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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 13  »  Prodromal herpes zoster – a diagnostic challenge in endodontics
Prodromal herpes zoster – a diagnostic challenge in endodontics
Discussion - References.

Herpes zoster infection in prodromal stages may represent a diagnostic challenge, as pain is the only clinical finding. Usually the prodromal stage precedes the acute stage by hours to several days (Strommen et al. 1988). In the present case, however, pain localized to the second premolar had lasted for approximately 7 months, and became more severe over a 1–2 months period prior to the acute stage of the disease.
The patient’s initial pain problems, 9 months prior to the acute herpes zoster attack, had been treated by extraction of the first, and root canal treatment of the second maxillary premolar. Retreatment of the second premolar and first molar did not have any positive effect on the pain, and except for increasing pain, no clinical or radiographic signs of apical pathosis were present. It seems difficult, therefore, to explain the pain problems without connecting them to prodromal herpes zoster.
Odontalgia and pulp death have been reported previously as a result of herpes zoster infection (Gregory et al. 1975, Goon & Jacobsen 1988, Mintz & Anavi 1992). The reactivated virus may travel the length of the nerve and infect the pulp vasculature leading to infarction and pulp death, and a time lag of up to 1 month between odontalgia and acute mucocutaneous lesions has been reported (Mintz & Anavi 1992). But in the present case, the time lag appeared to be much longer and the pain became more intense 1–2 months prior to the vesicular stage. Furthermore, sporadic episodes of pain were still experienced 6 months after the acute attack and were followed by tearing and visual problems in the left eye. Postherpetic neuralgia results when pain of acute zoster does not subside as the acute eruptions clear. Postherpetic neuralgia, occurring in approximately 10% of the cases, is usually a constant, intense, burning, hot discomfort of the skin which increases with any stimulus and may include sharp, stabbing pain as well. The history of acute herpes zoster infection and the scars it leaves behind, makes diagnosis simple in most cases. Postherpetic neuralgia may, on the other hand, as in the present case, persist or recur some time after the vesicular stage of the herpes zoster has healed.


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