Oral Manifestations of Monkeypox: A Global Scoping Review of Evidence

Monkeypox, a zoonotic disease caused by the monkeypox virus, has emerged as a significant global public health concern, particularly due to outbreaks in non-endemic regions. While cutaneous lesions are its hallmark, oral manifestations like mucosal lesions, ulcers, and enanthema may precede other symptoms, posing unique diagnostic challenges. This review aimed to assess the prevalence, clinical features, and implications of oral manifestations of monkeypox, emphasizing their importance in medical and dental practice.

A scoping review following PRISMA-ScR guidelines analyzed studies on oral symptoms of monkeypox published from 2005 to 2024. Comprehensive searches of databases like PubMed, Scopus, Web of Science, and Embase were carried out and MeSH terms such as "oral lesions," "monkeypox," and "stomatitis" were used. Three independent reviewers extracted data on clinical presentations, prevalence, and implications for dental care.

Oral lesions, including ulcers, vesicles, sore throats, and necrosis on the tongue, gingiva, and buccal mucosa, are key diagnostic markers of monkeypox. Prevalence rates varied widely (7-100%), with higher rates evident in immunocompromised individuals and pediatric populations, with smaller studies often reporting higher rates. Lesions typically lasted 7-14 days, extending to three weeks in severe cases and were associated with secondary infections, pain and dysphagia particularly in immunocompromised individuals. Management included hydration, analgesics, and, in some cases, antiviral therapy like tecovirimat. The findings emphasize the need for standardized reporting of oral symptoms to enhance diagnostic accuracy and clinical care.

Oral manifestations of monkeypox are critical diagnostic and transmission markers. Dental practitioners should consider monkeypox in the differential diagnosis of unexplained oral ulcers, particularly in high-risk populations. Heightened awareness and standardized reporting can optimize diagnosis, care, and epidemic control efforts.