floss regularly, present with healthier gums and teeth. As Karen, one of our hygienists of over 25 years at Colony Square Dental Associates says, “From my observation, patients that do floss have healthier gum tissue in comparison to those who do not. Patients that do not floss typically have bleeding and inflamed gum tissue. Water flossers are also effective and can help aid in keeping your oral health up to par.” And, what about articles asking, Is flossing dangerous? There was a small study that was released earlier this year reporting that women using a popular waxed floss were found to have higher levels of a specific type of PFAS (a chemical used to coat the floss). After reviewing the study the American Dental Association (ADA) determined that the cause and effect finding was not conclusive – as this chemical is found in the air, the water and even fast food containers. While further study is certainly warranted, according to the ADA Statement: “Study Involving Dental Floss”, released on January 14, 2019:


            “PTFE is often used in food and beverage, pharmaceutical, and cosmetic applications. The fact that the researchers were able to find the PTFE marker in several brands of floss does not mean that it is the source of the PFHxS in the women. Given that this was a retrospective study including self-reported use of products, there are likely many other differences between women who did and did not report having used the brand of floss mentioned. The ADA sees no cause for concern based on current evidence, and above all continues to encourage people to clean between their teeth daily with floss or other interdental cleaners as part of the ADA’s daily oral hygiene recommendations. 


At Colony Square Dental Associates we still say, “May the Floss be with You!”

The jury may still be out on whether waxed floss actually contains this chemical. And if it does, it is yet to be determined whether the chemical is released from the floss and ingested or whether it poses a risk. But, this is not an excuse to stop flossing! You may wish to read more about this topic before continuing with your current brand of floss. We encourage you to do so. And feel free to discuss alternatives with Drs. Hochberg, Diora and our hygienists – Karen, Cheryl & Gina. There are various options to break up the buildup of harmful bacteria on and between the teeth and at the gum line. Some floss is manufactured without chemical coatings and, as Karen says, there are other interdental devices such as the WaterPik®. So, we stand by the same old, same old mantra: Brush – twice a day! And Floss – at least once a day!


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When Is The Last Time You Checked Your Tongue?

When Is The Last Time You checked Your Tongue?

When you brushed your teeth this morning did you look at your tongue? If you answered no…it’s okay. Although we know oral health is important, many are unaware of the importance of examining their tongue.

The tongue is one of the most vital barometers to one’s oral health. Your tongue can serve as a detection tool, alerting you of health issues occurring inside of your body. At Colony Square Dental Associates, Drs. Hochberg and Diora examine the tongue of each patient they see; they know that an oral examination is not complete without a thorough evaluation of the top surface – and the undersurface – of this important muscular organ.

What does a healthy tongue look like?

If your oral hygiene isn’t up to par oftentimes symptoms are evident on the tongue. A healthy tongue will appear bright pink with small white nodes (little dots) throughout. Although tongues do come in all shapes and sizes, your tongue should not appear to be swollen nor should it protrude from your mouth.

What diseases can show symptoms on the tongue?

There are numerous diseases that Dr. Hochberg, Dr. Diora, and our dental hygienists are on the lookout for. They can be the result of stressors, infections or medications. The most frequently seen ailments are listed below.

Thrush: Thrush is an infection of the mouth caused by Candida fungus or yeast. Thrush occurs most commonly as a side effect of medications such as antibiotics or corticosteroids. The prescriptions affect the PH balance in your body. It is also seen in those with immune systems that are weaker, such as toddlers, those with cancer, or persons under stress. Indicators of thrush are white patches or a creamy white substance on the tongue that resembles cottage cheese. If you notice anything similar to the symptoms described, call us immediately. We will schedule for an examination to diagnose and provide treatment.

Vitamin Deficiency: Take your vitamins! Your daily vitamin intake plays a major role in your oral health. If you notice your diet doesn’t include all of the recommended vitamins, your tongue will be sure to let you know. A bright red tongue that appears smooth and may be a bit uncomfortable could be an indicator that you may be deficient in certain vitamins such as folic acid, iron or B vitamins.

Oral Cancer: Sores that don’t heal, pain, odd discoloring and chronic issues with swallowing or chewing, should not be neglected as these are possible signs of oral cancer. If any of these issues persist for longer than a week be sure to check in with your dentist. Don’t let symptoms linger! Be vigilant. If you notice changes, seek a professionals opinion. Early diagnosis and care save lives!

