Editing Shingles (section)

===Face===
Shingles may have additional symptoms, depending on the dermatome involved. The [[trigeminal nerve]] is the most commonly involved nerve,<!-- , accounting for 18–22% of shingles cases--><ref name=Gupta2015>{{cite journal| vauthors = Gupta S, Sreenivasan V, Patil PB |title = Dental complications of herpes zoster: Two case reports and review of literature |journal=[[Indian Journal of Dental Research]]|date=2015|volume=26|issue=2|pages=214–219|doi=10.4103/0970-9290.159175|pmid=26096121|doi-access=free}}</ref> of which the ophthalmic division is the most commonly involved branch.<ref name=Samaranayake2011>{{cite book|author=Samaranayake L|title=Essential Microbiology for Dentistry|url=https://books.google.com/books?id=xanRAQAAQBAJ&pg=PT638|edition=4th|year= 2011|publisher=Elsevier Health Sciences|isbn=978-0702046957|pages=638–642|url-status=live|archive-url=https://web.archive.org/web/20170908175310/https://books.google.com/books?id=xanRAQAAQBAJ&pg=PT638|archive-date=8 September 2017}}</ref> When the virus is reactivated in this nerve branch it is termed ''[[zoster ophthalmicus]]''. The skin of the forehead, upper eyelid and [[Orbit (anatomy)|orbit of the eye]] may be involved. Zoster ophthalmicus occurs in approximately 10% to 25% of cases. In some people, symptoms may include [[conjunctivitis]], [[keratitis]], [[uveitis]], and [[optic nerve]] [[:wikt:palsy|palsies]] that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain.<ref name=pmid12449270>{{cite journal| vauthors=Shaikh S, Ta CN| title=Evaluation and management of herpes zoster ophthalmicus| journal=[[Am. Fam. Physician]]| year=2002| volume=66| issue=9| pages=1723–1730| pmid=12449270| url=http://www.aafp.org/afp/20021101/1723.html| url-status=live| archive-url=https://web.archive.org/web/20080514021237/http://www.aafp.org/afp/20021101/1723.html| archive-date=14 May 2008}}</ref>

''Shingles oticus'', also known as [[Ramsay Hunt syndrome type II]], involves the [[ear]]. It is thought to result from the virus spreading from the [[facial nerve]] to the [[vestibulocochlear nerve]]. Symptoms include [[hearing loss]] and [[Vertigo (medical)|vertigo]] (rotational dizziness).<ref name=pmid12676845/>

Shingles may occur in the mouth if the maxillary or mandibular division of the trigeminal nerve is affected,<ref name=Neville2008/> in which the rash may appear on the [[mucous membrane]] of the upper jaw (usually the palate, sometimes the gums of the upper teeth) or the lower jaw (tongue or gums of the lower teeth) respectively.<ref name=Glick2014/> Oral involvement may occur alone or in combination with a rash on the skin over the cutaneous distribution of the same trigeminal branch.<ref name=Neville2008/> As with shingles of the skin, the lesions tend to only involve one side, distinguishing it from other oral blistering conditions.<ref name=Glick2014/> In the mouth, shingles appears initially as 1–4&nbsp;mm opaque blisters (vesicles),<ref name=Neville2008/> which break down quickly to leave [[mouth ulcer|ulcers]] that heal within 10–14 days.<ref name=Glick2014/> The prodromal pain (before the rash) may be confused with [[toothache]].<ref name=Neville2008>{{cite book| vauthors = Chi AC, Damm DD, Neville BW, Allen CM, Bouquot J | chapter = Viral Infections |title=Oral and Maxillofacial Pathology|year=2008|publisher=Elsevier Health Sciences|isbn=978-1437721973|pages=250–253| chapter-url = https://books.google.com/books?id=5QIEAQAAQBAJ&pg=P250 |url-status=live|archive-url=https://web.archive.org/web/20170908175310/https://books.google.com/books?id=5QIEAQAAQBAJ&pg=P250|archive-date=8 September 2017}}</ref> Sometimes this leads to unnecessary dental treatment.<ref name=Glick2014>{{cite book|author=Glick M|title=Burket's oral medicine|url=https://books.google.com/books?id=cBEqCAAAQBAJ&pg=PA62|edition=12th|year=2015|publisher=coco|isbn=978-1607951889|pages=62–65}}</ref> Post-herpetic neuralgia uncommonly is associated with shingles in the mouth.<ref name=Glick2014/> Unusual complications may occur with intra-oral shingles that are not seen elsewhere. Due to the close relationship of blood vessels to nerves, the virus can spread to involve the blood vessels and compromise the blood supply, sometimes causing [[ischemia|ischemic]] [[necrosis]].<ref name=Neville2008/> In rare cases, oral involvement causes complications such as [[osteonecrosis]], [[tooth loss]], [[periodontitis]] (gum disease), pulp calcification, [[pulp necrosis]], [[periapical periodontitis|periapical lesions]] and tooth developmental anomalies.<ref name=Gupta2015/>