What is it?
Shingles is the chickenpox virus caught in childhood lying quiet in a nerve root cluster and multiplying again years later. On the face it is most often the branches of the trigeminal nerve that are affected. Because the virus travels along the nerve, both the pain and the rash sit in the skin area supplied by that one nerve and do not cross the midline of the face.
The part of this picture that concerns dentistry is that the first two to four days pass without a rash. In this period there is one-sided burning, stinging, skin that cannot bear to be touched, and at times an ache that resembles toothache. It is known that healthy teeth can be given root canal treatment or taken out at this stage.
Small blisters in clusters then appear on reddened skin. They can be on the cheek, on the forehead, around the ear or directly inside the mouth, on only one half of the palate or the cheek. This one-sided, sharply bounded pattern is the clearest feature that separates it from mouth ulcers and other sores in the mouth.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
The virus stays in the body for good
In everyone who has had chickenpox the virus goes on living in the nerve ganglia. The immune system keeps it down; when that control weakens, the virus multiplies again and travels along the nerve to the skin.
- 02
Times when immunity has fallen
Older age, serious illness and treatments that suppress the immune system open the way for shingles. That is why an underlying condition is looked for when shingles keeps coming back or is widespread.
- 03
Physical and emotional strain
Feverish illnesses, the period after an operation, long spells without sleep and heavy stress are commonly reported as preparing the ground. They do not explain the condition on their own; they weaken immunity for a time.
- 04
Local strain and procedures
Shingles has been reported to start after an injury or a procedure in the area. Cause and effect has not been proven; it should be kept in mind that the timing may be coincidence.
How does it progress?
- 1
The period before the rash
It lasts two to four days. There is one-sided burning, tingling and an ache that resembles toothache; there is still nothing to see on the skin and diagnosis at this stage is difficult.
- 2
The blister period
Blisters appear in clusters on reddened skin. The fluid in the blisters is infectious; this stage generally lasts seven to ten days and the pain is at its most severe.
- 3
Crusting and healing
The blisters dry and crust over, and the crusts come away within two to four weeks. A difference in skin colour or a scar can remain; in most people the pain eases in this period.
- 4
Pain continuing after the rash
In some people a burning pain carries on after the skin has healed. This possibility increases with age and may need separate pain treatment.
How is it treated?
A dentist does not manage the treatment of this condition. When shingles on the face is suspected, you go to dermatology or infectious diseases the same day; if the area around the eye is involved, an eye specialist joins the assessment. The urgency is because antiviral treatment is aimed at being started in the first days of the rash, so the appointment is not put off.
Our job is to notice the rash and its one-sided nerve pattern, and to stop an irreversible procedure when the pain is not coming from a tooth. If there are blisters or shallow sores inside the mouth, they are told apart from mouth ulcers, recorded, and advice is given about mouth care. Dental treatment can be postponed until the condition is under control.
The treatment your doctor plans is antiviral medication and pain management; if the eye is involved, follow-up with an eye specialist is added. If the pain continues after the skin has healed, neurology or a pain specialist takes over. Do not put creams on the blisters on your own decision, do not pick off the crusts, and do not shorten the course of medication you have been given.
- Blisters on the tip of the nose, on the eyelid or around the eye
- Redness, pain, discomfort in bright light or blurred vision in the eye
- Blisters on the outer ear together with facial drooping, dizziness or hearing loss
- A rash that spreads beyond one area, or a high fever alongside it
How is it prevented?
- While the rash is present the blister fluid is infectious; stay away from children who have not had chickenpox, from pregnant women and from people whose immune systems are suppressed.
- Do not burst the blisters, use a clean dressing when covering them, and do not apply creams on your own decision.
- If you have an illness or a treatment that weakens your immune system, ask your own doctor whether the shingles vaccine is suitable for you.
- When a burning pain starts on one side of the face that a tooth does not explain, do not wait for days; coming in during this period keeps the treatment window open.
Frequently asked questions
- Can shingles be recognised before the rash appears?
- It is hard to be certain. Even so, pain that is one-sided, that gets worse when the skin is touched, that has no link with heat or cold and that X-rays cannot explain does raise suspicion. In such a picture it is sensible to wait and have a doctor's assessment before any irreversible procedure is carried out on a tooth.
- Can shingles be passed to someone else?
- Shingles is not passed on as shingles. But the virus in the blister fluid can cause chickenpox in someone who has not had chickenpox before and has not been vaccinated. Close contact with people at risk should be avoided until the blisters have dried and crusted over.
- Could my toothache be shingles?
- This possibility comes to mind if your pain is not linked to chewing or to hot and cold, if it is on only one side of the face and if your skin is extremely sensitive to touch. The decision is made by examination; over the first few days you should watch for blisters appearing on the skin and go back to your dentist if anything changes.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.