Lack of direct association between oral mucosal lesions and SARS-CoV- 2 in a cohort of patients hospitalised with COVID-19

Abstract

Background COVID-19 is a disease affecting various human organs and systems, in which the virus seeks to interact with angiotensin-converting enzyme 2 receptors. These receptors are present in the oral cavity, but the direct relationship between such an interaction and possible oral manifestations of COVID-19 is still unclear. Aim The present study evaluated oral manifestations in a cohort of COVID-19 patients during the period of hospitalisation. Methods In total, 154 patients presenting moderate-to-severe forms of COVID-19 had their oral mucosa examined twice a week until the final outcome, either discharge or death. The oral alterations observed in the patients were grouped into Group 1 (pre-existing conditions and opportunistic oral lesions) and Group 2 (oral mucosal changes related to hospitalization). Results Oral lesions found in the patients of Group 1 are not suggestive of SARS-CoV-2 infection as they are mainly caused by opportunistic infections. On the other hand, oral alterations found in the patients of Group 2 were statistically ( P < 0.001) related to intubation and longer period of hospitalisation. Conclusion It is unlikely that ulcerative lesions in the oral cavity are a direct manifestation of SARS-CoV-2 or a marker of COVID-19 progression.

A reflection on COVID-19 and oral mucosal lesion: a systematic review

“…Therefore, intubation in the course of treatment may be associated with the occurrence of traumatic ulcers, thus explaining their high prevalence in severe COVID-19 cases. Interestingly, in line with our findings, a recent study ( 69 ) also demonstrated a possible association between the intubation process in COVID-19 patients and traumatic ulcers. The cohort study analyzed COVID-19 patients with oral mucosal changes associated with hospitalization and found a statistical association between intubation and oral lesions.…”

“…Some proposed that oral mucosal lesions may act as a secondary manifestation of COVID-19 ( 6 , 10 , 12 , 17 ), or that COVID-19 disrupts the local microbiome or impairs oral mucosal immunity, causing oral mucosal lesions ( 12 , 27 , 72 ). Others pointed out that it may be caused by poor oral hygiene practice or intubation process during hospitalization, or adverse effects of COVID-19 medication ( 15 , 69 ). However, similar to the findings of this systemic review, most of them ( 3 , 5 , 16 , 20 , 21 , 23 , 24 ) still cannot conclude that COVID-19 has an association with oral mucosal lesions due to the lack of detailed reports.…”

SARS-CoV-2 in saliva, viremia and seroprevalence for COVID-19 surveillance at a single hematopoietic stem cell transplantation center: a prospective cohort study

“…On the other hand, the floor of mouth lesion (Figure 3b) was composed of asymptomatic reddish petechiae. We do not believe that oral mucosal lesions are directly associated with SARS-CoV-2 25 . However, previous studies 26,27 have shown vascular involvement and detection of the SARS-CoV-2 spike protein in inflammatory endothelial cells and keratinocytes, as well as in acinar and ductal cells of the minor salivary glands.…”

Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review

“…Italy accounted for the most articles, with 14 studies [ 16 , 19 , 20 , 22 , 23 , 28 , 29 , 36 , 37 , 58 , 66 , 72 , 81 , 86 ]. This was followed by India with 8 studies [ 17 , 33 , 44 , 45 , 50 , 55 , 80 , 83 ], United States with 7 studies [ 21 , 25 ,, 30 , 31 , 54 , 62 , 79 ], Brazil with 7 studies [ 9 , 47 , 49 , 52 , 56 , 75 , 77 ], and both Egypt and Turkey with 5 studies each [ 34 , 38 , 41 , 68 , 71 ] and [ 26 , 39 , 42 , 48 , 64 ], respectively. Iran [ 5 , 53 , 59 , 60 ], Iraq [ 12 , 43 , ...…”

“…We further subdivided the taste disorders into additional categories. These include complete loss of taste, or ageusia, as reported in 22 studies [ 12 , 14 , 20 , 23 , 35 , 40 − 42 , 44 , 49 , 53 , 55 , 56 , 58 , 63 , 65 , 67 , 70 , 72 , 74 , 85 ], taste alteration or dysfunction, as reported in 19 studies [ 5 , 13 , 16 − 19 , 21 , 22 , 29 , 36 , 38 , 46 , 51 , 54 , 66 , 78 , 84 − 86 ], dysgeusia, as reported in 7 studies [ 24 , 28 , 37 , 50 , 54 , 59 , 60 ], and amblygeustia, as reported in only one study [ 15 ].…”