To present brief review of H. Zoster, its 3 diagnostic stages, and the role of the Endodontist in diagnosis/management
- 3 Diagnostic stages
1.Prodromal – burning, itching, tingling over affected nerve distribution. Precedes active stage by few hours to several days.
2.Active – Emergence of rash, with malaise, headache, fever, nausea. Progresses from erythematous papules to vesicles (12-24hrs) to pustules (1-7 days).
3.Chronic – Post herpetic neuralgia. Pain lasting 1-3 months after skin lesions have cleared. May last years, decades. Constant, deep pain. May have brief, shooting episodes, with allodynia to light touch of skin.
1.Patient isolation – contagious until crusting of lesions occurs
2.Local management of skin lesions – Creams/lotions with corticosteroids NOT recommended
3.Control and elimination of pain – Mild to moderate analgesics (NSAIDs, acetaminophen)
4.Limitation of the extent, duration, and severity of the disease with antiviral agents (acyclovir)
5.Treatment of post herpetic neuralgia – does NOT respond to typical analgesics (CNS problem)
Herpetic attack of trigeminal nerve can cause pulpal necrosis (dental pulp contains trigeminal endings)
- Treatment will involve physician, but initial diagnosis may involve dental practitioners.