Spontaneous Tooth Exfoliation after Trigeminal Herpes Zoster: A Case Series of an Uncommon Complication
This 55-year-old HIV-negative female was hospitalized for painful vesicular lesions over right cheek, right half of tongue and buccal mucosa innervated by right mandibular nerve, and corresponding gingival swelling. Although she had toothache 2 days prior to onset of skin lesions, there was no blood, purulent exudates, granulation, or loose teeth. She had mild generalized periodontitis and few missing teeth, but teeth in right lower quadrant were intact. Systemic examination, complete blood counts, serum biochemistry, urinalysis, and chest X-ray showed no abnormality, and there were no predisposing factors for immune suppression. Clinical diagnosis of HZ was made, and she was treated with intravenous acyclovir (500 mg 8 hourly/d) for initial 2 days, followed by oral acyclovir (800 mg × 5 times/d) for the next 1 week and was sent home. Oro-cutaneous examination on return visit 2 weeks later showed hyperesthesia and hyperpigmentation of facial skin over right mandibular area, slight hypo-/hyperpigmentation of lower lip, and edentulous right lower alveolar ridge due total loss of teeth [ and ]. Orthopantograph showed complete loss of teeth in right lower quadrant and no necrosis or other abnormality of the alveolar bone []. The oral prophylaxis performed. She did not return for further follow-up.