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

Junjie Lin; Poorya Jalali; Fabricio B Teixeira; Yuhong Lin; Sarah Parker Allen; Jemma Hanson; Feng-Ming Wang

doi:10.1016/j.joen.2026.03.005

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

Journal article

Peer reviewed

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

Junjie Lin, Poorya Jalali, Fabricio B Teixeira, Yuhong Lin, Sarah Parker Allen, Jemma Hanson and Feng-Ming Wang

Journal of endodontics

03/18/2026

DOI: 10.1016/j.joen.2026.03.005

PMID: 41862013

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Abstract

Herpes zoster (HZ), caused by the reactivation of Varicella Zoster Virus (VZV), 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 two days later when a unilateral vesicular rash appeared along the maxillary division of the trigeminal nerve. The patient's acute non-odontogenic 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 (PHN) and enduring sensory disturbances. A comprehensive review of the literature revealed that beyond PHN, 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.

Pain

Varicella zoster virus

Postherpetic neuralgia

Herpes zoster

Trigeminal nerve

Details

Title: Subtitle: Herpes Zoster of the Maxillary Division of the Trigeminal Nerve Presenting as Endodontic Post-Treatment Pain: Case Report and Review of the Literature
Creators: Junjie Lin - Texas A&M University
Poorya Jalali - Texas A&M University
Fabricio B Teixeira - Texas A&M University
Yuhong Lin - Texas A&M University
Sarah Parker Allen - Texas A&M University
Jemma Hanson - Texas A&M University
Feng-Ming Wang - Department of Endodontics, Texas A&M University College of Dentistry, Dallas, Texas. Electronic address: wangfm@tamu.edu
Resource Type: Journal article
Publication Details: Journal of endodontics
DOI: 10.1016/j.joen.2026.03.005
PMID: 41862013
NLM abbreviation: J Endod
ISSN: 1878-3554
eISSN: 1878-3554
Publisher: Elsevier
Language: English
Electronic publication date: 03/18/2026
Academic Unit: Endodontics
Record Identifier: 9985144720502771

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