Prodromal herpes zoster--a diagnostic challenge in endodontics

Area of Science:

• Dentistry
• Neurology
• Infectious Diseases

Background:

• Herpes zoster (shingles) typically presents with a rash, but prodromal pain can precede this by days.
• Dental pain is a common symptom, potentially leading to misdiagnosis and unnecessary dental procedures.

Observation:

• A 58-year-old male experienced persistent left maxilla pain for 7 months, initially treated as a dental issue with tooth extraction and root canal therapy.
• Despite dental interventions, pain intensified, with clinical and radiographic findings inconclusive for dental pathology.
• Diagnosis of herpes zoster was confirmed only after 7 months, when acute edema and vesicles appeared.

Findings:

• The case illustrates an unusually prolonged prodromal stage of herpes zoster, lasting 7 months.
• Diagnostic confusion arose from the combination of atypical pain presentation and suboptimal root canal treatments in adjacent teeth.
• Antiviral treatment was not used diagnostically, as no supporting data exists.

Implications:

• This case underscores the importance of considering atypical presentations of herpes zoster in cases of persistent, unexplained facial pain.
• Dental professionals should be aware of neurological conditions that can mimic dental pain, especially when conventional treatments fail.
• Further research is needed to understand and manage prolonged prodromal pain syndromes in herpes zoster.