Review of Ebola Virus Disease in the Oral Cavity

Abstract

Ebola virus disease is a fatal viral hemorrhagic fever that has been an emerging concern in sub-Saharan Africa from the 1970s. Last year, Ebola virus disease reached epidemic levels in West Africa, and also spread in a limited number of cases to the USA, Europe and Antipodes via infected travelers. Human-to-human transmission of Ebola virus is known only by way of direct contact with tissues, blood, secretions or other bodily fluids, including saliva. Although there been no reported infection cases in the dental healthcare settings, the potential for transmission through saliva suggests a high risk of infection for dental healthcare workers. Therefore, it is imperative that dental healthcare workers be able to identify patients with suspected Ebola virus disease. This article will review oral signs and symptoms of Ebola virus disease, discuss pathogenesis, treatment and prevention, and propose infection control guidelines for oral healthcare workers. This review is based on a study of the literature, including research papers and case reports, to analyze the epidemiology, pathogenesis, transmission and prevention of Ebola virus disease. A literature search using PubMed and Google scholar with keywords ['Ebola' AND 'oral' OR 'facial' OR 'dental'] was performed (September 2015) and papers published since 1976 were reviewed. Of the many case reports and studies, those that described orofacial signs and symptoms from early stages of illness were selected and analyzed for the incidence and descriptions of orofacial signs and symptoms. Management guidelines for infection prevention of Ebola virus disease are based on the standard precautions published by certified health organizations, including the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO). Ebola virus disease is alarming, with a high mortality rate. Healthcare workers, who are always exposed to risk of infection, need to be especially careful of infection from a patient who is infected with Ebola virus but not yet displaying initial symptoms. To minimize risks, dental practitioners need to obtain accurate information about whether their patients have been in countries suffering from outbreaks of Ebola virus disease within the last 21 days or in contact with someone with Ebola virus disease, as well as assess for the presence of visible initial symptoms of Ebola virus disease (fever, headache, weakness, fatigue, myalgia, diarrhea, vomiting, abdominal pain, unidentified hemorrhage). Above all, in order to reduce the risk of infection and cross-infection by healthcare workers, specific infection control guidelines for healthcare workers should be strictly followed, keeping in mind that all patients have the possibility of infection by Ebola virus.