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FACT SHEET: Chikungunya (also known as “chikungunya fever”; caused by chikungunya virus [CHIKV])

Date of Publication: July 7, 2016
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Is the initiation of non-invasive dental hygiene procedures* contra-indicated?

  • Yes, if the patient/client is febrile and/or has significant morbidity.

Is medical consult advised? 

  • Yes, if the diagnosis is uncertain and/or the patient/client is not already under medical care.

Is the initiation of invasive dental hygiene procedures contra-indicated?**

  • Yes, if the patient/client is febrile and/or has significant morbidity.

Is medical consult advised? 

  • See above.

Is medical clearance required? 

  • No, unless severe bleeding tendency or severe immunosuppression is suspected.

Is antibiotic prophylaxis required? 

  • No.

Is postponing treatment advised?

  • Yes, while patient/client is acutely ill. 

Oral management implications

  • Mode of transmission is primarily by bite of an infected mosquito (principally day-biting types that also transmit dengue virus; mosquitoes are infected by biting persons with viremia1). Vertical maternal-fetal transmission in infected pregnant women also occurs. The incubation period in humans (i.e., time from mosquito bite to clinical signs/symptoms) is 1 to 12 days, and usually 3 to 7 days. Because of viremia in infected persons (which usually coincides with the first week of illness), transmission can occur through exposure to infected blood. While blood-borne transmission is possible (including, rarely, via needle stick injury), transmission is highly unlikely in the dental hygiene setting with appropriate application of standard infection control precautions.2 Otherwise, direct person-to-person transmission of chikungunya does not occur.
  • Although chikungunya fever is usually self-limiting, the diagnosis is important because of the similarity it has with dengue fever, the severe forms of which can be life-threatening. Hence, prompt medical referral is important for a traveller with fever returning from tropical or subtropical locales (where the differential diagnosis might also include malaria and bacterial infections).
  • Acetaminophen should be used for initial fever and pain control until dengue is ruled out. (Non-steroidal anti-inflammatory drugs [NSAIDs, such as ibuprofen and naproxen] and aspirin are contraindicated in dengue.)
  • Patients/clients may have difficulty chewing food during the acute phase of the disease due to temporomandibular joint arthralgia. In severe cases, the patient/client’s diet may need to be limited to soft, semisolid, or only liquid foods.

Oral manifestations

  • Oral manifestations are common, and most tend to last for 7 to 10 days and subside without any long-term sequelae.
  • Dysgeusia (altered taste) occurs in up to 85% of patients/clients.
  • While less common, painful aphthous-like ulcers may occur almost anywhere in the oral cavity, particularly on the tongue and palate. They may be accompanied by oral erythema.
  • Vesiculobullous lesions may occur on the oral mucosa, including the lips.
  • Pain and burning sensations in the oral mucous membranes may occur, and these can contribute to dysphagia in conjunction with palatal ulcers.
  • Angular cheilitis, erosions, erythema, and crusted lesions at the angles of the mouth are sometimes seen. Crusted lesions may also occur on the lips.
  • More rarely, depigmented macules on the lips and/or oral mucosal hyperpigmentation (including lips and hard palate) may occur.
  • Submandibular lymphadenopathy sometimes occurs. 
  • Hemorrhagic findings are uncommon (in contrast to dengue). However, mild gingivorragia (bleeding gums), often associated with gingitivis, can occur even in the absence of a low platelet count.
  • Oral candidiasis may occasionally occur, likely linked to transient immunosuppression caused by CHIKV. Other opportunistic infections such as herpes simplex may also occur.
  • Temporomandibular joint pain is sometimes seen as part of chikungunya’s characteristic polyarthralgia.

