Spontaneous Tooth Exfoliation after Trigeminal Herpes Zoster: A Case Series of an Uncommon Complication
This 80-year-old HIV-negative male had spontaneous loss of teeth from right upper jaw about 10 days after severe tooth pain, gingival swelling/ulceration, and cutaneous vesicular eruptions over right cheek, suggestive of HZ, for which he took analgesics only. He had few loose or missing teeth previously but not in the right upper quadrant. The skin and gingival lesions had healed in about 2 weeks, but he still had paresthesia over the right cheek. Oro-cutaneous examination [ and ] showed hyperesthesia, scarring, and milia over right facial skin innervated by maxillary division of right trigeminal nerve, slight deviation of upper lip, and edentulous right upper alveolar ridge due total loss of teeth. There was minimal periodontitis and few missing teeth in lower jaw, but no oral lesions, gingival ulceration/necrosis, blood, purulent exudates, granulation or loose teeth were noted. X-ray of the jaw and orthopantograph (OPG) showed complete loss of teeth in right upper quadrant and no necrosis or other abnormality of the alveolar bone [ and ]. Systemic examination, complete blood counts, serum biochemistry, urinalysis, and chest X-ray were essentially normal, and he had no other predisposing factors for immune suppression. The oral prophylaxis performed, and the patient was provided with artificial removable dentures later.