You are the best person to act as the first line of defense. When your brush and floss your teeth in the morning and evening, add a step to your home oral healthcare regimen. Scrape any residue off your tongue. This is buildup on your tongue, with unwanted bacteria, contributes to bad breath. As you do so, look at your tongue. Check the front, the back and the top of the tongue’s surface. Stick your tongue out. Do you notice any changes, growths, discolorations, and patches? Lift up your tongue. Look underneath. Any concerns?

As we finish April’s National Oral Cancer Awareness month, it’s critical to remember the word ‘awareness’. This month and every month hereafter, make it your mission to pay close attention to the signs your tongue is giving you. If you feel like you are experiencing any of the symptoms listed above, please call. Our goal is to help you stay healthy.

Early Detection Of Oral Cancer

Early Detection Of Oral Cancer

It’s time for your dental spring cleaning!

The month of April not only signifies the beginning of Spring, but it also is Oral Cancer Awareness month. As you start your spring-cleaning at home, be sure that you have scheduled your dental spring screening as well. Oral cancer affects almost 50,000 Americans each year. By visiting your dentist regularly, Drs. Hochberg and Diora can help detect any early signs of this deadly disease.


What you need to know

Research has identified a number of factors that are considered contributors to the development of oral cancer. Through time and study, researchers found that those at especially high risk of developing oral cancer have been  drinkers and smokers over the age of 50. However, today there are also concerns related to the potential risk of oral cancer in the younger generation. A new form of inhaling nicotine, vaping, has harmful chemicals which are yet to be tested and could be cancer causing. Another contributing factor is the human papillomavirus 16 (HPV), which has been identified as a factor in the rise of oropharyngeal (oral)cancer.  HPV attacks the tonsillar tissue, including the base of tongue, in our younger populations which can potentially lead to the development of oral cancer. It’s extremely important to note that oral cancer can affect anyone no matter the age; being vigilant in your oral healthcare routines and daily habits can help.


What are the signs to look for?

  • Continous soreness or irritation
  • Thick skin tissues, lumps, rough spots, crusty areas
  • Pain, red or white patches inside of the mouth or lips
  • Difficulty chewing, swallowing, speaking
  • Issues with jaw function

If you notice any of the symptoms above – don’t wait. It’s always better to, ‘be safe than sorry’. Early detection increases the opportunity to provide care when needed! The early the diagnosis, the better the prognosis. And at Colony Square Dental Associates, oral cancer awareness is an integral part of every examination.



Continuing our Dental Education

Continuing Our Dental Education

At Colony Square Dental Associates


For over 30 years we have done our utmost to provide our patients with quality dental care in a comfortable environment. This entails not only the smiles our front office team and clinicians sport every day and their caring nature, but also includes our ability to offer state-of-the-art dental services.

Dr. Hochberg at the Glidewell booth.

Hygienists Cheryl, Karen and Gina

As with all aspects of our healthcare, new information related to our oral health is frequently updated and augmented. And on TV and in the drug stores we see new products that are developed to help prevent cavities, brighten our teeth, protect the enamel of our teeth and so on. And, equally as important, products and techniques are enhanced frequently providing Drs. Hochberg & Diora with the tools to both optimize your oral health and enhance the aesthetics of your smile.



Front office team Sharon, Mariah, Lori and Tiffany.

But, to be kept abreast of all that is available in the dental field takes a commitment – a commitment to putting time and energies into continuing dental education.We, at Colony Square Dental Associates, are pleased to say that we regularly attend courses approved by the American Dental Association as one way to learn about the ‘latest and greatest’ so that we can offer you optimal dentistry. Just last week our clinicians and business team members attended the annual Hinman Dental Meeting held each year in Atlanta. They will be happy to share their new knowledge with you.

National Children’s Dental Health Month | How to Ensure Your Child Has a Lifetime of Healthy Smiles

Annually in our office, and in many offices around the country, February is recognized and celebrated as National Children’s Dental Health Month (NCDHM.) From the time a child’s first tooth comes in, it is important to begin a daily hygiene routine and schedule their introductory appointment at the dentist. Beginning dental visits at the early age of one, helps with making both child and parent comfortable.

Although it’s commonly referred to as a “ride in the dental chair”, there are a lot of very important tasks being completed at this appointment. The doctor will review the child’s medical history, complete an oral exam to check growth and development, evaluate risk for tooth decay, and determine if he or she is getting the correct amount of fluoride. This is also a great opportunity to discuss with the parent the importance of primary teeth, the eruption process, as well as teething, pacifier use, and finger or thumb sucking habits. To conclude the visit, a dental hygienist may apply fluoride as necessary and the child will be given a toothbrush and a gift to commemorate their first session.

