Oral lesions in monkeypox- A definite consideration!

Dear Editor,

With great interest, we read the recent article titled, “Mouthsores and monkeypox: A consideration” published recently in your esteemed journal by Sookaromdee and Wiwanitkit [1]. We genuinely appreciate the authors’ foresightedness in predicting the possibility of the occurrence of mouth sores in monkeypox (MPX). Concurring this, we would like to highlight recent reports of oral manifestations of MPX. The oral lesions in MPX include varying representations of tan-grey ulcerations on the tongue tip, vesiculo-ulcerative lesions on anterior ventral aspect of tongue and gingival papilla as well as perioral papules [2], [3], [4]. Interestingly, these intraoral manifestations precede other general symptoms and hence, add to the fact that they are a definite consideration in early diagnosis of MPX [2], [3], [4]. MPX cases spike day by day with a reported global count of 48,844 cases, amongst which 18,101 cases have been reported in the United States [5]. As MPX often presents first with enanthem in the oral cavity, the California Dental Association (CDA) recently emphasized that the dental team including dentists and dental hygienists should be in the frontline to screen and detect these early manifestations of MPX to effectively contain the community spread. At the same time, as dental practices already follow strict infection control measures and have implemented even more stringent protocol during the COVID-19 pandemic, it is advisable to follow the same to ensure a safe practice [4]. The World Health Organization (WHO) has recommended the following infection control and prevention measures to be adopted at all health care facilities: i) contact and droplet precautions, ii) airborne precautionary measures that include wearing the proper PPE, such as N95 respirators, especially during aerosol-generating procedures, iii) disinfection and sterilization of equipments as per national and facility guidelines and iv) appropriate safe handling and collection of linens, towels, fabric items, etc., [6]. As MPX virus infection can affect multiple organ systems in the host, including the protective barriers of skin, eyes and oral mucosal surfaces, lymphatics, lungs and gastro-intestinal tract, the key role of interdisciplinary team including oral and maxillofacial surgeons, anesthesiologists, ENT specialists, pulmonologists and gastro-enterologists is quite significant to combat the on-going outbreak of MPX [7].

Funding

None.

CRediT authorship contribution statement

Balasubramanian: Writing – original draft, Conceptualization. Divya Vinayachandran: Conceptualization, Writing – review & editing.

Declaration of Competing Interest

None