Introduction: Osteonecrosis of the jaws is often related to either radiation or bisphosphonate treatment. Rarely, osteonecrosis is related to viral infections.

Objective: To report four patients with Herpes Zoster related osteonecrosis in the jaws.

Materials and methods: The patient material comprised one man and three women, mean age 52 years. The patients were examined clinically and radiologically, and osteonecrosis was treated. The Zoster infection involved the maxillary branch of the trigeminal nerve in three cases and the mandibular branch in one case, and led to loss of teeth in three cases. The onset of osteonecrosis was spontaneous (1 case), related to tooth extractions (2 cases) and related to attempted bone augmentation and implant insertion (1 case). Several attempts by an experienced oral surgeon to perform bone augmentation and implant insertion failed.

The follow-up time was 7, 17, 20, and 60+ months, respectively. All patients had no sign of osteonecrosis at final examination, and all had removable dentures to replace the missing teeth.

Summary: This report shows that Herpes Zoster infection in the maxillary and mandibular branches of the trigeminal nerve may be associated with significant morbidity including loss of teeth, osteonecrosis and potential problems with implant treatment.

Conclusions: A working hypothesis was postulated that Herpes Zoster infection involving the jaws may lead to either immediate or late osteonecrosis, to be tested in a prospective trial . Triggering factors are tooth extractions or other surgery. It is advised to include previous Herpes Zoster infection in the medical history questionnaire.

Conflict of interest: None declared.