Oral Manifestations of Varicella and Their Contribution to Clinical Assessment in Hospitalized and Outpatient Patients

BACKGROUND: Oral lesions, particularly enanthema, may accompany chickenpox and represent an important but often underrecognized component of the clinical presentation. Their timely identification is especially relevant in dental practice, as oral manifestations may be more frequent in patients with a more severe clinical course. This study aimed to describe characteristic oral cavity changes in hospitalized and outpatient patients with chickenpox, to identify patterns in the occurrence of oral findings in relation to disease severity, and to support clinical assessment in practice. METHODS: A retrospective review of medical records was conducted for patients diagnosed with chickenpox in Bulgaria between December 2023 and May 2025. Data from hospitalized patients and outpatient cases were analyzed and compared to evaluate the distribution of oral manifestations and their association with clinical severity. RESULTS: A total of 144 patients were included, of whom 32.6% required hospitalization. Oral enanthema was more frequently observed among hospitalized patients (48.8%). In univariate analyses, oral enanthema and tongue changes were associated with hospitalization. Multivariable logistic regression identified age and body temperature as independent factors associated with hospitalization, while oral manifestations did not retain independent predictive significance. CONCLUSION: Oral enanthema was more frequently observed among hospitalized patients and was associated with a more severe clinical presentation in univariate analyses. Although oral findings should not be interpreted as independent predictors of disease severity, their recognition may support clinical assessment, dental treatment planning, and appropriate infection control measures.