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Mpox Considerations for Oral Health Providers

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What is the mpox virus?

Mpox virus is a rare disease caused by orthopoxvirus genus.

Spread

  • Respiratory secretions or droplets during prolonged (>3 hours of unmasked contact), face-to-face or skin-to-skin contact, or during intimate physical contact, such as kissing, cuddling, or sex
  • Direct contact with the infectious rash, scabs, or body fluids
  • Touching items (such as clothing or linens) that previously touched the infectious rash or body fluids
  • Pregnant people can spread the virus to their fetus through the placenta

Incubation Period

Approximately 7-14 days

Early Symptoms

  • Headache
  • Fever
  • Swollen Lymph Nodes
  • Exhaustion
  • Backache
  • Chills
  • Muscle Aches

Possible Rash Locations

(Following early symptoms)

Palms of hands and soles of the feet, face, genitalia, face, oral mucous membranes, cornea, and conjunctivae.

Stage Stage Duration Characteristics of Mpox Rash

Enanthem

The first lesions to develop are on the tongue and in the mouth.

Macules

1-2 days

The rash typically spreads to all parts of the body within 24 hours.

Papules

1-2 days

By the third day of the rash, lesions have progressed from macular (flat) to papular (raised).

Vesicles

1-2 days

By the fourth to fifth day, lesions have become vesicular (raised and filled with clear fluid).

Pustules

5-7 days

By the sixth to the seventh day, lesions have become pustular (filled with opaque fluid - sharply raised, usually round and firm to the touch).

Scabs

7-14 days

By the end of the second week, pustules have crusted and scabbed over. Scabs will remain for about a week before beginning to fall off.

Once all scabs have fallen off, a person is no longer contagious.

Mpox Considerations for Oral Health Providers

Aerosol-generating procedures on mpox-infected patients can put oral health personnel at risk of contracting the disease. When a suspected mpox lesion has been identified, non-urgent aerosol-generating procedures should be deferred until the area is healed. Below is more information on mpox and how to identify its oral manifestations.

  • Obtain patients’ history (any skin contact with similar lesions, travel history, sexual history)
  • Stay informed about cases in your community
  • Question patients about close contact with persons suspected or confirmed with mpox
  • Lesions/ulcers/scabs in the oral cavity may present as herpes, syphilis, and varicella, in addition to mpox, and should be considered in the differential diagnosis
  • Examine submandibular/cervical lymph nodes for any enlargements
  • Rash may first appear on the face with intra-oral lesions before spreading to other parts
  • Lesion can look like a pimple with a flat base, be deep-seated, and may be painful depending on location
  • If facial or oral lesions are distinguished, or suspicious of mpox, verify with the Illinois Department of Public Health (IDPH), your local health department or Centers for Disease Control and Prevention (CDC) recommended epidemiological criteria for suspected mpox cases

Prevention of Spread

  • Early detection
  • Early recognition
  • Isolation
  • Stringent cleaning protocols
  • If a lesion is in the mouth, wear a mask to protect others
  • Proper hand hygiene
  • Proper personal protective equipment (PPE) use and doffing procedures
  • Notify your local health department