Herpes Zoster of the Maxillary Division of the Trigeminal Nerve Presenting as Endodontic Post-treatment Pain: Case Report and Review of the Literature.
Junjie Lin, Poorya Jalali, Fabricio B Teixeira et al.
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Case in brief
A 54-year-old man presented to an emergency dental clinic with severe unilateral maxillary pain radiating from posterior to anterior teeth. The pain was initially attributed to symptomatic apical periodontitis in previously treated tooth #3. Two days later, a unilateral vesicular rash appeared in the maxillary division of the trigeminal nerve, supporting herpes zoster as the cause of the acute nonodontogenic pain. Systemic antiviral and adjunctive therapies resolved the acute symptoms without further endodontic treatment. He subsequently developed postherpetic neuralgia and persistent sensory disturbances.
What made this case unusual
The zoster prodrome mimicked pain from a previously endodontically treated tooth, but the later dermatomal vesicular rash redirected the diagnosis. The report also notes possible delayed dental and bony complications described in the literature, including pulp necrosis, root resorption, and osteonecrosis.
Diagnostic / clinical pearl
Unilateral maxillary pain may precede the vesicular eruption of trigeminal herpes zoster and resemble endodontic disease. Reassess the diagnosis if the clinical picture changes, particularly when a dermatomal rash appears.