Shingles is a viral infection that causes a painful rash. It’s caused by the varicella-zoster virus (VZV) – the very same virus that causes chickenpox. After you’ve had chickenpox, VZV hangs around in your body, chilling out in your nerve tissues.
Sometimes, the virus wakes up again, causing shingles. While shingles usually appears as a stripe of blisters on the torso, it can show up in other places. So, can you get shingles in your mouth? Yes, but it’s less common than shingles on other parts of the body. When it does happen, it can be incredibly painful and disruptive.
Catching and treating shingles early is really important to avoid potential complications. This article will give you a complete rundown of what you need to know about shingles in the mouth, from symptoms to treatment.
What is oral shingles?
Oral shingles, also known as oral herpes zoster, is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox.
Varicella-zoster virus reactivation
After you’ve had chickenpox, the virus stays in your body, dormant in the dorsal root ganglia (nerve cell clusters) or cranial nerve ganglia. It’s like the virus is sleeping, waiting for an opportunity to wake up.
Shingles happens when the virus reactivates and travels along nerve fibers to your skin. Typically, shingles affects a single dermatome — that’s a specific area of skin that’s connected to a single nerve.
Oral shingles defined
Oral shingles affects the trigeminal nerve, specifically the branches of this nerve that supply sensation to your mouth. It’s a less common presentation of the disease than shingles on the torso or back.
Symptoms of oral shingles
When shingles occurs inside your mouth, it can be quite painful, and it may be hard to eat or even talk.
Prodromal phase
In the early stages of shingles, before the tell-tale rash appears, you may experience pain, burning, tingling, or itching in the area where the rash will eventually erupt. These symptoms can appear several days before the blisters show up.
Because the early symptoms of shingles are similar to those of other conditions, you might mistake shingles for a toothache, a sinus infection, or some other type of nerve pain.
Acute eruptive phase
The shingles rash is characterized by blisters that typically form on one side of the mouth, following the path of a nerve. The blisters can break open and form ulcers.
If you have oral shingles, the blisters may appear on your tongue, gums, palate (roof of your mouth), or inner cheek.
Other symptoms
Besides the rash and pain, you may have other symptoms, such as:
- Severe pain that can be debilitating
- Difficulty eating
- Difficulty speaking
- Swelling and redness
- Fever
- Fatigue
Risk Factors and Causes
Several things can increase your likelihood of developing shingles.
Age
The older you are, the greater your chances of getting shingles. The risk starts to rise around age 50, and by age 85, you have at least a 50% chance of having had shingles at some point in your life.
Compromised Immune System
If you have a medical condition that weakens your immune system, such as HIV/AIDS or cancer, or if you’ve had an organ transplant, you’re more likely to get shingles. Immunosuppression raises the risk of both shingles and complications from the disease.
Stress
Stress can weaken the immune system, potentially triggering a shingles outbreak.
Prior Chickenpox Infection
You can’t get shingles unless you’ve had chickenpox at some point. The varicella-zoster virus (VZV) that causes chickenpox stays dormant in your body after you recover. Shingles is caused by a reactivation of this virus.
How is oral shingles diagnosed?
If you think you might have shingles in your mouth, a healthcare provider will need to evaluate you. This might be your dentist or your family doctor.
The evaluation usually involves:
- Clinical examination. The provider will carefully examine your mouth, looking for telltale rashes and blisters.
- Medical history. Expect to answer questions about your health history, including whether you’ve had chickenpox and if you have any other conditions.
- Lab tests. Your provider might swab one of the blisters and send the sample to a lab. Technicians can use PCR (polymerase chain reaction) or DFA (direct fluorescent antibody) tests to confirm the presence of the varicella-zoster virus (VZV).
Treatment Options for Oral Shingles
If you suspect you have shingles in your mouth, see a healthcare provider right away. The goal of treatment is to reduce the severity and length of the outbreak and to manage your pain.
Antiviral Medications
It’s important to start antiviral therapy as soon as possible, ideally within 72 hours of the rash appearing. Early treatment can significantly reduce the severity and duration of the outbreak.
Common antiviral medications used to treat shingles include:
- Acyclovir (Zovirax)
- Valacyclovir (Valtrex)
- Famciclovir
Some studies have suggested that valacyclovir (Valtrex) may resolve pain faster than acyclovir (Zovirax) in certain cases.
Pain Management
Pain management is a crucial part of shingles treatment.
- Over-the-counter pain relievers: Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help manage mild to moderate pain. Be sure to follow the package directions, and don’t exceed the maximum daily dose of 3,000 mg for Tylenol.
- Prescription pain medications: For severe pain, your doctor might prescribe stronger pain relievers like opioids (e.g., Percodan). Percodan is typically prescribed at a dosage of 5 mg four times daily, but be sure to follow your doctor’s specific instructions.
- Topical anesthetics: Over-the-counter topical anesthetics such as Oral-B Mouth Sore Special Care can provide temporary relief from mouth pain.
Oral Care and Hygiene
Gentle oral hygiene practices can help prevent secondary infections and promote healing. It’s important to:
- Use a soft-bristled toothbrush to avoid irritating the sores.
- Rinse your mouth with a mild saline solution (1/2 teaspoon of salt in a cup of warm water) several times a day.
- Avoid irritating foods and beverages, such as spicy, acidic, or hot items, which can worsen the pain.
Other Treatments
In some cases, your doctor might prescribe steroids to reduce inflammation. It’s also important to stay hydrated by drinking plenty of fluids and eating soft, nutritious foods that are easy to swallow.
Potential complications
Although shingles is usually a self-limited illness, it can lead to some complications.
Postherpetic neuralgia (PHN)
This is the most common complication of shingles. Postherpetic neuralgia is nerve pain that just doesn’t go away, even months or years after the shingles rash has healed. It’s caused by nerve damage from the varicella-zoster virus. About 10% to 18% of people over the age of 60 who get shingles end up with postherpetic neuralgia.
Secondary infections
The sores that shingles causes are vulnerable to bacterial infections. If you notice increased pain, redness, swelling, or pus coming from the blisters, see a doctor.
Other complications
- Vision loss. If shingles affects the ophthalmic branch of the trigeminal nerve, which affects the eyes, it can cause vision loss.
- Tooth loss. In rare cases, shingles can damage the nerves that supply the teeth.
Prevention and Recovery
There are steps you can take to reduce your risk of shingles and improve your recovery if you do get it.
Shingles Vaccination
The Shingrix vaccine is very effective in preventing shingles. Research shows it reduces the risk of getting shingles by more than 90% when used as directed. The CDC recommends vaccination for adults age 50 and older, even if you’ve had chickenpox or shingles before.
Lifestyle Modifications
Stress management, a healthy diet, adequate sleep, and regular exercise can all help boost your immune system and reduce your risk of shingles.
Techniques like meditation, yoga, and deep breathing exercises can help keep your stress in check.
Recovery Tips
If you have shingles in your mouth, eating soft foods can minimize irritation of the sores. It’s also important to maintain good oral hygiene to prevent secondary infections. To avoid the potential spread of the virus, don’t share food or drinks with others.
In Conclusion
Shingles in the mouth is a less common but very painful manifestation of the varicella-zoster virus. As with shingles on other parts of the body, early diagnosis and treatment of oral shingles are critical to preventing further complications.
One of the best ways to avoid shingles is to get vaccinated. The Shingrix vaccine is highly effective at preventing shingles and postherpetic neuralgia.
If you think you might have shingles in your mouth, see a doctor or dentist as soon as possible.