Shingles in Your Mouth

What are the symptoms of oral shingles?

The typical symptoms of oral shingles include:

• a tingling or burning sensation in the mouth
• facial tenderness
• tooth or mouth pain
• rash or blisters on the face or mouth (including the tongue)
• fever
• fatigue

The symptoms can vary depending on the stage of infection. The stages of shingles include:

• Prodromal phase. Also called the pre-eruptive stage, this phase happens about 48 hours before noticeable lesions develop. It may cause tooth pain, as well as fatigue and headaches.
• Acute eruptive phase. This stage involves painful lesions, which may occur in the mouth or skin. The acute eruptive stage can last 2 to 4 weeks.
• Postherpetic neuralgia phase. This phase includes pain that can last for 4 weeks or longer. It may involve abnormal skin sensations, like tingling, burning, or prickling. This phase does not occur in everyone who gets shingles.

What causes shingles in your mouth?

Shingles can affect the skin and mucosa, or tissues that line your body. This includes the inside of your mouth.

The cause of oral shingles is the same as shingles in general. The disease develops when your immune system becomes weakened. A compromised immune system is unable to control the virus, allowing it to multiply and cause shingles.

Several things can weaken your immune system and activate shingles, such as:

• emotional stress
• diabetes
• acute or chronic illness (such as HIV or cancer)
• immunosuppressant drugs
• exposure to cold temperatures
• exposure to the varicella-zoster virus
• too much sun exposure

Oral shingles is a less common form of shingles. However, it can appear on its own or with skin symptoms.

When to see a doctor

Visit a doctor if you develop mouth lesions or mouth pain of any kind. You should also see a doctor if you have mouth lesions and:

• fever
• unexplained fatigue
• severe tooth or mouth pain
• unusual sensations, like tingling, burning, or prickling
• the mouth lesions are oozing or bleeding

If your doctor thinks you have oral shingles, they’ll use several tests to make a diagnosis. This may include:

• Physical examination. Your doctor 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 health. They’ll also want to know if you’ve had chickenpox before.
• Swab test. Your doctor may swab the blisters in your mouth. The swab will be sent to a laboratory, where technicians will analyze it for the varicella-zoster virus.
• Blood tests. A blood test is used to check your blood for signs of infection. This includes antibodies, which your body creates in response to shingles.

How is shingles in the mouth treated?

There’s no cure for shingles. However, treatment can help minimize your symptoms and shorten the length of your infection.

Your treatment plan will likely include:

Antiviral medication

Antiviral medication is designed to combat the viruses that cause shingles. It’s best to start taking these medicines as soon as your symptoms develop.

Examples of antiviral medication used for shingles include:

• acyclovir
• valacyclovir
• famciclovir

These medications can help reduce pain and prevent long-term complications.

In addition to antiviral medications, your doctor may also prescribe oral corticosteroids like prednisone to reduce inflammation.

Pain medication

The symptoms of shingles can be painful. Your doctor may recommend over-the-counter (OTC) or prescription pain medication.

For shingles in the mouth, your doctor may also suggest topical oral pain relievers. These medications may come in the form of gel, cream, or liquids. They’re directly applied to the lesions in your mouth.

Self-care at home

There are some self-care measures you can take at home to manage your symptoms:

• Use alcohol-free mouthwash. The lesions caused by shingles can increase your risk of a bacterial infection. To reduce the risk of an infection, your doctor may recommend rinsing with an alcohol-free mouthwash.
• Opt for soft foods. Soft foods, like mashed potatoes, bananas, and avocados, will feel more comfortable to eat than harder foods that need a lot of chewing. Try to eat bland and cool foods as well.
• Eat a healthy diet. Focus on foods that will support your immune system, like non-acidic fruits, vegetables, and lean protein. Try to avoid certain foods, 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

How long does it take to recover?

As your shingles infection clears up, your oral symptoms will get better.

In general, the blisters begin to scab after 7 to 10 days. It takes 3 to 5 weeks for the infection to clear, but the pain can last for weeks or months.

To work toward a speedy recovery, be sure to carefully follow your doctor’s treatment plan. It’s also important to take care of yourself at home. This includes practicing self-care as mentioned above.

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

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

Are there preventive steps you can take?

Because a weakened immunity can trigger shingles, supporting your immune system may help reduce your risk of developing the disease.

This includes habits like:

• practicing stress management
• getting regular exercise
• not smoking
• getting good quality sleep
• eating a balanced diet
• limiting or avoiding alcohol
• avoiding too much sun exposure
• taking steps to avoid infections
• staying current on all recommended vaccinations

There’s also a shingles vaccine available to adults ages 50 and older. The vaccine, which is available under the brand name Shingrix, is given in two doses. It’s 90 percent effective against shingles.