Sir, following a recent letter (BDJ 2015; 218: 213) we would like to share a similar case.1 A 47-year-old male patient presented complaining of an inability to open his mouth and pain in its lower right posterior region. Examination revealed an inflamed pericoronal flap over tooth 48. The area was cleaned with chlorhexidine and analgesics were prescribed for 5 days. Extraction was advised to prevent further recurrence.

The patient returned after 5 days and agreed to the extraction. Although the inflammation had subsided his mouth opening was still restricted and the extraction was postponed to await improvement. After a month the mouth opening was still restricted although improved. During the extraction the patient suffered a few lacerations at the corner of the mouth and lower lip due to the restricted access to the third molar area.

The patient was advised to return after 5 days but did not attend until a month later. He told us that the delay was because he had developed a herpes zoster infection. He reported developing ulcers in the area of the lower right lip and corner of mouth. His family physician had referred him to a dermatologist. His ulcers were limited to the lower right lip area, which suggested that they had occurred due to the extraction trauma. The patient had discussed his dental appointment with the dermatologist, but it appears that the dermatologist did not consider the chances of the lower lip being traumatised during the third molar surgery and misdiagnosed it as herpes zoster infection.

We wish to highlight that traumatic ulceration is a differential diagnosis when considering herpes infection, especially when the patient has had a recent dental appointment.

1. New Delhi, India