title: Multiple Apical Radiolucencies and External Cervical Resorption Associated with Varicella Zoster Virus: A Case Report.
abstract: Varicella zoster virus (VZV) is responsible for the primary infection chickenpox. After the initial infection, it remains latent but can reactivate, resulting in shingles (herpes zoster). Previous reports have implicated VZV in the pathogenesis of apical periodontitis, but the involvement of the virus has not been investigated fully. The present case describes a patient who suffered from a severe episode of shingles and subsequently developed periapical radiolucencies of all the teeth in the affected nerve distribution. Molecular and culture techniques showed the presence of VZV DNA in the root canal system in the absence of bacteria. This confirms that VZV can cause localized pulp necrosis and apical periodontitis. The lesions healed after endodontic treatment, implying chemomechanical debridement using sodium hypochlorite irrigation and a calcium hydroxide interim dressing may be effective against the virus.
authors.affiliation: Department of Endodontology, Kings College Dental Institute at Guy's King's and St Thomas' Hospital, London, United Kingdom.
authors.forename: Kreena
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Endodontology, Kings College Dental Institute at Guy's King's and St Thomas' Hospital, London, United Kingdom.
authors.forename: Elia
authors.initials: E
authors.lastname: Schirru
authors.affiliation: Department of Endodontology, Kings College Dental Institute at Guy's King's and St Thomas' Hospital, London, United Kingdom.
authors.forename: Sadia
authors.initials: S
authors.lastname: Niazi
authors.affiliation: Department of Endodontology, Kings College Dental Institute at Guy's King's and St Thomas' Hospital, London, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Department of Endodontology, Kings College Dental Institute at Guy's King's and St Thomas' Hospital, London, United Kingdom. Electronic address: francesco.mannocci@kcl.ac.uk.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mannocci
mesh_terms: D002126:Calcium Hydroxide / Q000627:therapeutic use; D002644:Chickenpox / Q000150:complications*; D004279:DNA, Viral / Q000032:analysis; D003786:Dental Pulp Cavity / Q000000981:diagnostic imaging / Q000821:virology; D003790:Dental Pulp Necrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000821:virology; D006562:Herpes Zoster / Q000150:complications*; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000472:pathogenicity*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010485:Periapical Periodontitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000821:virology*; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D012388:Root Canal Irrigants / Q000627:therapeutic use; D012389:Root Canal Obturation / Q000379:methods; D018915:Root Canal Preparation / Q000379:methods; D012391:Root Resorption / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D012973:Sodium Hypochlorite / Q000627:therapeutic use
chemical_list: D004279:DNA, Viral; D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D012973:Sodium Hypochlorite; D002126:Calcium Hydroxide
keywords: Apical periodontitis; external cervical resorption; herpes zoster; shingles; sodium hypochlorite, varicella zoster; virus