Dental treatment and Ramsay Hunt Syndrome

[flappymcp]

I came down with Ramsay Hunt Syndrome four and a half years ago; this occurred about three months after having all four of my wisdom teeth removed in what was a fairly violent extraction that ended in a dislocated jaw. I had trouble with ear pain and fluid in the ear with dizziness starting about two or three weeks after which was diagnosed at allergies at the time. Things like this continued to occur until I woke up with half of my face paralyzed one morning. Long story short, I had an unusually sever case of Ramsay Hunt and I was left with permanent nerve damage to several of my facial nerves as well as inner ear damage and damage to the portion of my brain that receives balance information.
I recently had to have a broken molar removed (I believe it was tooth #31). The tooth was on the nerve damaged side and it took three tries to get it out because they could not get that tooth to numb all the way. I finally just had to power through the pain so they could remove it. The dentist mentioned something to me about the fact that the herpes zoster not only lays dormant in the spine, but in nerve endings as well and that trauma to the nerve endings could cause an eruption of shingles (which is what causes RHS). I was told by my previous doctors and dentists, all kaiser doctors, that the RHS was not caused by my wisdom teeth being extracted.
I want to know if it could have been cause by this. My current dentist also said that there is no guarantee that I will not get shingles again from this tooth being extracted. Can this happen!?!? Having nerve damage and partial facial paralysis poses many challenges for dental work, should I also be worried about this?    
I am a bit freaked out by all of this and I hope that someone can answer my questions.

[Jerome Tsang, DDS]

As far as I know, there's no exact casual relationship that an extraction would cause shingles.  Its actually poorly understood why shingles activates or what triggers it exactly but generally people with weaken immune systems tend to get shingles.  Perhaps your dentist can prescribe an anti-viral prophylatically to help with any possibly of shingles.  I, personally, have never seen or heard of any extractions resulting in shingles though.

[Jerome Tsang, DDS]

I would recommend maybe taking a pre-medication of an anti-viral just in case if you're afraid of a shingles infection.  It wouldn't be too harmful compared to getting a shingles infection but I've had patients who have actually had shingles before and I don't treat them any differently when doing dental treatment in regards to pre-medications but it doesn't hurt if your dentist may feel you're at higher risk for it.

[nana68]

I don't have facial paraylsis.my ent says its post herpatic neuralgia from the bellspalsy four years ago.I am coming to terms with that.my dad had bellspalsy and also early hearing loss maybe I inherited that from him,I don't know.I have other issues anyways.I have illness induced asthma so when I came down with a bad case of bronchitis last year it ended up putting me into status asthmaticus and subsequently respiratory failure from there I got infections and sepsis from the ventilator plus treacheal stenosis from the treacheotomy,paralyzed from the meds used to put me into a coma.It is nine months later and for the most part I am doing well.I just have the need to figure out the mystery of why I was getting sick every year since I've had the bellspalsy with one thing or another. I am grateful that now I can walk,and have use of my hands.I am just left through it all will nausea everyday,numbness in my foot,bad taste in mouth and insomnia.Almost every test out side a very few have been done so ,so far, by the process of elimination they are saying it is fibromyalgia.

[flappymcp]

Unfortunately Ramsay Hunt Syndrome is frequently missed by doctors as it is an uncommon illness. Mine was misdiagnosed as Bell's Palsy at first and as a result I did not get the proper treatment quickly enough to prevent the severe and permanent damage that I have.  
I am not a doctor so I cannot diagnose you but I can tell you that Bell's Palsy does not hurt and it goes away on its own after about a month (meaning that you will have no lasting facial paralysis).  
Another unfortunate thing is that Ramsay Hunt Syndrome rarely goes away without lasting effects. If you do not get treatment within the first days after you come down with it your rate of recovery is drastically effected.
It is possible to have shingles inside your ear that go unnoticed. This was the case with me but I did end up having them erupt in my mouth eventually as I had several reoccurrences. A cold sore that appears yearly wouldn't cause RHS but they (cold sores) have been linked to BP. RHS is caused by the herpes zoster virus (which is what causes chicken pox and shingles).
After four years I would say that there is no way to find out what caused your symptoms if it was RHS. Do you still have facial paralysis? If you do I would say that could be indicator along with your other symptoms (although I have not heard of bone or knee pain with RHS). Even though there is no real way to tell if it was RHS or not, there are still things you can do to improve your quality of life.  
I still have post herpatic neuralgia and permanent damage to inner ear, facial nerves and a portion of my brain. I use a cane to walk as my balance is very poor. However, through physical therapy I have much less vertigo than I once did (I still tip over easily but don't get the spins unless there is a lot of movement in my peripheral vision) and through the use of acupuncture I have reached a good amount of pain control.
A healthy diet and getting good rest will always keep you in better overall health and therefore, will make managing your symptoms much easier.
I would ask you ENT to refer you to vestibular therapy and look into acupuncture for the pain. Also, you can try the website ramsayhunt.org it has been very helpful to me. There are a lot of good and supportive people there in the forums.
Good luck to you and I hope I was able to help a little.  

[nana68]

I had an absessed tooth removed and 2 weeks later the doctor said I had bellspalsy but I am not so sure that was it,no tests were done.I am thinking it was ramsay hunt because 4 years later at times I get ear pain,whole face pain,a nerve that moves in the ear,balance and dizziness even my teeth hurt.Had lots of tests done seen every doctor except gastrologist.my ent says its post herpatic neuralgia,I said"after 4 years" he says yes.I wish it would go away.as I am typing this I feel sick to my stomach,my ear is twitching and I am so tired cause I can't sleep because my bones hurt so bad in my knees and the head and ear pressure are unbelieveable. Is there a way to find out if that is what I have,I have not had any sores except one on my lip every year since I was a little girl.Is it possible to have internal sores?

[flappymcp]

Thank you, that is what I though and this is how it was explained to me when was diagnosed with RHS. I was told back then that the only reason a healthy woman of my age would get shingles was due to unusual amounts of stress, which was the case for me at that time.
When my current dentists told what he did about the shingles it frightened me as they are a horrible thing to have. I thank you for easing my mind.