Shingles, a viral infection, can manifest within the mouth. Also known as oral herpes zoster, this condition stems from the varicella-zoster virus (VZV), the same virus that causes chickenpox. When VZV reactivates in nerves supplying the oral cavity, it can lead to symptoms inside the mouth.
Understanding Shingles
Shingles occurs when the varicella-zoster virus (VZV), dormant in nerve cells after a chickenpox infection, reactivates. This reactivation typically presents as a painful rash, often on one side of the body, following a nerve pathway called a dermatome. The rash commonly appears on the chest, back, or face, but it can occur anywhere.
Triggers for VZV reactivation include age, as the immune system weakens over time, and conditions that compromise the immune system, such as illnesses or medications. Stress can also contribute to a weakened immune response, potentially leading to reactivation. Most adults worldwide carry the dormant VZV, and about one in three people will experience shingles in their lifetime.
Shingles in the Mouth
Oral shingles occurs when VZV reactivates in cranial nerves, particularly the trigeminal nerve (cranial nerve V). This nerve is responsible for sensation in the face, mouth, and teeth. Reactivation in the trigeminal nerve can result in symptoms localized to the oral cavity and facial regions.
Initial symptoms often include burning, tingling, numbness, or pain in the mouth or face, preceding the rash by a few days. This prodromal pain can sometimes be mistaken for a toothache, potentially leading to misdiagnosis. Fluid-filled blisters, known as vesicles, typically develop after these initial sensations.
These blisters can appear on various oral surfaces, including the gums, hard or soft palate, tongue, or inner cheek. Oral shingles lesions are characterized by unilateral distribution, meaning they usually appear on only one side of the mouth, reflecting the nerve pathway affected. The blisters may burst, leaving behind open sores or ulcers that typically heal within 10 to 14 days.
Other symptoms include tooth pain, difficulty eating or swallowing due to discomfort, and an altered sense of taste. Depending on which branch of the trigeminal nerve is involved, individuals might experience facial pain or ear pain. For example, involvement of the maxillary or mandibular branches can lead to lesions on the upper or lower jaw, respectively.
Diagnosis and Management
Diagnosis often relies on the rash’s characteristic appearance and the patient’s reported symptoms, especially unilateral presentation. A healthcare provider, such as a dentist or doctor, may identify the condition during an examination. Laboratory tests, such as a polymerase chain reaction (PCR) test of fluid from blisters, can confirm VZV presence.
Management focuses on reducing illness severity and duration, and preventing complications. Antiviral medications, including acyclovir, valacyclovir, and famciclovir, are used for treatment. These medications are most effective when started early, ideally within 72 hours of the rash onset, to inhibit viral replication and promote healing.
Pain management is an important aspect of care. Over-the-counter pain relievers can help alleviate discomfort, and in some cases, prescription pain medications or topical anesthetics may be recommended. Maintaining good oral hygiene is important to prevent secondary bacterial infections. Gentle brushing, using alcohol-free mouthwash, and saltwater rinses can help keep the mouth clean and soothe irritation. Eating a soft diet can also minimize irritation and make eating more comfortable.
Potential Complications and Prevention
If oral shingles is severe or untreated, complications can arise. Postherpetic neuralgia (PHN) is a common complication, characterized by persistent nerve pain in the affected area after the rash clears. This chronic pain can last for months or even years.
Secondary bacterial infections of oral lesions are a concern, as open sores in the mouth are vulnerable to bacteria. In severe cases involving the gums or teeth, nerve damage to teeth, or even tooth loss, can occur, though this is less common. If the ophthalmic branch of the trigeminal nerve is involved, the virus can spread to the eye, potentially leading to vision problems.
Vaccination is the most effective way to prevent shingles, including oral manifestations. The recombinant zoster vaccine, Shingrix, is recommended for healthy adults aged 50 and older. It is also recommended for adults aged 18 and older who have weakened immune systems. This two-dose vaccine series is highly effective at preventing shingles and its associated complications, including postherpetic neuralgia.