Mpox Awareness for B.C. Dental Hygienists

Aug 23, 2024

Mpox Awareness for BC Dental Hygienists (August 15, 2024)

As oral health care professionals, we must remain vigilant about emerging public health threats while maintaining our commitment to meticulous infection control. Oral health providers play an important role in educating patients about these threats to public health (e.g., coronavirus, mpox, polio). This statement provides updated information on mpox considering the World Health Organization’s (WHO) recent declaration of a global public health emergency of international concern.

Key Updates

1. On August 14, 2024, the WHO re-declared mpox as a Public Health Emergency of International Concern (PHEIC) due to the emergence of a new sexually transmitted strain (clade 1b) and its spread to neighbouring countries.1

2. Clade II mpox virus is considered less severe than clade II.2

3. To date, there have been no cases of clade I mpox cases in Canada.2

3. There is an ongoing Clade II outbreak in Canada, and as of July 30, 2024, there have been 225 confirmed cases of mpox in British Columbia.3

4. According to the BCCDC, risk of spread to the general population in British Columbia is low.3 This information has not been updated since the WHO August 14, 2024, PHEIC declaration.

Infection Control and Prevention

The BC College of Oral Health Professionals (BCCOHP) maintains infection control protocols. Continue to adhere to the BCCOHP IPAC Guidelines. Those using aerosol-generating procedures should review the CDHA AGP Position Statement. Vaccination is available for individuals at increased risk of exposure. 4

Mpox Transmission and Symptoms


Mpox is a viral disease with an incubation period of 5-21 days.4 It is spread through close physical contact with symptomatic individuals or animals via mpox sores, bodily fluids, respiratory droplets, or contact with contaminated items.5,6 The virus can enter the body through broken skin, mucous membranes, or the respiratory tract.6 The two circulating clades of the virus are clade I and clade II, with the latter being associated with the current global outbreak and generally causing less severe illness.4,5 Oral health professionals in clinical settings are more likely to be exposed to viruses that spread via aerosol, droplet, and contact routes such as mpox or COVID-19.7

Mpox is spread through5,6

  • Animal-to-human contact
  • Person-to-person contact
  • Fomites

Mpox lesions may present orally, peri-orally and oropharyngeally.7,8 Oral health professionals should conduct a thorough head and neck exam, noting any lesions resembling mpox, including the presence of lymphadenopathy.5 Additional symptoms of mpox are outlined below.

Symptoms to watch for:5,6

  • Oral lesions (often painful)
  • Skin rash or vesicles
  • Fever, chills
  • Lymphadenopathy
  • Sore throat
  • Headache
  • Fatigue
  • GI symptoms
  • Musculoskeletal symptoms (e.g., back pain)

Patient Management

If you suspect a case of mpox:

1. Isolate the patient; non-urgent care should be postponed9

2. Have the patient isolate at home and contact their primary care provider or local public health unit for further instructions (public transit should be avoided)9

3. Document the encounter

Inclusive Care

Provide unbiased, evidence-based care to all patients. While certain groups may be at higher risk based on current transmission patterns, anyone can contract mpox regardless of age, gender, sexual orientation, or ethnicity. The WHO provides Public Health advice on Understanding, Preventing and Addressing Stigma and Discrimination Related to Mpox.

Stay Informed

For more information and to remain up to date, please monitor the following pages:

The BCDHA remain committed to supporting our members as we navigate this evolving public health situation. Your dedication to maintaining safety for yourselves, your patients, and your communities is deeply appreciated.

References

  1. World Health Organization. WHO Director-General declares mpox outbreak a public health emergency of international concern [Internet]. Geneva: WHO; 2024 Aug 14 [cited 2024 Aug 14]. Available from: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
  2. Government of Canada. (2024, August 14). Government of Canada’s response to the World Health Organization’s declaration on mpox. [Government of Canada]. Retrieved from https://www.canada.ca/en/public-health/news/2024/08/government-of-canadas-response-to-the-world-health-organizations-declaration-on-mpox.html
  3. BC Centre for Disease Control. Mpox [Internet]. Vancouver: BC Centre for Disease Control; 2023 [updated 2024 Jul 30; cited 2024 Aug 14]. Available from: http://www.bccdc.ca/health-info/diseases-conditions/mpox#:~:text=The%20risk%20to%20the%20general,)%20on%20July%2021%2C%202022.
  4. BC Centre for Disease Control. Mpox. In: Communicable Disease Control Manual. Chapter 1 – Management of Specific Diseases. BC Centre for Disease Control; 2024 Feb. Available from: http://www.bccdc.ca/Documents/Mpox_guidance.pdf
  5. Amato M, Di Spirito F, Boccia G, Fornino D, D’Ambrosio F, De Caro F. Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice. J Pers Med. 2022;12(12):2000.
  6. Public Health Agency of Canada. Mpox (monkeypox): For health professionals. Government of Canada. 2024. https://www.canada.ca/en/public-health/services/diseases/mpox/health-professionals.html
  7. Zemouri C, Beltrán E, Holliday R, et al. Monkeypox: what do dental professionals need to know? Br Dent J. 2022;233:569-74.
  8. Gandhi PA, Patro SK, Sandeep M, et al. Oral manifestation of the monkeypox virus: a systematic review and meta-analysis. EClinicalMedicine. 2023;56:101817.
  9. Public Health Agency of Canada. Mpox: Symptoms, getting tested, what to do if you have mpox or were exposed. 2024 May 29 [Accessed 2023 Jan 4]. Available from: https://www.canada.ca/en/public-health/services/diseases/mpox/symptoms-management.html#a7