Herpes Zoster of the Maxillary Division of the Trigeminal Nerve Presenting as Endodontic Post-treatment Pain: Case Report and Review of the Literature.

Herpes zoster (HZ), caused by the reactivation of varicella zoster virus, presents a major diagnostic challenge in dentistry, particularly when involving the trigeminal nerve. The prodromal symptoms of HZ can closely resemble endodontic pain, leading to misdiagnosis and delayed appropriate treatment. This case report described a 54-year-old male who presented to the emergency dental clinic with severe unilateral, radiating maxillary pain originating from posterior to anterior teeth. Initially diagnosed with symptomatic apical periodontitis on a previously endodontically treated tooth #3, the patient's condition underwent a shift in diagnosis 2 days later when a unilateral vesicular rash appeared along the maxillary division of the trigeminal nerve. The patient's acute nonodontogenic pain attributed to HZ was successfully managed through systemic antiviral and adjunctive therapies without endodontic intervention on tooth #3. While the acute symptoms of HZ were resolved, the patient subsequently developed postherpetic neuralgia and enduring sensory disturbances. A comprehensive review of the literature revealed that beyond postherpetic neuralgia, patients may experience other complications manifesting years after the HZ episode, including pulp necrosis, root resorptions, and osteonecrosis. It is evident that early recognition and diagnosis are paramount in the treatment of HZ. Understanding orofacial manifestations and effective management of HZ are crucial to prevent diagnostic mistakes, ensure optimal patient care and mitigate potential complications.