The outbreak of the monkeypox virus (MPXV) raised global health concerns. Attention was called to the oral manifestations and implications of MPXV.¹ The MPXV spreads through direct contact with body fluids such as saliva, respiratory secretions in close face-to-face contact, and through broken skin and mucous membranes, among others.² The dental practice has been widely recognized for increased risk of bacterial and viral infections due to the close contact with patients' airways and the performance of aerosol-generating procedures.^{1, 3} Indeed, dentists should keep an eye out for the oral findings in MPXV and be aware of the inter-human transmission risk through respiratory droplets. The reported oral findings in MPXV may play a role in diagnosis, especially in patients at higher risk for developing this condition.⁴ Some points, however, are worth to be addressed.

Monkeypox is a vesicular and pustular illness involving the skin.⁵ Although the cutaneous manifestations of monkeypox infection have been well documented, oral monkeypox lesions in humans are not frequently described.^{1, 4} The current MPXV outbreak spreads through a route of transmission that involves the direct inoculation of the virus in the oral and rectal mucosa. Moreover, the lifecycle of MPXV includes a viremic stage which is how the virus spreads from the site of inoculation to distant sites and results in the disseminated rash and eventual complications.⁶ It is known that the oral cavity usually presents ulceration, bleeding, and blistering as either direct or secondary results of systemic disorders.^{7, 8} Initial observations of the ongoing outbreak showed that MPXV harbors concomitant infections.⁹ As evidence on the underlying mechanisms of the oral findings in MPXV is lacking in the literature, it is also possible these oral presentations may be also related to other viruses or as a consequence of a synergistic effect of poor oral hygiene. Overall, studies are still necessary to unveil the precise pathophysiological mechanism of the oral findings reported on MPXV.

Unlike the first known outbreak of the novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection in Wuhan, China, MPXV does not seem to be as easily transmissible⁵ and effective vaccines for its prevention are already available.¹⁰ However, vaccine hesitancy is not a new phenomenon¹¹ and the epidemiological and social crises brought about by COVID-19 have exacerbated skepticism toward vaccines,^{12, 13} even among healthcare workers.¹⁴ In fact, vaccine hesitancy could result in outbreaks of vaccine-preventable illnesses such as MPXV. Healthcare workers, including dental professionals, should encourage vaccination to prevent further disease outbreaks.

Several published reports had drawn attention to the implications of MPXV for dental practice and the detection of MPXV DNA in nasopharyngeal swabs and saliva has been reported.^{15, 16} However, the real role of the salivary glands in MPXV is not clear as the source of MPXV in saliva has not been fully investigated. In terms of postpandemic infection control, it is imperative to maintain a very high degree of suspicion in dental practice.¹⁷ In addition, the preventive measures highlighted in the COVID-19 pandemic could be useful to identify and mitigate the spread of MPXV and other vaccine-preventable illnesses.¹⁷

CONFLICT OF INTEREST

The authors declare no conflict of interest.