Dental implications of Monkeypox-premonitory signs appear on oral mucosa as macules and ulcers

Monkeypox (MPX) caused by the MPX virus, is a contagious disease confined mainly to African regions and is currently making multiple appearances outside of disease-endemic countries. World Health Organization (WHO) very recently declared the current monkeypox outbreak a Public Health Emergency of International Concern. They review here the salient features of Monkeypox and its possible impact on dentistry.

The data on the aetiology, transmission modes, signs and symptoms, diagnosis, and management, including the risk of its occupational transmission in dental settings, were garnered from the current literature, mainly from the World Health Organization and Centers for Disease Control and Prevention databases.

Results:

• Over recent months, Monkeypox has reemerged in more than 88 countries in Europe, North America, and Australia, with some 22000 case reports to date (as of July 2022).
• The initial signs of Monkeypox appear during the prodromal period, in the oral cavity as single or multiple macular lesions on the oral mucosa, accompanied by generalised lymphadenopathy.
• Subsequently, the characteristic rash appears on the skin and spreads centripetally from the trunk towards the palms and soles.
• Monkeypox is a self-limiting disease with very low mortality and may last from 2 to 4 weeks.
• Although Monkeypox is similar to chickenpox, there are a number of differentiating signs, the main element being lymphadenopathy.
• Strict adherence to standard, contact, and droplet infection control precautions, including wearing N95 masks, FFP3 respirators, fluid-resistant attire, and eye protection, is necessary to prevent its spread.

Thus, Monkeypox appears to be a significant travel-related disease. Dental care workers should note that premonitory signs of the disease usually appear on the oral mucosa as macules and ulcers prior to the characteristic skin lesions. Implementing standard, contact, and droplet infection control measures, patient isolation, and referral are important, particularly during a local outbreak. A vaccine specific for Monkeypox is under development, although the smallpox vaccine appears to be effective.

Reference:

Lakshman Samaranayake, Sukumaran Anil, et al. The Monkeypox Outbreak and Implications for Dental Practice. International Dental Journal, Volume 72, Issue 5, 2022, Pages 589-596, ISSN 0020-6539. https://doi.org/10.1016/j.identj.2022.07.006