Herpes Zoster and association with pulp necrosis and development of apical periodontitis – a review and presentation of two case reports

Abstract

The varicella zoster virus as an aetiological agent for endodontic disease is not a well‐recognised entity despite several published case reports. While advances in DNA molecular analysis techniques (PCR) have contributed to the current understanding of the potential role of the varicella zoster virus in the initiation and progression of endodontic disease, a review indicates a need for ongoing research. Case reports are presented of two female patients with a history of herpes zoster who developed pulp necrosis, with one patient progressing to apical periodontitis. Both patients received non‐surgical endodontic therapy, followed by intra‐coronal bleaching in one of the patients due to tooth discolouration which developed during the prodromal and acute phases of the herpes zoster infection. Clinical and radiographic examinations at 23 and 22 years, respectively, showed the affected teeth to be retained in an asymptomatic and aesthetically satisfactory state with no radiographic evidence of apical pathosis.

Mechanisms of bone remodeling and therapeutic strategies in chronic apical periodontitis

“…The pathological process of CAP is induced by predominantly bacterial pathogens, and studies have reported the contribution of viruses such as: EBV (Jakovljevic et al, 2020), varicella zoster virus (Heithersay and Chew, 2021) and other novel pathogens to the development of periapical inflammation.…”

Odontogenic Herpes Zoster Infection: A Case Report and Review

“…There are multiple published case reports of prodromal herpes zoster pain initially misdiagnosed as a primary dental condition with subsequent identification of the correct diagnosis when classical features of zoster reactivation become evident later during the disease [10] [11] [12] [13]. Anatomic and radiographic findings mimicking other more customary odontogenic conditions have also been noted in the dental and endodontic literature [12] [13]. Viral infections such as intraoral VZV have been implicated in the formation of periapical abscesses, though the precise relationship between these two is yet to be elucidated.…”