An integrative review of oral manifestations in patients with COVID‐19: signs directly related to SARS‐CoV‐2 infection or secondary findings?

Abstract

We conducted an integrative review on oral manifestations in patients with COVID‐19 based on the current available literature evidence. A bibliographic search was carried out on March 11, 2021, among published studies in the years 2019–2021 in the PubMed database and based on the search strategy (“COVID‐19” AND “oral lesions” OR “oral mucositis” OR “oral manifestation”). After applying the inclusion and exclusion criteria, 29 articles were considered suitable for this review. A total of 110 cases of patients with COVID‐19 who had oral manifestations were reported. The presence of ulcerated lesions was the most common finding, having a herpetiform and aphthous clinical pattern observed in most cases. Macules, petechiae, hemorrhagic blisters, pustular enanthem, mucositis, and halitosis were also among the most frequently described oral manifestations. The tongue was the most commonly affected site, followed by the palate and lip. Most of the reported cases were diagnosed only by the clinical aspect of the lesion associated with a positive SARS‐CoV‐2 test or the presence of other COVID‐19 symptoms. Current scientific evidence still could not affirm that most of the oral lesions observed in patients with COVID‐19 are related to the virus's direct or indirect action on the oral mucosa. To confirm this association, prospective and longitudinal studies are further needed, together with a larger number of patients, complemented by histopathological examination of these lesions. Additionally, molecular techniques, such as immunohistochemistry and in situ hybridization, may be necessary to perform the differential diagnosis with other oral lesions.

Do COVID-19 patients receiving hospital care in the ICU develop oral complications? A case series study

“…To confirm this association, prospective and longitudinal studies are further needed, together with a larger number of patients, complemented by histopathological examination of these lesions. Additionally, molecular techniques, such as immunohistochemistry and in situ hybridization, may be necessary to perform the differential diagnosis with other oral lesions [13,14].…”

“…It is believed that the virus is associated with the interference in hematopoiesis, excessive destruction of platelets by antibodies, and platelet consumption because of hypercoagulability causing macules, petechiae and hemorrhagic lesions [13].…”

“…Regarding the occurrence of xerostomia in COVID-19, other authors also suggested the association with medications, nasal congestion, mouth breathing, nutritional deficiency, diabetes, and the anxiety and distress related to the pandemic or long-term hospitalization [7].Candidiasis due to long-term AB and/or corticosteroids therapy, deterioration of general status, immunosuppression, and decline in oral hygiene can be the cause of candida growth in the form of white or red patches/plaques. Therefore, it is likely that this fungal infection is not directly related to COVID-19 but is secondary to the use of medications and the patients' immunosuppression condition [13].…”

“…It has been suggested that the pathogenesis of recurrent aphthous stomatitis is associated with an immune reaction mediated by T cells and an increase in cytokines as the tumor necrosis factoralpha. Therefore, the production of cytokines triggered by the virus may induce an immune reaction that culminates in the destruction of the oral mucosa [13,14]. SARS-CoV-2 may infect nasal and oral mucosal cells, which may explain the occurrence of smell and taste dysfunctions early in the course of the disease.…”

Self‐reported oral manifestations during COVID‐19 pandemic: Egyptian cohort

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To the Editor, Oral mucosa is placed as a potential target organ for SARS-CoV-2 virus due to high expression of ACE2, a hypothesized SARS-CoV-2 virus receptor, in oral epithelium. 1 Oral Medicine researchers monitored and documented oral manifestations among COVID-19 patients. Yet, most studies concerned with oral mucosal lesions are case reports, which can't confirm the association or reflect the frequency of occurrence.

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