Page 8 - GP spring 2023

Neurotropic Herpes Virus - Varicella Zoster: A Case Study

Authors: Erfun, M. Sadeghi, MS, Jason J. Starace, DDS, Asma Muzaffar, DDS, MPH, MS, and Lucretia Depaola-Cefola, DDS, MS

Abstract: 2000 years ago and has been termed for its of the affected area. It has been said that

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Introduction: ability to appear, disappear, and spread. 20% of individuals with herpes zoster ex-
Varicella Zoster Virus (VZV) is a member Human Herpesvirus III, also known as perience post-herpetic neuralgia; 50% of
of the herpes virus that can infect humans. Varicella Zoster Virus, is a virus known to all post-herpetic neuralgia cases are indi-
VZV causes chickenpox in children/ad- cause a primary infection, “Chickenpox,” viduals over 60, and 75% of all post-her-
olescents and shingles in adults/geriatric in children and young adults and a second- petic neuralgia cases are older than 70
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population. Once infected with VZV, the ary infection, “Shingles”, in adults. This years of age (CDC).
virus tends to stay dormant in a sensory enveloped double-stranded DNA virus be- CLINICAL REPORT
or dorsal root ganglion. Dentists must be longs to the family Herpesviridae and can A 75-year-old Caucasian female presented
familiar with VZV’s signs and symptoms enter the human body via droplets in the to the College of Dentistry for an emergen-
to prevent misdiagnosis and inappropriate air or through direct contact with an active cy visit. The patient’s chief complaint was,
treatments. lesion. Generally, entering through respira-
tory epithelial cells eventually spreads to “My lower left jaw goes numb,” and she
Case Presentation: various cell types. 2 wanted to know whether it was due to her
A 75-year-old female presented to the implant placement of tooth #20.
NYU College of Dentistry for an emer- The initial infection of this virus is known MEDICAL HISTORY:
gency evaluation. The patient’s chief com- as chickenpox or varicella. The virus goes The patient reported that she had no med-
plaint was, “My lower left jaw goes numb,” through two stages during the initial in- ical conditions that she was being treated
and she was concerned if it was due to her fection: primary viremia and secondary for and was otherwise healthy. The patient
recent implant placement of tooth #20. Af- viremia. During primary viremia, the virus does not take any medications. However,
ter reviewing the patient’s medical, dental, attacks the reticuloendothelial system and the patient mentioned that she was allergic
and social histories along with an extra/in- eventually works its way to attack immune to latex and had a history of shingles. Vi-
tra-oral examination, including radiographs response cells such as T-cells, also known tals taken at the time of her emergency visit
and diagnostic exam, an odontogenic cause as secondary viremia. During secondary were within normal limits.
was ruled out. Her history of shingles and viremia, the infected T-cells express pro-
recent life stressors pointed to the possibil- teins that bind to skin cells. Once the virus DENTAL HISTORY:
ity of post-herpetic neuralgia. An internal reaches the skin, they begin infecting the The patient initially reported for a com-
referral to the Orofacial Pain department keratinocytes, which can be seen on the prehensive evaluation in 2019. It was then
was made for the patient. skin as lesions. VZV can also retrogradely determined that tooth #20 required a dis-
infect sensory neurons, which will be our
Conclusion: primary focus for this case report. Once the tal-occlusal class II restoration, and the
tooth was restored. The patient returned
Herpes Zoster is highly prevalent in the virus attacks a sensory cell, it can travel two years later stating “pain” in tooth #20,
geriatric population and has different clin- back to either the dorsal root ganglion or and an internal consult was sent to the Oral
ical presentations. In this patient’s case, it the trigeminal ganglion. Upon reaching the and Maxillofacial Surgery (OMFS) de-
lacked the typical superficial skin lesions ganglion, this virus can stay dormant until partment. Tooth #20 was extracted and the
that one would expect and instead elicited its reactivation due to a lowered immune socket was preserved using 0.5 ccs of can-
mild paresthesia as a response to its reac- system. 3 cellous bone with no complications. The
tivation. Treatment modifications for this post-operative evaluation of the extraction
patient included using antiviral prophylax- The reactivation is herpes zoster or shingles site was performed and was deemed a
is before receiving any dental treatment or and usually affects one side/dermatome healthy recovery, and the patient did not re-
before getting the shingles vaccine, Shin- of the body or face and doesn’t cross the port any pain or discomfort. A consult was
grix. These precautions will prevent any midline. Looking into the epidemiology of done the same year to place an implant for
further reactivation of the virus. Besides herpes zoster, it has been reported that an tooth #20. Oral surgery performed a surgi-
the modifications mentioned above, no oth- estimated one million cases occur annually cal endosteal implant placement of the im-
er specific dental changes are necessary. in the United States. The rate of incidence
is up to 4 cases per 1,000 people. This rate plant body using a 12mm Straumann Nar-
KEYWORDS: increases for individuals older than 60 or row CrossFit connection (NC-3.3mm). The
Varicella Zoster Virus, Herpes, Shingles, with a compromised immune system to 1 postoperative implant evaluation showed
Life Stressors case per 100 people. One complication of routine osteointegration and the patient
herpes zoster is known as post-herpetic did not report any pain or discomfort. The
INTRODUCTION: neuralgia, defined as persistent neuropathic patient returned for the second stage of
The term Herpes is derived from an an- pain for more than three months following implant surgery for #20, where the cover
cient Greek word that means to “creep” herpes zoster. The symptoms range from screw was removed, and the healing abut-
or “crawl.” This term dates back as far as allodynia and paresthesia to total paralysis ment was placed. The patient returned for
a fractured crown on tooth #19 and to take

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