Shingles In Mouth: Symptoms, Causes, And Treatment

Shingles (herpes zoster) is a viral infection that affects one in every three people in the US. The varicella-zoster virus causes it. This virus first causes chickenpox, which mainly occurs in children.¹

After a chickenpox infection, the virus stays dormant in the body without causing any symptoms. It can later reactivate, thus causing shingles.

This condition typically affects the skin, but it's not uncommon to get shingles in the mouth. This can lead to a painful outbreak of blisters in the mouth. Early diagnosis and treatment are vital for reducing long-term damage and other complications.

So, keep reading to get more information about this illness.

Can you get shingles in your mouth?

Yes, you can. When the varicella-zoster virus reactivates, it can affect any part of the body, including the mouth. One key point about shingles is that they tend to be unilateral, meaning they are limited to one side of the body.

With this in mind, an oral shingles infection will typically occur along a branch of the trigeminal nerve of the face. This can either be the maxillary nerve of the upper jaw or the mandibular nerve of the lower jaw. This is good news because it can help you distinguish oral shingles from other oral blistering conditions.

Shingles in the mouth start as blisters and form lesions that tend to occur on the palate or roof of the mouth. Remember that many of the motor and sensory neurons of the brain's frontal cortex are connected to the face and mouth.

For this reason, oral shingles can be quite painful and more diffuse. Additionally, the frontal cortex is responsible for memory, problem-solving, and speech. Hence, oral shingles require early diagnosis and treatment to avoid serious complications.

What are the symptoms of shingles in the mouth?

A rash or blisters in the mouth can be mistaken for several diseases, including oral herpes simplex virus (HSV) and shingles. So, how do you know which one you have?

Oral shingles symptoms will vary depending on what stage of infection you're in. 

Here are the stages of oral shingles:

Pre-eruptive or prodromal phase

This stage happens 1–2 days before the noticeable shingles rash develops. A person may experience a tingling and burning sensation in the infected area and general malaise. This pain can often be mistaken for a toothache, headache, or fatigue in oral shingles.

Acute eruptive phase

In the next phase, rash and fluid-filled blisters appear in dense clusters. These usually start as tiny bumps and quickly transform into full-blown painful blisters.

The blisters can occur in the mouth alone or with a rash on the face. Like any shingle infection, oral shingles will affect only a small section on one side of your mouth.

If the infection occurs along the mandibular nerve, you can get shingles on the tongue or shingles on the gums of the lower teeth. If the infection is on the maxillary nerve, blisters can develop on the gums of the upper teeth and the palate.

The acute eruptive phase can last up to four weeks. All this pain in the mouth can also lead to:

• Difficulty chewing

• Lack of appetite

• Altered taste

• Drooling

• Mouth sensitivity

• Fatigue

• Muscle aches

• General body aches

Postherpetic neuralgia (PHN) phase

This stage doesn't occur in everyone who gets oral shingles. According to the CDC, only about 10–18% of those who get shingles will experience PHN. This is the phase where the blisters have healed, but the pain lingers.

The pain can be chronic or recurrent and can last weeks or longer. In the meantime, be ready to experience the following:

• Dull, throbbing pain

• Severe tingling, burning, or prickling

• Shooting, shock-like pain

These symptoms may worsen with jaw movements like chewing. The good news is that the pain will gradually go away with time. But if the nerve damage is severe, the pain may continue for much longer and even become permanent and disabling.

As a viral disease, shingles will often present other symptoms, including:

• Fever

• Chills

• Upset stomach

• Nausea

• Headache

How do you get oral shingles?

As mentioned earlier, shingles are caused by the reactivation of the varicella-zoster virus. Several things can weaken your immune system and reactivate this virus, including:

• Stress

• Aging

• Compromised immunity, such as with cancer or people with HIV

• Acute or chronic illness like diabetes

• Exposure to cold temperatures

• Exposure to the varicella-zoster virus

• Too much sun exposure

• Immunosuppressant drugs

Oral shingles are a less common form of this viral infection. It can appear on its own or along with skin symptoms.

How do you treat the shingles of the mouth?

First off, note that there's no cure for shingles. You can minimize symptoms, though, and even shorten the length of your infection with several treatment options.

Visit your doctor immediately if you suspect you have oral shingles based on the symptoms mentioned earlier. 

