Shingles causes a painful skin rash with fluid-filled blisters that usually affects the skin on the torso or face. However, it can develop inside the mouth. This is called oral shingles.

Shingles is a viral infection that develops due to the varicella-zoster virus, the same virus that causes chicken pox.

Once a person contracts the varicella-zoster virus, it can remain dormant in the nervous system and may reactivate in later life.

About 1 in 3 American adults will develop shingles in their lifetime.

This article discusses the symptoms of oral shingles and how to treat them.

A 2022 article states that it is possible for shingles to affect the mouth.

Shingles can develop in the mouth if the virus affects the trigeminal nerve. This is the nerve in the head responsible for sensation in the face and motor functions, such as biting and chewing.

Oral shingles can cause:

  • facial tenderness
  • mouth pain
  • tooth pain
  • rash or blisters that affect the mouth or face
  • burning, tingling, or pain in the mouth

Oral shingles occur in three phases that follow the same pattern as other shingles infections. These stages include the following:

Pre-eruptive or prodromal phase

For 1–2 days before a shingles rash develops, a person may experience pain, burning, or tingling on the area of skin where the rash is going to develop.

The pain before the rash develops can sometimes be mistaken for toothache, which can result in unnecessary dental procedures.

Acute eruptive phase

In this phase, a rash and fluid-filled blisters appear in dense clusters. The rash can develop in the mouth alone or alongside a rash on the face.

When the rash develops inside the mouth, it can affect both the upper and lower jaw, including the:

  • palate
  • gums of the upper or lower teeth
  • tongue

In this phase, a person may also experience symptoms such as:

  • severe pain
  • difficulty chewing
  • loss of appetite
  • mouth sensitivity
  • drooling

According to the 2022 article, the blisters on the skin rupture, turn into ulcers, and then crust over. However, the blisters in the mouth do not crust over. Instead, they break down quickly and form ulcers that heal within 10–14 days.

The virus is most contagious in the acute eruptive phase, which can last for 2–4 weeks.

Postherpetic neuralgia phase

This phase does not occur in everyone who gets shingles. According to the Centers for Disease Control and Prevention (CDC), approximately 10–13% of those aged 60 or older will experience postherpetic neuralgia (PHN).

In this phase, a person may continue to experience pain. The pain can be recurrent and may last for 4 weeks or longer.

In this phase, a person might experience symptoms such as long lasting severe tingling or burning, or shock-like pain. Jaw movements such as chewing may worsen the pain.

The pain gradually goes away over time.

Other symptoms

Other symptoms of shingles include:

A shingles outbreak in the mouth can be quite painful and typically take up to 10–14 days to heal.

The National Institute on Aging notes that the blisters begin to crust over after 7–10 days. It may take up to 5 weeks for the infection to go away, and for some people, the pain can last longer.

A person should contact a doctor if they develop:

  • mouth or tooth pain
  • fever
  • fatigue
  • odd sensations, such as tingling or burning on one side of the mouth or jaw
  • blisters in the mouth

If the doctor suspects oral shingles, they may ask about the person’s medical history. This is to determine the risk of developing shingles. Afterward, the doctor may order the following tests:

  • Physical examination: The doctor will check the mouth for blistering, inflammation, and crusting. They will also examine the skin for other signs of shingles.
  • Swab test: To check for the cause of blisters, the doctor may swab the blisters in the mouth. They then send the swab to a laboratory where technicians will analyze the swab for the varicella-zoster virus.
  • Blood tests: The doctor may also draw a person’s blood for a blood test. A blood test helps check for signs of infection. This includes antibodies, which the body creates in response to shingles.

Although there is no cure for a shingles infection, treatment can help reduce the severity of the symptoms and minimize the duration of the illness.

It is important to receive early treatment for oral shingles to reduce the risk of complications, such as:

  • tooth loss
  • osteonecrosis — when the bone tissue dies
  • periodontitis — a severe gum infection
  • pulp calcification — when calcified tissue develops in the dental pulp
  • pulp necrosis — when the pulp tissue inside the tooth dies
  • periapical lesions — inflammation of the tissues surrounding the tooth
  • anomalies in tooth development

Treatment options for oral shingles include:

  • Antiviral medications: These can help reduce pain, shorten infection duration, and prevent long-term complications. Examples of antiviral medications include:
  • Anti-inflammatory medications: In addition to antiviral drugs, anti-inflammatory drugs such as oral corticosteroids can also treat oral shingles. These help to reduce inflammation and aid healing. A doctor will only prescribe these alongside antiviral drugs.
  • Over-the-counter (OTC) medications: OTC drugs, such as pain relievers, can help reduce pain and inflammation.

Due to the pain and discomfort, maintaining proper oral hygiene with oral shingles can be challenging.

People may wish to try the following tips:

  • Using alcohol-free mouthwash: An antibacterial alcohol-free mouthwash helps lower the risk of infection and relieve mouth pain.
  • Eating soft foods: Food such as bananas, mashed potatoes, or avocados may help to reduce the pain from chewing.
  • Using a soft-bristled toothbrush: People should be careful not to irritate the blisters with the toothbrush while brushing. They may benefit from using a soft-bristled toothbrush.

A person can speak with a doctor to discuss other ways of promoting oral hygiene with oral shingles.

The CDC recommends the shingles vaccine for people aged 50 and over and other adults with weakened immune systems due to medication or health conditions. Vaccination helps lower the risk of a shingles infection and reduces complications such as PHN.

People can help maintain a strong immune system by:

Shingles is a viral infection that causes painful fluid-filled blisters on the skin. A shingles rash can also develop in the mouth.

People may experience:

  • tooth or mouth pain
  • facial tenderness
  • burning, pain, or tingling in the mouth
  • rash or blisters in the mouth

Oral shingles can lead to complications, so a person should contact a doctor if they experience any signs and symptoms of shingles.

The doctor will prescribe antiviral medications and OTC pain relievers. People should also discuss with a doctor how to maintain good oral hygiene for the duration of the rash.