Shingles, also known as herpes zoster, is a viral infection that results in a painful rash. This condition arises from the reactivation of the varicella-zoster virus (VZV), the same virus responsible for causing chickenpox. After an individual recovers from chickenpox, VZV remains inactive within nerve cells for many years. It can reactivate later in life, particularly when the immune system weakens, leading to shingles.
Understanding Oral Shingles
Shingles can indeed manifest inside the mouth, a condition referred to as oral shingles or oral herpes zoster. This occurs when the varicella-zoster virus reactivates specifically along a branch of the trigeminal nerve, which supplies sensation to the face, including the oral cavity. The lesions appear as small, fluid-filled blisters that can form on various oral surfaces, such as the gums, tongue, palate, and inner cheeks. These blisters often rupture quickly in the moist environment of the mouth, leading to the formation of painful ulcers that may take 10 to 14 days to heal.
A distinguishing characteristic of oral shingles is its unilateral presentation, meaning the rash and associated symptoms usually affect only one side of the mouth, following the path of the affected nerve. This unilateral distribution helps differentiate it from other oral blistering conditions. Before the visible rash appears, individuals may experience prodromal symptoms, which can include a tingling, burning, or shooting pain in the mouth or face. This discomfort can be intense and may even resemble a toothache.
Beyond the lesions and pain, oral shingles can lead to other symptoms that affect daily activities. Patients often experience significant mouth sensitivity, making it difficult to chew, swallow, or speak. Some may also report a change in taste sensation, loss of appetite, or increased drooling. Systemic symptoms like fever, fatigue, and headache can also accompany the oral manifestations.
Identifying Oral Shingles
Diagnosing oral shingles primarily relies on a clinical assessment by a healthcare professional, such as a doctor or dentist. The characteristic appearance of the lesions, particularly their unilateral distribution, combined with the patient’s reported symptoms and medical history (including a past chickenpox infection), are key indicators. The clinician will examine the mouth for blistering, inflammation, and crusting, and may also check for other signs of shingles elsewhere on the body.
While a clinical diagnosis is often sufficient, laboratory tests can confirm the presence of the varicella-zoster virus if the presentation is atypical or the diagnosis is uncertain. The most useful and sensitive test is the polymerase chain reaction (PCR) test, which detects viral DNA from a fluid sample taken directly from the blisters. A healthcare professional will gently unroof a blister and swab its base to collect the sample. Blood tests, which check for antibodies to VZV, are less helpful for acute diagnosis as most adults already have these antibodies from a prior chickenpox infection.
Medical Approaches to Oral Shingles
The primary goal of treating oral shingles is to alleviate pain, shorten the duration of the rash, and prevent potential complications. Antiviral medications are central to treatment, with common prescriptions including acyclovir, valacyclovir, and famciclovir. These medications are most effective when started as early as possible, ideally within 72 hours of the rash’s onset, to help reduce the severity and duration of symptoms.
Pain management is a key aspect of care for oral shingles, given the discomfort it can cause. Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage milder pain. For more severe discomfort, prescription pain medications, including topical anesthetics like viscous lidocaine, may be recommended. In some cases, nerve pain medications like gabapentin may be prescribed, especially if postherpetic neuralgia develops.
Supportive care measures also contribute to comfort and healing. Maintaining good oral hygiene is important, though it can be challenging due to pain. Using an alcohol-free antibacterial mouthwash can help reduce infection risk and relieve pain. Consuming soft foods, such as mashed potatoes or bananas, minimizes irritation to the mouth during chewing.
Protection Against Shingles
Vaccination is the most effective way to prevent shingles, including its oral manifestation, and reduce the risk of its complications. The Centers for Disease Control and Prevention (CDC) recommends the Shingrix vaccine for adults aged 50 years and older. This recommendation also extends to adults aged 19 and older who have weakened immune systems due to underlying conditions or medications.
The Shingrix vaccine is a recombinant zoster vaccine, meaning it uses a non-live component of the virus to stimulate an immune response. It is given in two doses, spaced two to six months apart. Studies have shown that Shingrix is highly effective, providing over 90% protection against shingles and postherpetic neuralgia. Even individuals who have previously had shingles or received an older shingles vaccine should consider getting Shingrix.