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FACT SHEET: Mononucleosis (also known as “mono”, “infectious mononucleosis”, “glandular fever”, “kissing disease”, “monocytic angina”, and “Pfeiffer’s disease”; caused by Epstein-Barr virus [EBV], a type of human herpesvirus)

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

  • Yes, if patient/client is acutely ill. 

Is medical consult advised? 

  • If patient/client is febrile or has tonsillar exudate or has head/neck lymphadenopathy or has general malaise or any combination of these signs/symptoms, refer to primary care provider (e.g., physician or nurse practitioner) for follow-up and definitive diagnosis (including possible blood test). 

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

  • Yes, if patient/client is acutely ill.

Is medical consult advised? 

  • See above.

Is medical clearance required? 

  • No.

Is antibiotic prophylaxis required? 

  • No.

Is postponing treatment advised?

  • Yes, if patient/client is acutely ill. Reschedule dental hygiene appointment for when patient/client feels well.

Oral management implications

  • Mode of transmission is usually person-to-person spread by the oropharyngeal route, via saliva.1 Mouth kissing is commonly implicated, along with sharing food and drinks and using the same personal oral items that an infected person recently used.
  • No special precautions or isolation procedures are recommended, because the virus is frequently found in the saliva of healthy people. Standard precautions apply. Many healthy people carry and spread the virus intermittently for life.
  • Period of communicability may be prolonged; pharyngeal excretion may persist for a year or more after infection, and 15−20% of EBV antibody-positive healthy adults are long-term oropharyngeal carriers.
  • In industrialized countries, age of primary infection is typically in older childhood and young adulthood (most recognized in high school and college students), whereas in developing countries infection is widespread in early childhood.
  • Affected patients/clients should be advised not to share their toothbrushes to reduce transmission risk to others.
  • There is no vaccine to protect against EBV infection.

Oral manifestations

  • Tonsillar exudate (white, yellow, or grey patches), pharyngeal erythema, and cervical lymphadenopathy (especially posterior) are common. 
  • Palatal petechiae occur infrequently.
  • Upper airway obstruction from pharyngeal lymphadenopathy is a rare complication.
  • Cranial nerve palsies are rare complications of EBV infection.
  • Some studies suggest that oral EBV infection is associated with periodontitis, particularly in older adults.
  • While not characteristic of mononucleosis per se, oral hairy leukoplakia (OHL), which manifests as white hair-like patches2 on the tongue, can be triggered by EBV (usually in persons with weakened immune systems). EBV is also associated with cancers of the nasopharynx and salivary glands, and recent research suggests it may play a role in some cancers of the oral squamous mucosa.

Related signs and symptoms

  • Mononucleosis is very common, and over 90% of adults are carriers of the causative virus.
  • The classical triad of mononucleosis is fever, pharyngitis (sore throat), and lymphadenopathy (swollen lymph nodes, particularly in the armpits), most typically seen in persons age 15 to 24 years following primary infection. Fatigue, general malaise, and head and body aches are also common in this age group. A non-specific, generalized, maculopapular rash infrequently occurs.
  • In young children, the disease is generally mild and more difficult to recognize.
  • Splenomegaly (swollen spleen) occurs in 50% of infected young adults, and liver involvement results in jaundice in 4%.
  • In persons who are symptomatic from primary oral EBV infection (usually teens and adults)3, recovery usually occurs in 2 to 4 weeks.4 However, malaise may persist for months.
  • Mononucleosis is rarely fatal, although it is more severe in older adults and persons with a weakened immune system.5 Complications include splenic rupture, autoimmune hemolytic anemia, hemolytic uremic syndrome, erythema multiforme, and eye inflammation (including episcleritis and uveitis. Rare nervous system complications of EBV infection include encephalitis, psychosis, peripheral neuritis, and Guillain-Barré syndrome.

References and sources of more detailed information

 


Date: December 10, 2012
Revised: January 5, 2020; January 11, 2026


FOOTNOTES

1 EBV can also spread via blood and semen during sexual contact, blood transfusions, and organ transplantations.
2 The “hairy” appearance of oral hairy leukoplakia is due to projections of keratin.
3 Incubation period (i.e., time between exposure to infectious agent and start of signs/symptoms) of mononucleosis is from 3 to 6 weeks. Most patients/clients do not recall the exposure.
4 Treatment of mononucleosis is symptomatic, including drinking fluids to keep hydrated, getting plenty of rest, gargling with warm salt water, sucking lozenges, and using over-the-counter medications ((e.g., non-steroidal anti-inflammatory medications [NSAIDs]) for fever and pain.
5 Epstein-Barr virus is also associated with stomach cancer and several lymphomas. EBV establishes a lifelong latent infection in most persons after initial exposure.


* 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.