Is there a test for oral shingles? No, there isn't a single test for diagnosing shingles. So, the doctor will conduct a physical exam to check for signs of oral shingles.

They will then ask about your medical history to determine your risk of developing the infection. Have you had chickenpox before or have an illness that could be lowering your immunity?

Last but not least, the doctor might swab the blisters in your mouth to analyze them for the varicella-zoster virus.

That being said, here's how to cure shingles on lips and mouth without leaving scars:

Antiviral and pain relief medications

Your doctor will first prescribe antiviral drugs to fight the shingles-causing virus. This helps to shorten the infection duration and prevent long-term complications. Common antiviral medications used for treating shingles include:

• Zovirax (acyclovir)

• Valtrex (valacyclovir)

• Famvir (famciclovir)

Additionally, your doctor may prescribe anti-inflammatory drugs like oral corticosteroids. This helps to reduce inflammation and aid healing.

Oral shingles can be quite painful. So, your doctor may offer over-the-counter (OTC) or prescription pain medication to help relieve the pain. They may also prescribe topical oral pain medication that you can apply directly to the mouth shingles.

At-home self-care

You can do several things to aid healing and reduce the risk of complications.

First, maintain proper oral hygiene to ensure the raptured blisters don't get infected. While you're encouraged to brush and floss daily, be careful not to irritate the blisters, as this may make things more painful and heal slowly. Your dentist may recommend alcohol-free antibacterial mouthwashes. This will help reduce pain and the risk of bacterial infection.

In addition to oral care, a soft food diet will help you feel more comfortable. Go for foods like mashed potatoes and eat bland and cold foods.

What to eat with shingles in mouth

A weak immune system often triggers the dormant virus that causes shingles. A nutritious and well-balanced diet is vital for boosting your immune system and supporting healing. Once the blisters are healed and you can eat well again, consider the following:

• Non-acidic fruits

• Vegetables

• Lean protein

Foods to avoid include:

• Sugary beverages

• Sugary cereals

• White bread and white rice

• Ice cream

• Packaged snacks, fast food, deep-fried foods

• Pies, pastries

• Alcohol

Are there preventive steps you can take?

The first risk factor of shingles is having had chickenpox before. It goes without saying that a chickenpox vaccine reduces the risk of being infected with the varicella-zoster virus.

The second risk factor for shingles is older age. The good news is that a shingles vaccine called Shingrix is recommended for adults 50 years and older. This vaccine lowers the risk of shingles infection, and in case you get infected, it reduces complications like PHN.

In a clinical trial of more than 30,000 people, this vaccine proved to be 96.6% effective at preventing shingles. It was also 91.2% effective at preventing postherpetic neuralgia.²

Another way to prevent shingles is to support your immunity. This includes managing your stress, getting quality sleep, and exercising. You'll also need to take steps to avoid infections.

The lowdown

Shingles in the mouth are not as well-defined as shingles on the skin. This can make oral shingles more challenging to diagnose. This condition might need earlier and more aggressive treatment to prevent severe consequences. Hopefully, this article has been a useful guide to help you identify, treat, and even prevent oral shingles.

Be sure to consult your doctor if you are unsure about any symptoms or treatment plans.

Frequently asked questions

How serious are shingled in the mouth?

There are many risks associated with oral shingles. For starters, the prodromal pain before the rash is often confused with a toothache. This can lead to unnecessary dental treatment like extraction or fillings.

With shingles of the skin, the blisters will crust over and dry once they erupt. But given the moist environment in the mouth, the oral blisters cannot dry. Instead, they break down and form moist ulcers that heal pretty slowly and are vulnerable to bacterial infection.

Oral shingles can cause dental complications without proper treatment. This includes issues like gum disease, tooth loss, or osteonecrosis (bone death).

That being said, the most common complication of shingles, in general, is postherpetic neuralgia. This causes severe pain even after the shingles rash has cleared. Other rare complications of oral shingles include:

• Pneumonia

• Hearing problems

• Brain inflammation

How long do shingles in the mouth take to heal?

The oral shingles blisters will begin to scab in seven to ten days. It may take up to five weeks for the infection to clear and heal; in some people, the pain can last weeks or even months. Following your doctor's treatment plan and taking care of yourself at home is essential for a speedy recovery.

Get enough sleep, eat a nutrient-dense diet, and manage stress.