Association of Viral Infections With Oral Cavity Lesions: Role of SARS-CoV-2 Infection

Abstract

Different viral agents, such as herpesviruses, human papillomavirus, and Coxsackie virus, are responsible for primary oral lesions, while other viruses, such as human immunodeficiency virus, affect the oral cavity due to immune system weakness. Interestingly, it has been reported that coronavirus disease 2019 (COVID-19) patients can show cutaneous manifestations, including the oral cavity. However, the association between oral injuries and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still unclear. This narrative review aimed to summarize the available literature and provide an overview of oral lesions associated with COVID-19. An online literature search was conducted to select relevant studies published up to November 2020. The results of 17 studies showed variability in oral lesions associated with COVID-19, including ulcerations, aphthous-like lesions, and macules. The tongue, lips, and palate were the most frequent anatomical locations. According to current knowledge, the etiopathogenesis of multiple COVID-19-associated lesions seems to be multifactorial. The appearance of such lesions could be related to the direct or indirect action of SARS-CoV-2 over the oral mucosa cells, coinfections, immunity impairment, and adverse drug reactions. Nevertheless, COVID-19-associated oral lesions may be underreported, mainly due to lockdown periods and the lack of mandatory dispositive protection. Consequently, further research is necessary to determine the diagnostic and pathological significance of oral manifestations of COVID-19. All medical doctors, dentists, and dermatologists are encouraged to perform an accurate and thorough oral examination of all suspected and confirmed COVID-19 cases to recognize the disease's possible early manifestations.

Review of oral ulcerative lesions in COVID-19 patients: A comprehensive study of 51 cases

“… 4 , 5 , 6 According to the associated studies, the most frequent oral finding was oral ulceration, and there were distinct clinical patterns observed in different case studies. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 Despite growing literatures investigating oral presentations in COVID-19 patients, few of them provide deep insight into oral ulcerative lesions, the most frequent but diverse one. The detailed clinical features, histological findings, immune profile, and the possible underlying pathogenetic mechanism of the oral ulcerative lesions are still lacking.…”

Oral lesions in patients infected with SARS-CoV-2: a case series

“…These receptors on the tongue, salivary glands and oral mucosa may be related to the development of dysgeusia, ulcerations, inflammation and erosion of the oral mucosa (Mariz et al, 2020;Tong et al, 2020;La Rosa et al, 2021). In most of the reported cases, lesions in different areas of the oral mucosa were observed, as well as reports of loss of taste and smell, which suggests a strong relationship between the loss of function of these cells caused by the virus.…”

Manifestaciones Orales Asociadas Al Covid-19: Revisión Bibliografica

“…Según La Rosa & cols se presenta en sectores como paladar, labios y la lengua. (14) En un reporte de caso por Corchuelo, 2020, se presentaron manifestaciones orales como petequias y ulceras en un paciente asintomático con COVID-19 confirmado. (24).…”

“…(13) Además, las barreras de la cavidad bucal como el epitelio oral y la saliva no son imposibles de atravesar. (14) El epitelio oral y la glándula salival de los casos confirmados de COVID-19 presentan un receptor llamado ACE2 que tiene la función de unirse al virus SARS-CoV-2 causando luego la infección. Por lo que se podría considerar un factor patogénico en el desarrollo de las manifestaciones orales asociadas a la infección del virus.…”