Monkeypox infection: Risk for oral healthcare provider.

Abstract

Dear Editor, Starting from 2020 when the COVID-19 pandemic represented a difficult challenge of early diagnosis, containment of the infection, and hospital management of severe cases, the role of the dentist and oral screening as a tool to contain the infection spread and early detection began to be relevant (Cazzolla et al., 2022; Scotto, Fazio, Lo Muzio, et al., 2022; Scotto, Fazio, Spirito, et al., 2022). The spread of other known viruses such as Monkeypox and West Nile in countries where the disease is not endemic poses new challenges for healthcare professionals. Monkeypox patients, after an incubation period of 5–21 days, generally present prodrome symptoms such as fever, fatigue, headache, muscle aches, and lymphadenopathy followed by the development of the typical rash (Thornhill et al., 2022). Monkeypox disease is typically self-limited in 2–4 weeks, but complications such as pneumonia, encephalitis, acute kidney injury, and myocarditis may occur, mostly in children, pregnant people, or immunocompromised patients (Guarner et al., 2022). The case fatality ratio is estimated between 1% and 10% (Bunge et al., 2022). The skin lesions are noted in 95% of cases and range from macules and papules to vesicles and pustules that ulcerate and crust (Thornhill et al., 2022). Lesion progression follows a centrifugal pattern and typically starts in the facial regions and trunk before spreading to the extremities, involving hands and feet, soles, and palms. Oral mucous membrane involvement has been reported in 70% of case (WHO, 2022). An accurate case definition and a good clinical examination are essential for identifying suspected cases. For this reason, since the oral mucosa and the perioral regions, together with the involvement of the laterocervical lymph nodes, could represent the first signs, healthcare provider can play an important role in early case identification (Pandey & Reddy, 2022). However, the other side of the coin is the risk of contagion for healthcare professionals and in this case for dentists. Indeed, the current outbreak illustrates the easy human-to-human transmissibility by direct contact with lesions that contain the virus. Monkeypox is not a sexually transmitted infection in the typical sense, but it can be easily transmitted during sexual and intimate contact; however, other routes of transmission could be possible, such as contact with infected material present in skin lesions or body fluids or respiratory secretions and saliva droplets during direct and prolonged face-to-face contact. Additionally, this virus could be transmitted through contaminated objects (WHO, 2022). Skin and mucous membrane lesions remain contagious until complete healing, whereby healthcare workers and close contacts of active cases could be at greater risk of infection. It is therefore essential that oral care providers wear personal protective equipment (PPE) such as N95 masks, FFP3 respirators, fluid-resistant attire, and eye protection (Samaranayake & Anil, 2022). Furthermore, poxviruses may remain contagious over months to years on surfaces and are highly resistant to desiccation and heat. High-touch surfaces should be treated with appropriate disinfectants, and aerosolizing procedures should be avoided (Palmore & Henderson, 2022). Lorenzo Lo Muzio: Supervision; writing – original draft; writing – review and editing. Francesca Spirito: Conceptualization; writing – original draft; writing – review and editing. None. None. The peer review history for this article is available at https://publons.com/publon/10.1111/odi.14356.