Once the initial relationship is established, we like to continue influencing children to maintain healthy practices even well after they are brushing their own teeth. This is implemented in their bi-annual visits, however, we also make time during NCDHM to visit schools in our area and speak to the students. We typically prepare a small child-friendly presentation that includes hands-on learning. The teachers are provided with posters from the American Dental Association (ADA) highlighting the NCDHM theme.


This year we had the pleasure of visiting Primrose School of Midtown located in Colony Square. We spoke to their 4 and 5 year old students on the importance of a healthy smile. They learned how a toothbrush, toothpaste, floss, and mouthwash all contribute to pearly whites and help to remove the cavity causing “sugar bugs.” Each student received a goodie back with a poster-sized reminder to brush, as well as an activity worksheet, a toothbrush, smile stickers, an informative brochure, and a letter to parents informing them of our presentation. If you’d like us to visit your child’s school please let us know! We are always open to exploring new opportunities with schools in our community.

A Year of Things to Smile About

Last January, we created a social media campaign in honor of the late, Dr. Richard Sugarman, to benefit the Ben Massell Dental Clinic. Located here in Midtown, Ben Massell has provided state-of-the-art comprehensive dental care to those in the community who need it most. The clinic has been serving the Atlanta area for over 100 years. Dr. Hochberg is one of many dentists who volunteer on a consistent basis, allowing Ben Massell to treat thousands of patients each year.

The campaign asked that our patients and visitors like or share our monthly Facebook video posts. For each like or share, our office pledged to donate $3 toward the clinic fund. We are ecstatic to say by end of December, we were able to write a check for over six thousand dollars! This is huge and was only made possible because of each one of you. Thank you from all of us at TEAM CSDA!

Snoring and Sleep Apnea | Getting a good night’s sleep

It is estimated that almost 100 million people, just in the United States, snore. It’s a staggering number. And, as any bed partner of a snorer can attest to – it’s annoying! Maybe not overtly to the person who snores, but to the person listening to an unwelcome nightly concert. Drs. Hochberg and Diora are frequently asked if there is anything they can do help. Before delving into possible solutions, it’s important to understand that while there are some crossover treatment options for those suffering from sleep apnea and for those who snore, they are not the same conditions.

If I snore, do I have sleep apnea?

The terms sleep apnea and snoring are not interchangeable. One can snore and not have sleep apnea; and even though most with sleep apnea do snore, one can have sleep apnea without snoring. It is important to understand that there are differences and, while snoring is bothersome and can leave the snorer tired during the day, sleep apnea can be life threatening. Snoring occurs when there is a relaxation of the intra-oral tissue(s) causing a partial blockage or a partial obstruction. Whether it’s the uvula, a nasal obstruction, a tongue that is large in relation to the oral cavity or an elongated soft palate, there is a constriction as air moves, causing a vibration – the sound of snoring. For some, lifestyle changes such as loosing weight or reducing alcohol consumptions helps.


While loud and frequent snoring oftentimes is a symptom of sleep apnea, termed Obstructive Sleep Apnea (OSA), those with OSA have periods of time during sleep when breathing actually stops or is greatly slowed. Be it an apnea, an abnormal pause in breathing, and/or a hypopnea, a reduction in the amount of breathing, oxygen flow, the sleeper may wake gasping for air or they may be completely unaware that this is occurring. It can occur infrequently each evening or repeatedly. There may be a physical blockage or, less common, central sleep apnea – a reduction in the body’s ability to maintain adequate respiratory effort during sleep – the brain is failing to send adequate signals to breathe.


So, while snoring is annoying to sleep partners, both conditions can impact the quality of the patient’s life and overall health. Patients may go to bed at a reasonable hour and arise after an 8-hour sleep cycle, but the quality of their body’s ability to fully rest is diminished. A general feeling of fatigue may persist. And evidence-based research findings have found that those with OSA are not only feel sleep, they may actually fall asleep during the day and often report difficulty in cognitive processes. This illness is linked to an increased risk of heart diseases, diabetes, certain types of cancer and dementia. Some deaths have even been attributed to OSA.


How do I know if I have sleep apnea?

