Shingles is a condition caused by the reactivation of varicella-zoster virus in a person who previously had chickenpox, and it mainly affects the nerves and skin. The symptoms of shingles typically include an itchy or painful rash, fever, headache, and muscle pain. There are two types of this condition: zosteriform (in which lesions form on one side of the body) and disseminated (in which lesions occur all over). In this blog post, we will discuss a third type called oral shingles.
Oral shingles may be challenging to diagnose, and the symptoms are similar to other oral diseases such as cold sores, primary syphilis, or simply recurrent aphthous ulcers. However, oral shingles can be diagnosed via a physical exam and a review of a person’s medical history. The appearance of clustered blisters on one side of the mouth coupled with severe pain is often a telltale sign of oral shingles, especially if the person is older and has no prior history of mouth sores. For further confirmation, doctors may also order a swab of the sores to be sent to the lab for evaluation using a polymerase chain reaction (PCR) test or a blood test to detect varicella-zoster virus antibodies. (Myhre & Sifris, 2021).
Just as with other types of shingles, oral shingles blisters can be painful, and these blisters may take up to four weeks to heal. Shingles in the mouth can lead to:
- Mouth sensitivity
- Difficulty chewing
- Generalized muscle aches
- Lack of appetite
- Altered taste
- Increased risk of bacterial infections
Blisters from other types of shingles affecting the skin can crust over and dry once the blisters erupt, allowing healing to take place. However, in oral shingles, the mouth’s moist environment does not allow the oral blisters to dry. Instead, these blisters are slow to heal and vulnerable to bacterial infection. If it is left untreated, oral shingles could lead to gum disease, degradation of bone, and tooth loss.
If you have newly formed or existing shingles blisters in the mouth, maintaining proper oral hygiene is vital to ensure that the open blisters are not infected. While this may be difficult depending on the severity of the infection, you should continue to brush your teeth and floss daily. Gently brush your teeth to avoid irritating the blisters with your toothbrush, as this may worsen the condition of the healing blisters and make them more painful. Your dentist may also recommend an antibacterial mouthwash containing benzydamine hydrochloride or menthol to keep your mouth clean and promote healing. Incorporating soft food such as yogurt or smoothies into your diet can also help with the pain and speed recovery.
Oral shingles is usually treated with oral antivirals such as acyclovir, valacyclovir, or famciclovir within 72 hours of the outbreak. Additionally, other adjuvant therapies include oral corticosteroids like prednisone to reduce inflammation and aid with healing, or painkillers such as acetaminophen or nonsteroidal anti-infammatory drugs to help with pain relief.
You should contact a doctor as soon as possible if blisters appear on your tongue or inside your mouth to avoid complications and start on antiviral therapy within 72 hours of the outbreak. Open, liquid-filled blisters caused by shingles are key in transmitting the virus. There is the risk of transmitting the virus to others and other parts of your body via a process called autoinoculation. Coughing or sneezing while these blisters develop in the oral cavity can result in the transmission of the virus. Therefore, you should avoid contact with uninfected persons and wash your hands frequently with soap and water.
Myhre, J., & Sifris, D. (2021, May 25). What to do if you have shingles in your mouth. Verywell Health.