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FACT SHEET: Impetigo (usually caused by staphylococcal [staph] bacteria — typically S. aureus —  but also sometimes by streptococcal bacteria [strep] bacteria — typically S. pyogenes)

Date of Publication: March 11, 2013

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

  • No.

Is medical consult advised?  

  • Yes. While a medical consult for oral health reasons is not required, a referral to a primary care provider (e.g., physician or nurse practitioner) is appropriate for definitive diagnosis and treatment.

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

  • No.

Is medical consult advised? 

  • Yes; see above.

Is medical clearance required? 

  • No.

Is antibiotic prophylaxis required?  

  • No.

Is postponing treatment advised?

  • Possibly; see below.

Oral management implications

  • Mode of transmission is often autoinfection; staph and strep often live harmlessly on the skin. Children are commonly infected through a break in the skin via a cut, scrape or insect bite, but they can also develop impetigo without having visible skin damage. In adults, impetigo is usually the result of an injury to the skin, such as dermatitis. Impetigo can also be spread by direct contact with a person who has a purulent lesion or is an asymptomatic (usually nasal) carrier of a pathogenic strain. There is also the potential for spread via touching items that have come in contact with impetigo lesions. Impetigo spreads easily in schools and daycare settings.  
  • Ensure appropriate infection control measures are in place (e.g., gloves and hand washing) to prevent spread from the patient/client’s face to the dental hygienist. If facial lesions are widespread or if there is pain with mouth opening, dental hygiene procedures should be deferred until patient/client’s impetigo has been treated.

Oral manifestations

  • None internal in the mouth. However, in children (especially those aged 2 to 6 years), perioral lesions are common, as described below.

Related signs and symptoms

  • Impetigo is a skin infection most commonly seen in young children (2−6 years). While lesions can appear anywhere, they usually appear on the face, arms, or legs.
  • Lesions present in different ways, including the following: red or pimple-like sores that rupture and ooze and then form ‘golden’ crusts (“impetigo contagiosa”, which typically occurs around the mouth and nose); itching; painless, fluid-filled blisters (“bullous impetigo”); and painful fluid- or pus-filled sores that result in deep ulcers (“ecthyma”). Treatment usually involves topical antibiotics and/or oral antibiotics. While impetigo usually isn’t dangerous, it sometimes leads to cellulitis and, more rarely, serious complications such as kidney damage from post-streptococcal glomerulonephritis.

References and sources of more detailed information

Date: December 10, 2012
Revised: February 22, 2020