You may know you snore … because you were told. Or you may have been told that you seem to stop breathing or gasp for air. Or you may find that after a full night ‘sleeping’, you are still tired. However, to determine if you have OSA, and its severity, a visit to a physician with specialized training in sleep medicine is recommended. Testing may be indicated, which takes place in a medical ‘sleep center’ for a sleep study or at home with equipment provided by the specialist. These studies are designed to measure patterns that occur while sleeping, to see if there are disruptions, how many and how often, oxygen levels and brain activity.


How do I get a better night’s sleep if I snore or have sleep apnea?

While snoring and sleep apnea are different, the goal – an even and adequate supply of oxygen, is the same. As long as the problem is not related to missed signals from the brain, an airway that stays open and clear throughout the night helps both those who snore or have sleep apnea.


A CPAP – Continuous Positive Airway Pressure – has been considered the gold standard, especially for those with OSA. There are many types of CPACs, but in general a machine is used at nighttime and continuously pushes air, keeping the airway from closing when sleeping and providing sufficient oxygen to oxygenate the blood. If the results of testing by your physician indicate that this is needed, you will be given a prescription. And new technologies, such as Provent® Sleep Apnea Therapy (also available by prescription for mild cases of OSA – an Expiratory Positive Airway Pressure (EPAPs) product), come onto the market, your physician will discuss your options.


How does a dentist assist in treating snoring or OSA?

One alternative frequently recommended, especially for those who do not have sleep apnea or cannot adapt to the CPAP (termed ‘CPAP intolerant)’ and fall into the mild or moderate category, are oral appliances provided by a dentist. Just ask Drs. Hochberg and Diora; they are available to discuss Oral Appliance Therapy (OAT). These Mandibular Advancement Devices (MADs) are custom fabricated mouth-guards. They look similar to guards worn to protect teeth while playing sports. However, they actually reposition the lower jaw by easing it forward slightly to help keep the airway open. There is an upper guard that snaps over the top teeth and a lower guard that snaps over the bottom teeth. These guards are joined together by connectors that adjust. This allows the dentist to adjust as necessary to optimize your care and help ease discomfort that may arise in your TMJ as you adapt to the appliance.

Sleep Well!

From parents insisting that their children go to bed on time to medical professionals advising us that a good night’s sleep is the foundation for health, we know that waking up refreshed helps start our day reinvigorated. When sleep is disrupted, deep sleep cycles are shortened, tossing and turning occurs, or the body undergoes the stressors when breathing is impaired, if only for seconds, our day and our health is negatively impacted. When you are told that you snore frequently, when you are not rested, if you wake gasping for air, don’t ignore the symptoms. Seek care! We, at Colony Square Dental Associates are available to discuss your concerns.

New Year | New Baby

As the end of the year draws near, we are all looking forward to spending time with close family and friends. This year, our office has a little something extra to celebrate. Our very own, Dr. Mira Diora, and her husband are expecting baby boy number two!


If you or someone you know is expecting a bundle of joy this holiday season, keep in mind the following:

  • You should let your dental office know you are pregnant.
  • Yes, it is safe to have an x-ray taken and your clinician will cover your abdomen with a lead apron to minimize exposure. Keep in mind radiation from dental x-rays are extremely low.
  • If you need a composite, root canal treatment, or an extraction, it is safe to use a numbing medication for both you and your baby.
  • Your dentist may recommend cleanings more frequently as some women can develop pregnancy gingivitis. This is inflammation that can cause both swelling and tenderness when brushing or flossing.


Dental care when pregnant is a crucial. Drs. Hochberg and Diora are here to help with any questions and wish both you and your little one a healthy New Year!

The 12 Days of Dental | Good Oral Hygiene Should Never Take a Holiday

The holiday season is here once again. And no matter the celebration, whether it be a traditional Christmas, Hanukkah, Kwanzaa, Yule, Festivus, or otherwise, we want you to enjoy this important time of year with your close family and friends, who matter the most. All the while, we want to ensure your oral health isn’t forgotten. Therefore, we have made a 12 days of “dental” checklist. These fun reminders and tips will ensure you remember to treat your teeth as well as your tummy this year.

