Shingles is caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. After an individual recovers from chickenpox, the virus remains dormant in nerve tissues near the spinal cord and brain. Certain conditions, such as a weakened immune system or use of immunosuppressive drugs, chronic inflammation, acute or chronic disease, lack of or routinely disturbed sleep, acute stress, aging, and extended exposure to the sun or extremely cold temperatures, can reactivate the virus, which then travels down the nerve to the skin or mucosa.
While shingles is commonly associated with a painful rash on the torso, oral shingles involves the development of these painful, fluid-filled blisters in the mouth and surrounding tissues. Since the oral cavity is primarily innervated by the maxillary and mandibular divisions of the trigeminal nerve, trigeminal nerve involvement is the most common cause of oral shingles. When the reactivation involves the maxillary (upper jaw) nerve, painful shingle blisters may appear on the upper gums and palate. Reactivation in the mandibular (lower jaw) nerve can lead to blisters formation on the tongue, lower gums, and the floor of the mouth.
When the virus is reactivated in the facial nerve, blisters may appear on the palate and anterior of the tongue and in or around the ear. You may also develop alterations to taste, dry mouth and eyes, ringing in the ear (tinnitus), hearing loss, vertigo, and facial paralysis (Ramsey Hunt Syndrome). If the facial nerve is damaged, it may regrow in the wrong location (synkinesis) and send signals to the wrong facial muscles. These misdirected signals may result in such aberrant motions as eye closure while smiling or tear production while chewing.
While it is rare, reactivation in the glossopharyngeal nerve can lead to blisters on the posterior one-third of the tongue, as well as on the uvula and the oropharynx. In addition, it is often accompanied by reactivation of the virus in the vagus nerve. Other symptoms include sore throat, difficult and/or painful swallowing, and hoarseness. Potential complications include vocal cord paralysis, aspiration pneumonia and encephalitis.
Once you are diagnosed with oral shingles, your physician will prescribe an antiviral medication. While there is no cure for shingles, antiviral medications can help reduce the severity and duration of the illness and reduce the risk of complications. Do not put off filling your prescription, as antivirals are most effective when started within 72 hours of the rash appearing.
To assist with the pain and inflammation, alternate Tylenol with ibuprofen, rinse with warm salt rinses and stay hydrated with fluoridated tap water. Hydration not only combats dry mouth, but it is also critical to your immune system in the healing process. Using a humidifier in your home will increase the moisture in the air, especially in your bedroom while you sleep. This can also help to soothe your dry throat. No matter how miserable you may be feeling, keep your mouth healthy by flossing and brushing gently with a soft-bristled toothbrush. Unfortunately, bacteria are opportunistic and will invade any area in your mouth where food and plaque have not been removed. Poor oral hygiene also makes you more vulnerable to fungal infections. Fighting both a viral infection and a bacterial or fungal infection in your oral cavity weakens your immune response to both.
Pain and sensitivity in the mouth can make chewing, swallowing, and speaking difficult. A diet of soft, unseasoned, and nutrient-rich foods minimizes irritation to your mouth and gums and supports recovery. Your doctor may order an oral lidocaine rinse to numb painful sores in the mouth and throat to aid you in eating, drinking and oral hygiene. Do not use mouthwash containing alcohol, tobacco products in any form or eat spicy, acidic, or crunchy foods as all of these will irritate the blisters.
Some things to consider: While shingles itself is not contagious (you can’t “catch” shingles), you can spread the varicella-zoster virus (VZV) that causes it to someone who has never had chickenpox. In other words, they could develop chickenpox, not shingles. This means you should avoid contact with people with weakened immune systems, newborns, any child who has not had chicken pox or been vaccinated against it, and pregnant women. To avoid spreading the virus, all elective dental procedures will be cancelled until the shingle blisters have been fully resolved.
The most common complication of shingles is postherpetic neuralgia (PHN), which is persistent nerve pain that can last for months or even years after the rash has healed. This pain can be severe and debilitating. Some of the other long-term, adverse effects include vision, hearing, tooth and bone loss, vertigo, post-viral fatigue, long term to permanent facial paralysis and/or changes to facial appearance.
Currently, one in three Americans will develop shingles at some point in their life and this risk increases significantly with age. Fortunately, thanks to the development of Shingrix, a highly effective, two-dose vaccine against shingles, healthy adults over the age of fifty and immunocompromised adults over the age of 19, have the opportunity to lower their risk of suffering from this virus and its complications by proactively getting vaccinated.
Dr. Stephen Petras
An Illinois Licensed General Dentist