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FACT SHEET: Measles (also known as rubeola, red measles, hard measles, and morbilli; caused by measles virus; should not be confused with rubella, also known as “German measles”)

Date of Publication: March 11, 2013
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Is the initiation of non-invasive dental hygiene procedures* contra-indicated?

  • Yes, during the period of communicability (see below). Measles is highly contagious.

Is medical consult advised?  

  • Yes, if the patient/client is not already under medical care.1

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

  • Yes, during the period of communicability (see below) and in the presence of significant morbidity. Measles is highly contagious.

Is medical consult advised? 

  • See above.

Is medical clearance required? 

  • No.

Is antibiotic prophylaxis required?  

  • No.

Is postponing treatment advised?

  • Yes, during the period of communicability (see below).

Oral management implications

  • Mode of transmission is via airborne droplets (coughing and sneezing) or direct contact with nasopharyngeal secretions (saliva, sputum, and nasal mucus) of infected persons. Less commonly, the virus spreads through contact with articles freshly soiled by nasopharyngeal secretions (i.e., within two hours). This highly communicable disease is contagious to others from four days before to four days after the rash appears. Measles virus can live the air for 2 hours after the infectious individual leaves the space. 90% of non-immune persons exposed to an infected person will contract the disease.
  • Suspect measles cases, particularly persons with travel history to areas with endemic or epidemic measles, should be reported as soon as possible to local public health authorities (i.e., local public units in Ontario) by designated parties (see below). Patients/clients should be isolated for four days after appearance of the rash. Immunization of exposed susceptible contacts can limit the spread of disease.
  • Healthcare providers should suspect measles in persons who have a rash accompanied by fever plus clinically compatible symptoms (see below) and who recently have traveled abroad or have had contact with travelers. Providers should implement isolation precautions immediately. This includes wearing of masks by healthcare providers (ideally at least N-95 equivalent), and, when possible, by the person with suspected (or confirmed) measles (typically at least a surgical mask) and by other potentially exposed persons (typically at least a surgical mask). Measles-susceptible healthcare personnel should not enter the room if providers who are immune to measles are available.
  • MMR vaccine provides protection against measles, mumps, and rubella, while the MMRV vaccine also protects against varicella (chicken pox). In Canada, it is recommended that children receive two doses of a combined measles-containing vaccine. The first dose is usually given when children are one year old and the second is given either when they are 18 months or before they start school (between ages 4 and 6 years); Ontario has adopted the school-entry regimen. Measles is rare in Canada due to widespread immunization, but periodic outbreaks occur amongst unvaccinated persons, often associated with travel outside Canada (such as cases in Ontario in 2024).
  • Healthcare workers, including dental hygienists, should ensure they are appropriately immunized. A simple blood test is available to determine immunity status and hence whether adult immunization is indicated.
  • Healthcare workers who contract measles should refrain from working during the acute illness phase, as well as after exposure and during the incubation period if not vaccinated.
  • In Ontario, measles is a specified Reportable Communicable Disease (as per Ontario Regs 559/91 and amendments under the Health Protection and Promotion Act). Thus, physicians and laboratories (and other designated parties) are obligated to report this disease to the local Medical Officer of Health2 so the local public health unit can take measures to limit spread to susceptible persons, including those who are not immunized due to medical contraindications or religious/conscientious objections or those too young for vaccination. Infants born to immune mothers are usually protected for 6 to 9 months, depending on the extent of transplacental maternal antibody acquisition and subsequent degradation.

Oral manifestations

  • Measles causes Koplik’s spots in most affected persons. These are small spots, often irregularly shaped, with white or bluish-white centers on a red base found inside the mouth, typically on the buccal mucosa. They typically appear two or three days after the onset of other symptoms (e.g., fever, cough, runny nose, red eyes, and sore throat), and before the onset of rash. These flat lesions rapidly increase in number and coalesce to form small patches.
  • As a dental hygienist, you should have a high index of suspicion that a patient/client may have measles if you see oral lesions resembling Koplik’s spots, particularly during periods of increased measles activity.
  • Petechiae (pinpoint hemorrhages) may occur on the palate and pharynx, in addition to generalized inflammation, congestion, swelling, and ulceration of the gingiva, palate, and throat. 
  • Enamel hypoplasia can result from measles (and other febrile illnesses) that occurs during the time of tooth formation. It is characterized by pitting of the enamel.

Related signs and symptoms

  • Although measles is no longer considered endemic in Canada, in 2023 there were 7 laboratory-confirmed cases in Ontario. At the time of the most recent updating of this Fact Sheet, cases in Ontario3, Canada, and globally were on the increase. About 9 million cases of measles occurred world-wide in 2022 (mostly in developing countries with low immunization rates), and about 136,000 children died from complications of the disease.
  • The symptoms of measles generally begin about 7−21 days after a susceptible person is exposed (with 10−14 days being a typical incubation period), and include:
    • Fever
    • Cough
    • Runny nose
    • Red, watery eyes (conjunctivitis)
    • Fatigue and aches
    • Blotchy, generalized rash.
  • Affected adults may experience a transient hepatitis (i.e., inflammation of the liver).
  • Three to seven days after the start of symptoms, a red or reddish-brown rash appears. Classically, the rash begins on a person’s face at the hairline and spreads downward to the neck, torso, arms, legs, and feet. After several days, the fever subsides and the rash fades.
  • Infectiousness begins from one day before the beginning of the prodromal period (usually about four days before rash onset) to four days after appearance of the rash.
  • Approximately 30% of persons with measles develop complications, which are more common in children under five years and adults over 20 years of age. About one out of 10 children with measles will also develop a middle ear infection (otitis media), which sometimes leads to hearing loss. Up to one out of 20 affected children will develop pneumonia, and one in 1,000 will develop encephalitis (inflammation of the brain). Diarrhea occurs in about 8% of cases. For every 1,000 children who get measles, one or two will die as a result of complications. Measles can also result in miscarriage, premature birth, and low-birth-weight birth in affected pregnant women.

References and sources of more detailed information


Date: February 18, 2013
Revised: August 19, 2019; May 21, 2024


FOOTNOTES

1 In addition to being diagnosed clinically, measles can be confirmed in the laboratory through serologic (antibody) testing or by polymerase chain reaction (PCR) testing of throat/nasopharyngeal swabs or urine samples. (Viral culture is less commonly used now in many Western countries, including Canada.) Treatment of measles mainly consists of supportive care, including good hydration with fluids, rest, and antipyretic (anti-fever) medications. Vitamin A supplementation may be indicated in some cases.
2 It is also a requirement for Ontario-licensed dentists to report a suspected or confirmed case of a reportable communicable disease (including measles) to their local Medical Officer of Health.
3 By early May 2024, the number of laboratory-confirmed cases in Ontario for the calendar year was 21 (mostly in unvaccinated persons; 13 in children and 8 in adults). The COVID-19 pandemic contributed to the increase, because it interrupted global efforts to vaccinate against measles (including in Canada) and disrupted routine surveillance in many countries.


* 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.