  1. Honor existing dental appointments
    We understand the holidays are a busy time of year, with traveling plans and family coming into town, many unexpected factors arise that clutter your already tight schedule. This is why we encourage you to proactively plan your day, to allow time for your reserved dental appointment. Also, maximizing your dental insurance benefits prior to the end of the year is another added factor that can assist with cutting your overall out-of-pocket costs. And we want to ensure your appointment isn’t postponed, as our schedule tends to book in advance for dental hygiene sessions, especially around this time of year.
  2. Stop smoking
    Shopping for the perfect gift, making sure you have all the ingredients for grandma’s special recipe, and decorating your home for the holidays are all additional stresses. And key triggers, such as stress, have proven to be the reason smokers oftentimes increase their nicotine intake during these months. Smoking is a direct link to gum disease, the leading cause in tooth-loss. What better gift to give your family this year, than a smoke free environment?
  3. Avoid using your teeth as a gift wrapping tool
    It is so easy to misplace the scissors with all the extra hands scrambling to wrap presents, not to mention the mail and packages to open as well. Take caution to avoid chips, fractures, or emergency based visits to the dentist by avoiding the use of your teeth as a tool for cutting. It might be tempting, but we assure you that is not the way you want to spend the holiday.
  4. Purchase a Travel-size Hygiene Kit
    An inexpensive way to keep your teeth looking their best at all your family gatherings is to purchase a small travel-size hygiene kit. Complete with a travel toothbrush, toothpaste, dental floss, and toothpicks, it is the perfect solution for touching up between house to house visits. The conveniently sized pouch can easily be placed in your car or purse for easy access.
  5. Stock your Stockings Well
    Stockings by the fireplace are filled with wonderful goodies enjoyed by people of all ages. This year when shopping for those miniature treats, be sure to purchase stuffers that offer more than an oral sugary bath for the recipient. Many gift ideas, such as playing cards, socks, and bath essentials are great alternatives to candy.
  6. Avoid Excessive Hard Candy
    Although it’s tempting, ensure that hard candy such as lollipops, hard mints, and candy canes are kept to a healthy minimum. These sugary treats tend to linger on the surface of your teeth and can cause chipping if you are biting down on them. It’s in best practice to allow the candy to dissolve and then brush afterward.
  7. Rinse after Holiday Beverages
    Eggnog, hot chocolate, sparkling juices, and alcoholic beverages are always readily available at dinner and office parties this time of year. After enjoying these tasty drinks discretely swish with water until you are able to brush your teeth properly. This will help to avoid decay. If you can locate a straw to use, even better!
  8. Let your kids “carol while they clean”
    The golden rule, as recommended by the American Dental Association, is to brush for at least 2 minutes. However, for those with small children, it can be a challenge to achieve. This year make it a game! Let your child choose their favorite carol, and have them hum while they are brushing. By the time a verse or two and a chorus has gone by the two minutes will be up and it will have been fun and painless for both adult and child.
  9. Watch-out for Wine
    A glass of wine while the turkey finishes up in the oven, sounds like a nice way to relax before the guests begin to arrive. However, it is important to remember that wine, especially those that are red or dark in color, can cause staining. Choose your beverage carefully and be sure to only enjoy in moderation to avoid dulling the appearance of your teeth. Ask our doctors about both in office and at home whitening treatments to keep them bright all year long.
  10. Choose cheese & veggies
    Broccoli and carrots are terrific treats for your teeth as they are rich in Vitamin A, which strengthens your enamel. And if you are choosing to indulge in alcoholic beverages, snacking on cheese cubes are a great way to balance the acid that’s in those drinks and doubles as a great source of calcium. So if you don’t know what covered dish to bring, a veggie and cheese tray might just be the perfect (and healthier) option to go for.
  11. Make the holidays more meaningful
    Grazing on food throughout the day is not an uncommon practice on big holidays. After dining with your family this year, maybe try a new practice centered more on activity and games. By avoiding a constant state of eating, you can monitor your waist as well as your oral health.
  12. When in doubt, give the gift of dental care
    Practical gifts always give the recipient something to smile about. So when in doubt, give the gift of dental products. Whether a small stocking stuffer or a last minute teacher gift, toothbrush, floss, and a little lip gloss will always be a fan favorite.

We hope this helps with putting your holiday dental woes at ease. Drs. Hochberg and Diora wish you a wonder-filled holiday season.

Canker Sores and Cold Sores | Something hurts!

You woke up and noticed, and felt, something sore on your face or lips or inside your mouth. Should you be concerned? Usually, the answer is no. Most often that lesion, is a canker sore or a cold sore caused by a fungal or viral infection. Though quite different, they both typically resolve in a few weeks with or without attention.


How do I know if I have a problem?

