Shingles in Your Mouth: Signs, Causes, and Treatment Options

The early signs and symptoms of oral shingles (shingles in the mouth) may include:

• a tingling or burning sensation in and around the mouth
• skin tenderness around your mouth and face
• pain that resembles a toothache
• mucosal irritation

After a few days, you may also experience a painful rash of tiny fluid-filled blisters on the face or mouth (including the tongue).

General symptoms of shingles may also include:

• fever
• fatigue
• headache
• chills

The symptoms of shingles in the mouth may vary depending on the stage of infection. These stages may include:

• Prodromal phase: Also called the pre-eruptive stage, this phase happens about 48 hours before a rash becomes visible. It may cause tooth pain, as well as fatigue and headaches.
• Acute eruptive phase: This stage involves the development of a painful rash, which may occur in the mouth or the skin around it. The acute eruptive stage may last up to 4 weeks.
• Postherpetic neuralgia phase: Although not everyone experiences it, this phase involves mild to severe pain that lasts longer than 5 weeks. It may also involve atypical skin sensations, like tingling, burning, or prickling.

The cause of oral shingles is the same as the cause of shingles in general. Once you have had chickenpox, the virus may stay dormant in your body for years. Different factors may awaken or reactivate the virus, which then travels through a nerve pathway affecting the areas that the nerve supplies.

A weakened immune system is often the main factor behind the reactivation of the shingles virus. It may be the result of:

• exposure to the varicella-zoster virus (from someone with chickenpox or shingles)
• emotional or physical stress
• diabetes
• acute or chronic illnesses (such as HIV or cancer)
• use of immunosuppressant drugs, like corticosteroids
• exposure to extremely cold temperatures
• too much sun exposure

Oral shingles is a less common form of shingles. However, it can appear on its own or with rashes in other nearby areas.

Medical care is highly advised if you experience:

• persistent fever
• inability to eat or drink
• signs of dehydration, such as decreased urine output and dry mouth
• unexplained fatigue
• severe tooth or mouth pain
• unusual sensations, like tingling, pins and needles, burning, or prickling
• mouth ulcers or a rash inside your mouth
• oozing or bleeding blisters in or around your mouth

If a healthcare professional believes you may have oral shingles, they may examine you and recommend some tests to confirm a shingles diagnosis. This may include:

• Physical examination: They will check the lesions in your mouth for redness, blistering, and crusting. They’ll also examine your skin for other signs of shingles.
• Medical history: To determine your risk of developing shingles, your doctor will ask questions about your past and present health. They’ll also want to know if you’ve had chickenpox before.
• Swab test: The healthcare team may swab the blisters or lesions in your mouth. The swab will be sent to a laboratory, where technicians will analyze it for the varicella-zoster virus.
• Blood tests: They may check your blood for signs of infection. This includes antibodies, which your body creates in response to shingles and other conditions.

There’s no cure for shingles. However, treatment for shingles helps minimize the severity of your symptoms and may shorten the duration of the infection.

Antiviral medication

Antiviral medications help your body fight the virus. It’s best to start taking these drugs as soon as your symptoms develop, ideally within 72 hours.

Examples of antiviral medication used for shingles include:

• acyclovir (Zovirax)
• valacyclovir (Valtrex)
• famciclovir (Famvir)

These medications may also reduce shingles pain and prevent long-term complications.

In addition to antiviral medications, a healthcare professional may also prescribe oral corticosteroids, like prednisone, to reduce severe inflammation.

Pain medication

Shingles is can be a painful condition. Your healthcare professional may recommend over-the-counter (OTC) or prescription pain medication.

For shingles in the mouth, they may also suggest pain relievers you can apply topically. These medications may come in the form of gel, cream, or liquids. You can apply them directly to the shingles lesions in your mouth to numb the sensation.

Self-care at home

Self-care for oral shingles may involve:

• Alcohol-free mouthwash: The lesions in shingles may increase your chances of a bacterial infection. To reduce this risk, you may rinse with an alcohol-free mouthwash.
• Soft foods: Mashed potatoes, bananas, apple sauce, and avocados may be easier for you to eat if you have an active shingles rash in your mouth. Bland and cool foods in general may be soothing.
• Healthy diet: Foods that support your immune system, like non-acidic fruits, vegetables, and lean protein may be a good idea. Try to avoid certain foods that may lower your immune response, including:
  • high glycemic carbohydrates, such as baked goods, sugary drinks, sugary cereals, white bread and white rice, and ice cream
  • highly processed foods, such as packaged snacks, deep-fried foods, fast food, pies, and pastries
  • alcohol, especially if you’re taking medication

As your shingles infection clears up, your oral symptoms will get better. How long shingles last depends on many factors.

The early signs before a rash may last for up to 10 days and the blisters may begin to scab 2 weeks after they first appear. It may take up to 5 weeks for the infection to clear, but the pain can last for weeks or months.

Antiviral medication may speed up recovery. Natural remedies like essential oils and avoiding certain foods may also help.

Other things you can do to improve your shingles recovery include:

• getting enough sleep
• eating a nutrient-dense diet
• avoiding alcohol
• managing your stress

Because a weakened immune system may facilitate the reactivation of the varicella-zoster virus, supporting it may be a good idea. Boosting immunity may also reduce your chance of other conditions.

This includes building habits like:

• engaging in stress management strategies like meditation, deep breathing, and self-care
• getting regular physical activity, including exercising and moving more in general
• stopping tobacco use if you smoke
• optimizing your sleep hygiene so you get around 8 hours of sleep each day
• prioritizing a nutrient-dense diet and limiting processed foods
• limiting or avoiding alcohol intake as much as possible
• avoiding excessive and unprotected sun exposure
• following hygiene habits like washing your hands often and not sharing personal objects
• staying current on recommended vaccinations whenever possible

The shingles vaccine for adults ages 50 and older may also reduce the chance of developing shingles. The vaccine, which is available under the brand name Shingrix, is given in two doses. It’s 90% effective against shingles.