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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.



Discussion.
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.

References.

Barrett AP, Katelaris CH, Morris JG, Schifter M (1993) Zoster   sine herpete of the trigeminal nerve. Oral Surgery, Oral Medicine and Oral   Pathology 75, 173-5.
Goon WWY, Jacobsen PL (1988) Prodromal odontalgia and multiple devitalized   teeth caused by a herpes zoster infection of the trigeminal nerve: report of   a case. Journal of the American Dental Association 16, 500-4.
Gregory WB, Brooks LE, Penick EC (1975) Herpes zoster associated with pulpless   tooth. Journal of Endodontics 1, 32-5.
Marbach JJ (1993) Phantom tooth pain: differential diagnosis and treatment.   New York State Dental Journal 59, 28-33.
Marbach JJ (1999) Medically unexplained chronic orofacial pain. Temporomandibular   pain and dysfunction syndrome, orofacial phantom pain, burning mouth syndrome,   and trigeminal neuralgia. Medical Clinics of North America 83, 691-710.
McKendrick MW, Care CC, Kudesia G, Bates CJ, Oxley MK, Eley A (1999) Is VZV   reactivation a common cause of unexplained unilateral pain? Results of a prospective   study of 57 patients. Journal of Infection 39, 209-12.
Millar EP, Troulis MJ (1994) Herpes zoster of the trigeminal nerve: the dentist's   role in diagnosis and management. Journal of the Canadian Dental Association   60, 450-3.
Mintz SM, Anavi Y (1992) Maxillary osteomyelitis and spontaneous tooth exfoliation   after herpes zoster. Oral Surgery, Oral Medicine and Oral Pathology 73,   664-6.
Strommen GL, Pucino F, Tight RR, Beck CL (1988) Human infection with herpes   zoster: etiology, pathophysiology, diagnosis, clinical course and treatment.   Pharmacotherapy 8, 52-68.
Treede RD, Magerl W (1995) Modern concepts of pain and hyperalgesia. Beyond   the polymodal Cnociceptor. News in Physiological Sience 10, 216-28.
Vickers ER, Cousins MJ (2000) Neuropathic orofacial pain. Part 1. Prevalence   and pathophysiology. Australian Endodontic Journal 26, 19-26.