The first step is to raise awareness. After all, we take time to brush and floss our teeth, do our hair, and apply makeup. We look at ourselves in the mirror numerous times each day. But, are we only looking to see if our clothes and hair are in place as we go out in public? It’s important to really look. Do we notice changes? Does something look or feel different around your mouth? Inside your mouth? Do we know what to look for? Use an illuminated magnifying mirror. Look inside at the surface of your cheeks, the top of your tongue and under your tongue. Does the area feel sore? Is there a different texture or color in one area? Is there swelling? Are there patches that are white, red, gray or yellow?

Canker Sores / Mouth Ulcers

Canker sores are not contagious. They look like an ulcer with a red border and a white or yellowish center and a center depression. They can pop up inside your mouth or on your tongue. And they usually cause discomfort. The most common canker sore, called a Minor Aphthous Ulcer, is small, under .4”, and is round or oval and typically heals in less than two weeks. Less common are Major Aphthous Ulcers; they are larger, deeper, more painful, take longer to resolve and can scar. When canker sores appear in clusters, from 10 to 100, they are called Herpetiform Ulcers. Not to be confused with herpes, they too are not contagious and heal quickly.


Cold Sores / Fever Blisters

Caused by Herpes Simplex Virus 1, cold sores, also called fever blisters, are contagious. They are seen in clusters of red, fluid-filled raised blisters around lips or underneath the nose or chin. For many patients there is awareness, before the breakout. There may be a tingling feeling, itching, or even a burning sensation before the blisters are visible.


What causes Canker & Cold Sores?

As mentioned, cold sores are manifestations of the Herpes Simplex Virus 1 (HSV-1 – oral herpes) a person-to-person transmitted viral infection that, once contracted, remains in the body. It is so easily contracted – by kissing, sharing utensils, and even using someone’s chapstick – it is estimated that around two-thirds of adults have this virus even though they may remain symptom free. For others cold sores may erupt infrequently with years between outbreaks or they may be frequent occurrences.


Canker sores, on the other hand, result from a variety of causes such as:

  • Daytime habits: chewing on the inside of your cheeks
  • Nighttime habits: biting the cheeks while sleeping
  • Prosthesis, dentures and partials, and retainers that are ill-fitting and cause irritations
  • Teeth that have fractured that have sharp edges or fillings that are not smooth
  • Brushing too aggressively or using a toothbrush with hard bristles that irritate the gums
  • Spicy foods, acidic foods, and hot foods can irritate or burn delicate tissues; hard foods such as chips or pretzels have sharp edges can catch on the tissue
  • Sensitivity to toothpastes with sodium lauryl sulphate (SLS toothpastes)
  • Side effect of medications
  • B12 or iron vitamin deficiencies
  • GI diseases such as Crohn’s and Coeliac Disease
  • Weakened immune systems
  • Smoking
  • Heredity


And stress! With a list this long it can be challenging to determine which, if any, of these caused your canker sore. And, if it resolves in a short time, under 2 weeks, and occurs infrequently, there’s no need to determine causality. However, if the sore does not resolve, or you frequently have canker sores, it is time to see Dr. Hochberg or Dr. Diora to determine if there is an identifiable and resolvable contributing factor or an underlying medical problem that requires attention.


How to reduce the discomfort from canker sores and cold sores?

If you have a cold sore, there are topical, medicated lip balms specifically formulated to help reduce the discomfort of those with HSV-1. When persistent or frequently reoccurring, Drs. Hochberg and Diora can provide prescriptions, including anti-viral medications and rinses, once a diagnosis has been confirmed. If you have a canker sore, watch irritants (the spicy, acidic, or hot liquids and foods) that can aggravate the sore. A saltwater rinse with lukewarm water helps as well. Corticosteroids and cauterization of canker sores are also options that your dentist may offer.


Beyond Canker Sores & Cold Sores

However, canker sores or cold sores are not the only causes for lesions or changes around or inside the mouth. There are manifestations of other diseases that are seen intra-orally and are not to be taken lightly. If there are gray patches, white patches, red patches, a mixture of red and white, or changes in the appearance of the tissue, there is the possibility that a serious problem could be the cause. Most often, pre-cancerous tissue does not cause pain as do canker or cold sores, lulling patients a false sense of being okay and ignoring the visual changes. But, don’t discount warning signs. When a symptom, or change, does not resolve in a short time frame – seek a professional’s opinion. And remember, your periodic visit to your dental hygienist at Colony Square Dental Associates not only results in clean teeth, it’s an opportunity for your dentist and hygienist to provide an oral cancer screening and see if any changes in the intra-oral tissue has occurred.