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PHOTO ESSAY
Year : 2017  |  Volume : 29  |  Issue : 2  |  Page : 142-143

Spontaneous teeth loss following herpes zoster


1 Department of Ophthalmology, Dr. Yashwant Singh Parmar Governmentt Medical College, Sirmaur, Himachal Pradesh, India
2 Department of Dermatology, Regional Hospital Hamirpur, Hamirpur, Himachal Pradesh, India
3 Private Practitioner at Pine Castle, Near Mist Chamber, Khalini, Shimla - 171 002, Himachal Pradesh, India

Date of Web Publication10-Aug-2017

Correspondence Address:
Anubhav Chauhan
Department of Ophthalmology, Dr. Yashwant Singh Parmar Governmentt Medical College, Nahan, Sirmour, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_80_17

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How to cite this article:
Chauhan A, Sharma N, Chauhan S. Spontaneous teeth loss following herpes zoster. Kerala J Ophthalmol 2017;29:142-3

How to cite this URL:
Chauhan A, Sharma N, Chauhan S. Spontaneous teeth loss following herpes zoster. Kerala J Ophthalmol [serial online] 2017 [cited 2021 May 7];29:142-3. Available from: http://www.kjophthal.com/text.asp?2017/29/2/142/212763



A 45-year-old male [Figure 1] presented with a history of burning sensation and deep boring pain over the left half of the face with loss of teeth over the left side of the lower jaw for the past 3 days. The patient was a diagnosed case of herpes zoster (HZ) ophthalmicus and had received treatment from the Department of Dermatology around 1 month back in the form of tablet Valacyclovir 1 g orally 3 times daily for 10 days and tablet amitriptyline 25 mg at bedtime for postherpetic neuralgia plus supportive treatment. He had also received consultation from the department of ophthalmology then. His ocular examination was within normal limits except for the swollen left lids and watery discharge for which he was prescribed a 2-week course of topical antibiotics and lubricants plus a regular follow-up. He was also advised blood examination in the form of complete hemogram, ELISA for HIV, liver function tests, and renal function tests. All the investigations were within normal limits.
Figure 1: Site of herpes zoster lesions

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At present, there were healed skin lesions over the left forehead, left eye, and left maxillary area. A dental consultation was advised. Gingival hypertrophy with loss of crown was present in the left lower mandibular arc and only the root stumps were visible [Figure 2]. He was advised X-ray of the jaw and orthopantograph and an oral prophylaxis was planned. Unfortunately, the patient never reported back and was lost for follow-up.
Figure 2: Teeth loss following herpes zoster

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HZ is an acute, infectious, and painful viral disease characterized by inflammation of dorsal root ganglia or extra medullary cranial nerve ganglia, associated with vesicular eruptions of the skin or mucous membrane. The most commonly affected dermatomes are the thoracic (45%), cervical (23%), and trigeminal (15%).[1] Involvement of C3, T5, L1, L2, and first division of trigeminal nerve are the most frequently encountered whereas the involvement of second and third division of trigeminal nerve is rarely seen. Factors leading to HZ reactivation are increased age, physical trauma, psychological stress, malignancy, radiation therapy, and immunocompromised states. The most common complication of HZ infection are postherpetic neuralgia while other complications are meningoencephalitis, uveitis, keratitis, cellulitis, and bronchitis.[2]

Reports of dental complications are rare. These are secondary to HZ of second and third division of the trigeminal nerve. These include osteonecrosis, exfoliation of teeth, periodontitis, and calcified and devitalized pulps, periapical lesions and resorption of roots, irregular short roots and missing teeth.[3] Dental complications are probably as a result of vasoconstriction, endarteritis, or vasculitis with ischemia of the blood supply that may be caused by the virus migrating along the trigeminal neurovascular bundle.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgments

We would like to thank our patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bandral MR, Chidambar YS, Japatti S, Choudary L, Dodamani A. Oral complications of herpes zoster infection – Report of 3 cases. Int J Dent Clin 2010;2:70-3.  Back to cited text no. 1
    
2.
Patil S, Srinivas K, Reddy BS, Gupta M. Prodromal herpes zoster mimicking odontalgia – A diagnostic challenge. Ethiop J Health Sci 2013;23:73-7.  Back to cited text no. 2
    
3.
Gupta S, Sreenivasan V, Patil PB. Dental complications of herpes zoster: Two case reports and review of literature. Indian J Dent Res 2015;26:214-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Mahajan VK, Ranjan N, Sharma S, Sharma NL. Spontaneous tooth exfoliation after trigeminal herpes zoster: A case series of an uncommon complication. Indian J Dermatol 2013;58:244.  Back to cited text no. 4
[PUBMED]  [Full text]  


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