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

Is medical consult advised? 

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

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

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.

• Mode of transmission is via airborne transmission or droplet spread (coughing, sneezing, and talking), as well as direct contact with saliva or mucus of infected persons. The virus may also spread indirectly when someone with mumps touches an item with contaminated hands and then someone else touches the same item and rubs his/her mouth, nose or eyes. While considered highly contagious, mumps is less contagious than chickenpox or measles.
• Persons infected with mumps are contagious from 7 days prior to 9 days after the onset of salivary gland swelling (parotitis), while maximum contagiousness occurs from 2 days prior until 5 days after parotitis onset. Patients/clients should be isolated for at least 5 and up to 9 days after their salivary glands begin to swell. Asymptomatic persons with mumps (i.e., those without parotitis or other symptoms) can also be contagious to others.
• Given long-standing provincial immunization programs², mumps is now uncommon in Canada. However, unimmunized persons remain at risk of contracting mumps given potential contact with persons from other countries where mumps remains endemic, or with certain religious communities that object to immunization.
• Oral healthcare professionals play an important role in identifying cases.
• 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 mumps should refrain from working during the acute illness phase (including at least 5 days after onset of parotitis), as well as after relevant exposure and during the incubation period if not vaccinated. Healthcare workers without evidence of immunity should be excluded from the 12^th day after the first unprotected exposure to mumps through the 25^th day after the last exposure. Because the mumps vaccine cannot be reliably used to prevent the development of mumps after exposure, this exclusion includes unvaccinated health care personnel who receive a first dose of vaccine after an exposure. “Relevant exposure” includes unprotected face-to-face interaction (e.g., no mask) within 1 metre (3 feet) of an infectious mumps case.
• In Ontario, mumps is a specified Reportable Communicable Disease (as per Ontario Reg. 559/91 and amendments under the Health Protection and Promotion Act). Thus, physicians and laboratories (and other designated parties) are obligated to report all suspect and confirmed cases to the local Medical Officer of Health³ 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. Immunization of susceptible contacts may help limit the spread of disease, but does not always prevent infection.

• Parotitis occurs in fewer than half of individuals infected with mumps, and, when present, usually lasts 7−10 days in unvaccinated persons. It manifests as local pain, tenderness, and swelling in one or both parotid salivary glands. First visible in front of the lower part of the ear, swelling then extends downward and forward as fluid builds up in the skin and soft tissue of the face and neck. Swelling usually peaks in 1−3 days and then subsides over the course of the next week. The swollen gland pushes the angle of the ear up and out. As swelling worsens, the angle of the mandible below the ear becomes no longer visible. Often the mandible cannot be palpated, because of swelling of the parotid gland. One parotid gland may swell before the other, and, in about 25% of affected patients/clients, swelling remains unilateral.
• The submandibular and sublingual salivary glands may also swell, but this occurs in only about 10% of cases.
• Sharp pain may result from stimulation of the parotid gland’s secretory mechanism by food or drink. This pain stems from partial occlusion of Stensen’s duct as the parotid gland swells. 
• Dry mouth and difficulty chewing, swallowing, or talking may be other manifestations.
• Mumps infection may be confused with swelling of the neck’s lymph nodes. Lymph node swelling can be differentiated from mumps by the well-defined borders of the lymph nodes, their location behind the angle of the jawbone, and lack of ear protrusion or obscuring of the angle of the jaw.
• The differential diagnosis for swelling of the major salivary glands includes chronic nonspecific sialadenitis (inflammation of the salivary glands), acute postoperative parotitis, Sjögren disease, and sarcoidosis.

• Mumps, while uncommon in Ontario⁴ and Canada, is the most widespread form of viral sialadenitis globally. It remains a significant health threat in developing countries, and outbreaks occur in developed countries where vaccination rates are low.
• The incubation period of mumps (i.e., time from exposure to clinical illness) is typically 16 to 18 days (range 12 to 25). 
• Persons with mumps usually first feel ill with nonspecific symptoms such as headache, myalgia (muscle aches), fatigue, and decreased appetite, which precede the onset of parotitis. A low-grade fever may persist for 3 to 4 days. Respiratory symptoms may also occur, particularly in children less than 5 years of age. Mumps is usually a mild disease in children, whereas adults tend to have more serious disease and more complications.
• Mumps may present only with nonspecific or primarily respiratory symptoms, and up to 20% of persons with mumps infection are asymptomatic.
• Most persons who contract mumps recover fully.⁵ However, mumps can cause complications, sometimes serious in nature, and these complications may occur even in the absence of parotitis. Complications include:
  • orchitis (inflammation of the testicles) in males who have reached puberty, which rarely leads to sterility
  • encephalitis (inflammation of the brain)
  • meningitis (inflammation of meninges membranes covering the brain and spinal cord), which can manifest as neck stiffness
  • oophoritis (inflammation of the ovaries) and mastitis (inflammation of the breasts) in females who have reached puberty
  • pancreatitis, which can manifest as abdominal pain
  • hearing loss (due to neuritis of the auditory nerve), which may be temporary or permanent
  • miscarriage⁶.

• Government of Canada
  https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/mumps.html
  https://www.canada.ca/en/public-health/services/canadian-immunization-guide.html
• Government of Ontario
  https://www.ontario.ca/page/ontarios-routine-immunization-schedule
• Public Health Ontario
  https://www.publichealthontario.ca/en/health-topics/immunization/vaccine-preventable-diseases/mumps
  https://www.publichealthontario.ca/-/media/Documents/M/25/mumps-ontario.pdf
• Ottawa Public Health
  https://www.ottawapublichealth.ca/en/professionals-and-partners/laboratory-testing-for-mumps.aspx#
• Centers for Disease Control and Prevention
  https://www.cdc.gov/mumps/index.html 
• Mayo Clinic
  https://www.mayoclinic.org/diseases-conditions/mumps/symptoms-causes/syc-20375361
• Dimensions of Dental Hygiene
  https://dimensionsofdentalhygiene.com/article/preventing-spread-mumps/
  https://dimensionsofdentalhygiene.com/article/vaccination-recommendations/
• Heymann DL (ed.). Control of Communicable Disease Manual (21^st edition). Washington, D.C.: American Public Health Association; 2022.
• Regezi JA, Sciubba JJ, Jordan RCK. Oral Pathology — Clinical Pathologic Correlations (7^th edition). St. Louis: Elsevier; 2017.
• Ibsen OAC, Peters SM. Oral Pathology For The Dental Hygienist (8^th edition). St. Louis: Elsevier; 2023.

¹ In addition to clinical presentation, several tests are used to diagnose mumps. These include a buccal or throat swab plus urine sample for polymerase chain reaction (PCR) testing, as well as serology (blood test) for mumps-specific antibodies.
² 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 mumps-containing vaccine. The first dose (for mumps protection) is usually given when children are one year old and the second (for measles protection) is given either when they are 18 months of age or before they start school (between ages 4 and 6 years); Ontario has adopted the school-entry regimen.
³ It is also a requirement for Ontario-licensed dentists to report a suspected or confirmed case of a reportable communicable disease (including mumps) to their local Medical Officer of Health.
⁴ In 2024, 95 cases of mumps were reported in Ontario.
⁵ Treatment of mumps is symptomatic. This includes rest, over-the-counter pain relievers (e.g., acetaminophen or NSAIDs [non-steroidal anti-inflammatory drugs] such as ibuprofen), hydration, cold or warm cloth for swollen salivary glands, and a cold cloth or cool pack for swollen testicles.
⁶ Contracting mumps during the first 12 weeks of pregnancy may increase risk of spontaneous abortion.

* 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.