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HZV infection

Herpes Zoster (HZ) is an acute viral infection caused by re-activation of Varicella Zoster Virus (VZV). Following the primary Varicella infection (Chickenpox), typically in childhood, VZV becomes latent / dormant in the nerve (dorsal root / cranial nerve ganglia). Reactivation / Recrudescence of VZV, although uncommon, results in virus passing & manifesting itself in the corresponding dermatome(s), producing neuro-cutaneous signs and symptoms – HZ / shingles.

What is it?

Reactivation of VZV may occur spontaneously or when host defences are compromised, such as:

• Increasing age
• Physical trauma (including dental manipulation)
• Psychological stress
• Malignancy
• Radiation therapy &
• Immuno-compromised states including transplant recipients, immune-modulatory therapy & HIV infection.

How is it triggered?

The triggering may be multi-factorial.

1. Fear and stress for dental procedures increases HZV virus asymptomatic shedding.
2. This may be further increased by the nerve injury during extraction. In fact, during surgical procedures involving the Trigeminal Nerve Root, HZV reactivation occurs in up to 50 % of the patients. However, HZV shedding seems to occur independently from clinical recurrences.
3. Nerve irritation by the anæsthetic block may also lead to viral reactivation & recrudescence

These 3 elements probably lead to a higher viral load, explaining the increased severity of the eruption. These infections seem to be more severe than usual outbreaks.

How does it manifest itself?

Recrudescence usually occurs at the same anatomical site, in general, the vermillion border of the upper / lower lip.

Recrudescences often present a similar clinical course in terms of duration, pain and lesion severity.

Less well recognised maxillofacial complications of HZV infections, include:

• Developmental anomalies such as irregular short roots & missing teeth
• Facial scarring
• Osteonecrosis
• Exfoliation of teeth
• Periodontitis
• Calcified / devitalised pulps &
• Periapical lesions & resorption of roots.