Tooth exfoliation, osteonecrosis of the jaw and neuralgia following herpes zoster of the trigeminal nerve

Alveolar Bone Necrosis and Tooth Exfoliation Following Herpes Zoster Infection: A Review of the Literature and Case Report

“…9 It can develop after situations of stress 11 or local trauma, but it is more frequently associated with situations of diminished immune response as in individuals under systemic corticosteroid treatment, cytostatic chemotherapy, immunosuppressive agents, or radiotherapy, or it is associated with malignancies like chronic lymphocytic leukemia and lymphomas. 10,[12][13][14][15][16] It has been suggested that approximately 2% of patients with HZ will develop a second episode of the infection. 1,2 HZ infection may affect cranial nerves, and the trigeminal nerve is the most frequently affected (18.5% to 22% of total cases), followed by glossopharyngeal nerve and hypoglossal nerve.…”

“…The vesicles dry and crust over after 1 to 2 weeks, but it may take several weeks for the skin to return to normal. The skin lesions usually precede the intraoral mucosa lesions 14 and very rarely the skin appears free of lesions. [1][2][3] The intraoral vesicles, scattered and surrounded by an erythematous zone, soon become ulcerated and covered by a white pseudomembrane.…”

“…[1][2][3] The intraoral vesicles, scattered and surrounded by an erythematous zone, soon become ulcerated and covered by a white pseudomembrane. 8,12,14,20 The patient may have general malaise, and lymphadenopathies in the submandibular region may be present. 5,12,17 Spontaneous exfoliation of teeth in the area innervated by the affected nerve has been reported.…”

“…5,12,17 Spontaneous exfoliation of teeth in the area innervated by the affected nerve has been reported. Some authors believe that this is an early event occurring during the first 2 weeks of the infection, [12][13][14][15]21 while others consider this to be a late complication that will occur between the third to twelfth week after the onset. 22 Loss of teeth is due to alveolar bone necrosis and/or to necrosis of the periodontal ligament.…”

“…22 Loss of teeth is due to alveolar bone necrosis and/or to necrosis of the periodontal ligament. 12 After tooth extraction, healing of the periodontal tissues is usually slower than normal, and frequently fragments of necrotic bone remaining after the extraction need to be removed 5,[13][14][15]20,23 to preserve the height of the alveolar process. 14,21 In our case the teeth were extracted due to extreme mobility 4 weeks after the onset of the HZ infection.…”