Monkeypox: what do dental professionals need to know?

Abstract

Infection control is critical for the safe delivery of dental care. Infection control practices must be responsive to emerging and re-emerging infectious diseases and outbreaks, as was clearly seen during the peak of the COVID-19 pandemic. An emerging global outbreak of the monkeypox virus has again raised potential challenges for infection control in dentistry. Monkeypox is an infectious disease, characterised by a rash affecting the skin and soft tissues, including the oral cavity. Previously, cases were mostly seen following contact with infected animals in Central and West Africa, with limited human-to-human transmission within and outside of these areas. However, since May 2022, sustained human-to-human transmission has occurred globally. Monkeypox can be transmitted via close contact with an infected person, contaminated objects and surfaces, or by droplets and possibly aerosols, which is therefore of potential importance to dental settings. This article discusses the relevance of monkeypox to dental professionals, the typical presentation of the disease, its potential impact on infection prevention and control practices and the delivery of dental services. The current monkeypox outbreak highlights the need for a more sustained programme of research into dental infection control that can provide a solid evidence base to underpin preparedness planning for future outbreaks and pandemics.

Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice

“…The main entry sites for MPX are open wounds, non-intact skin, mucous membranes, and inhalation [25,26]. Therefore, the human-to-human transmission of MPXV, similarly to animal-to-human transmission, occurs by direct contact with the material in lesions or airborne droplets [27].…”

“…In detail, the infection spreads through large respiratory droplets and typically requires prolonged close contact, unlike SARS-CoV-2 infection, which, on the other hand, can spread through even small droplets [28,29]. However, similarly to other airborne infections, the transmission depends on the presence of respiratory protective equipment, infectious dose, duration of exposure, and environmental temperature, humidity, and ventilation [26,29].…”

“…Mucocutaneous lesions were observed in 95% of individuals [12]. Noteworthy, perioral mucocutaneous lesions may be among the first MPX manifestation [12], presenting as papules, which evolve into blisters and ulcers [33] around the lips, chin, and nose [26].…”

“…Fever usually reduces within 3 days following the onset of the mucocutaneous lesions, which generally resolve in 2 to 4 weeks [54,57]. Indeed, MPX is usually self-limiting and resolves within approximately one month [26], although viral positivity has been found up to 21 days after symptom onset [12] and recent evidence found the viral DNA in saliva more than 70 days after positivity confirmation [57]. Profound lymphadenopathy is the unique feature clinically discriminating between MPX and chickenpox, smallpox, and chickenpox [12,43,57]; thus, laboratory testing is essential [57].…”

“…Oral ulcerations of the tongue, tonsils, and buccal mucosa are estimated to be the most common oral lesions, possibly associated with the impaired ability of patients to drink and eat and consequent dehydration and malnutrition [12,26]. Similar to skin lesions, the oral lesions typically progress through the maculopapular, vesicular, pustular, and erosive phases over a period of 14 to 21 days (Figure 3), potentially resulting in a depigmented scar [61,63].…”