Herpes zoster of the trigeminal nerve third branch: a case report and review of the literature

By Tidwell E, Hutson B, Burkhart N, Gutmann JL, Ellis CD.

Date: 01/1999
Journal: IEJ


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.ChronicPost 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.

  • Treatment

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)

Clinical Significance:

  • Treatment will involve physician, but initial diagnosis may involve dental practitioners.