Abstract
Case Summary: The patient was a woman in her early 70s. About four years before her first visit to our liaison outpatient clinic, the patient experienced severe pain in the left molar area of her mandible that kept her awake at night, and her family dentist diagnosed her with periodontitis of the left second bicuspid 5. The pain disappeared after about one week, but one month later, the patient experienced dull pain and numbness in the same area. The patient underwent removal of root canal filling material and root canal treatment for 5, which had been treated 20 years earlier, but the pain was not relieved. The patient was referred to our clinic after having visited a total of 10 dental facilities over a 4-year period. The patient’s diary led to a diagnosis of postherpetic neuralgia. The authors prescribed neurotropin for 4 months in consideration of complications, and the pain almost disappeared.
Discussion: Postherpetic neuralgia is persistent neuropathic pain that occurs after healing of herpes zoster. When herpes zoster causes toothache in the region of branches Ⅱ and Ⅲ of the trigeminal nerve, the toothache is severe but resolves within about one week. A few days after the toothache, vesicles may appear in the same nerve-controlled area, but vesicles may not appear. Based on this history, it is difficult to diagnose orofacial pain caused by herpes zoster. In the present case, a key diagnostic point was that the toothache described in the patient’s diary started as severe pain that kept her awake at night, resolved once, and appeared one month later as neuropathic pain with a different pathophysiology.
Conclusion: We experienced an elderly woman who developed postherpetic neuralgia without being diagnosed as toothache possibly caused by herpes zoster and continued to complain of orofacial pain for four years. The difficulty in diagnosing orofacial pain caused by herpes zoster and postherpetic neuralgia should be reaffirmed.