Related signs and symptoms

  • Prior to 2013, chikungunya outbreaks occurred in tropical and subtropical countries primarily in Africa, Asia (particularly India), Europe (Italy and France), and the Pacific and Indian Oceans. Since 2013, local transmission of CHIKV has spread to Caribbean islands and most of Central and South America; cases have also occurred in the southern USA. Chikungunya often occurs as large outbreaks with high attack rates.
  • Canadian travellers are at risk of contracting chikungunya in affected regions, especially in urban and suburban areas.3 The principal CHIKV mosquito vectors (Aedes species) are very common, and chikungunya is an increasing concern in the Americas. Depending on the timing of the bite of an infected mosquito, signs/symptoms may not manifest until the traveller has returned home. Currently, the Aedes mosquitoes that transmit CHIKV are not established in Ontario or elsewhere in Canada.4
  • In most persons, chikungunya is an acute, self-limiting viral disease that elicits lifelong immunity.5 Acute symptoms usually resolve within 7 to 10 days.
  • Infection with CHIKV is rarely fatal, but most infected people become symptomatic. Sudden onset of fever and polyarthralgia are the primary clinical findings, sometimes accompanied by maculopapular rash (which may be mildly pruritic in a minority of patients/clients.) Joint swelling and tenderness are usually symmetric and most often occur in the small peripheral joints (i.e., wrists, hands, ankles, and feet), although knees and shoulders can also be affected. The joint manifestations can be severe and debilitating, and some patients/clients may have persistent joint pain for months to years.6 As well, some persons may have relapse of rheumatologic symptoms (polyarthralgia, polyarthritis, and tenosynovitis7) in the months following resolution of the acute illness.
  • In some patients/clients, hyperpigmentation of the skin may occur after resolution of the acute rash. Xerosis (abnormal dryness of the skin) and associated scaling may also be seen, as may exacerbation of pre-existing dermatoses (e.g., psoriasis). Hemorrhagic manifestations are rare, with petechiae8 and ecchymoses (bruises) occurring occasionally. 
  • Other signs/symptoms include lethargy, headache, retro-orbital pain, photophobia, arthritis, myalgia (muscle aches), non-purulent conjunctivitis, nausea, vomiting, diarrhea or constipation, and lymphadenopathy (cervical or generalized).
  • Lymphopenia (reduced lymphocyte white blood cell count) and thrombocytopenia (reduced platelet count) may be found on laboratory blood testing.
  • Rare complications include retinitis, uveitis9, hepatitis, myocarditis (inflammation of the heart muscle), nephritis (inflammation of the kidneys), vesiculobullous or ulcerative skin lesions, hemorrhage, myelitis (inflammation of the spinal cord), meningoencephalitis, cranial nerve palsies, and Guillain-Barré syndrome10.
  • Patients/clients at risk for severe disease include persons aged > 65 years, persons with underlying medical conditions (e.g., diabetes, hypertension, or cardiovascular disease), and neonates exposed intrapartum.
  • While chikungunya’s signs/symptoms overlap with those of dengue and non-congenital Zika virus disease, persons infected with DENV tend to have more bone and muscle pain, neutropenia, thrombocytopenia, and hemorrhagic manifestations, and persons infected with Zika virus are more likely to have conjunctivitis and less likely to have oral manifestations. Patients/clients infected with CHIKV are more likely to have high fever, pronounced joint pain, arthritis, rash, and lymphopenia.11 Unlike dengue, chikungunya rarely progresses to become life threatening.

References and sources of more detailed information


Date: May 30, 2016
Revised: May 12, 2021, May 8, 2026


FOOTNOTES

1 In Africa, the virus is also maintained in a sylvatic cycle involving non-human primates and forest-dwelling mosquitoes. Rodents, bats, and possibly birds additionally serve as a reservoir for the virus.
2 CHIKV can also be present in saliva, although transmission has not been documented.
3 At the time of this most recent fact sheet update, a chikungunya live attenuated vaccine (CHIK-LAV) is authorized in Canada to prevent chikungunya infection. The Committee to Advise on Tropical Medicine and Travel (CATMAT) advises that the vaccine may be considered for adults 18 to 64 years of age, travelling to or living in areas with ongoing CHIKV transmission and at high risk of infection after an individualized assessment by a clinician. CHIK-LAV is not publicly funded in Ontario and is available only through private sale. In the United States, an additional chikungunya vaccine, made from pieces of the virus, has been approved by the Food and Drug Administration (FDA) for persons 12 years of age older.
4 By contrast, Aedes albopictus has spread to more than 32 states in the USA, and more than 25 countries in Europe, largely due to the international trade in used tires (a breeding habitat) and other goods (e.g., lucky bamboo). This mosquito is highly adaptive.
5 There is no specific treatment for chikungunya. Management is symptomatic, including rest, fluids, and analgesics.
6 The name “chikungunya” derives from a word in the Kimakonde language of east Africa. It means “to become contorted”, which describes the stooped appearance of infected persons with arthralgia (joint pain).
7 tenosynovitis = inflammation of a tendon and its sheath
8 Petechiae are red or purple spots on the mucosa or skin, which do not blanch to applied pressure, caused by extravasation of blood (i.e., hemorrhages). They are pinpoint to pinhead in size (i.e., 1 to < 3 mm in diameter).
9 Uveitis is inflammation of the uvea of the eye, the middle pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea. It can cause permanent vision loss.
10 Guillain-Barré syndrome (GBS) is rapid onset of muscle weakness caused by the body’s immune system attacking the peripheral nervous system, often following an infectious illness.
11 Blood tests can confirm a diagnosis of chikungunya.


* Includes oral hygiene instruction, fitting a mouth guard, taking an impression, etc.
** Ontario Regulation 501/07 made under the Dental Hygiene Act, 1991. Invasive dental hygiene procedures are scaling teeth and root planing, including curetting surrounding tissue.