The Monkeypox Outbreak and Implications for Dental Practice

Abstract

Objectives: 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. We review here the salient features of MPX and its possible impact on dentistry.

Methods: 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, MPX 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 MPX 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. MPX is a self-limiting disease with very low mortality and may last from 2 to 4 weeks. Although MPX 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.

Conclusions: MPX 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 MPX is under development, although the smallpox vaccine appears to be effective.

Keywords: Dentistry; Infection control; MPX virus; Monkeypox; Oral manifestations.

Fig. 1

A negative stain, pseudo colour, electron micrograph showing mature, oval, mulberry-shaped virus particles (pink) and the immature particles (blue) from a skin lesion of a patient with monkeypox. (Photo credit: Cynthia S. Goldsmith, Russell Regnery; Courtesy CDC Image library.)

Fig. 2

Modes of the spread of the monkeypox virus.

Fig. 3

The wrist and palm of a patient with monkeypox, displaying the appearance of the papular and blister stage lesions prior to disruption and scab formation. (Photo credit: Nigeria Centre for Disease Control.)