Oral lesions in patients with SARS-CoV-2 infection: could the oral cavity be a target organ?

Brandão, Thaís Bianca; Gueiros, Luiz Alcino Monteiro; Melo, Thayanara Silva; Prado‐Ribeiro, Ana Carolina; Nesrallah, Ana Cristina Froelich Alo; Prado, Gladys Villas Boas do; Santos‐Silva, Alan Roger; Migliorati, Cesar A.

doi:10.1016/j.oooo.2020.07.014

Cited by 217 publications

(401 citation statements)

References 16 publications

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“…The documented manifestations of oral mucosa were quite heterogeneous, varying in the kind of lesion and the location. The most frequent findings were ulcerations ( 9 , 50 , 60 – 62 ), sometimes associated with necrotic areas ( 50 , 51 ), aphthous-like lesions ( 51 , 55 , 56 , 58 ), and petechiae ( 51 , 52 , 54 ). Maculae ( 53 , 60 ), blisters ( 10 , 57 ), lingual papillitis or depapillation ( 58 ), and erythema or red plaques ( 52 , 63 ) were also among the described oral lesions.…”

Section: Resultsmentioning

confidence: 99%

“…Tongue ( 9 , 51 , 54 , 55 , 58 – 62 ), lips ( 10 , 50 , 51 , 57 , 59 , 60 , 63 ) and palate ( 52 , 54 , 60 ) were the most frequently described anatomical locations.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, oral mucosa involvement was described during SARS-CoV-2 infection. Since the first description of oral lesions in SARS-CoV-2 positive patients, reported by Martín Carreras-Presas et al ( 10 ), several more recent studies have also reported oral mucosa lesions in COVID-19, such as ulcers ( 50 , 60 – 62 ), aphthae ( 51 , 55 ), and maculae ( 53 , 60 ). The clinical significance of oral mucosa involvement during SARS-CoV-2 infection remains controversial.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

“…Tongue ( 9 , 51 , 54 , 55 , 58 – 62 ), lips ( 10 , 50 , 51 , 57 , 59 , 60 , 63 ) and palate ( 52 , 54 , 60 ) were the most frequently described anatomical locations.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

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

et al. 2021

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“…The spectrum of the oral lesions reported in the literature to be associated with COVID‐19 includes aphthous ulcers and vesicular ulcerations 7 . A report on oral necrotic ulcers and aphthous‐like ulcerations that developed after taste alteration and affected the tongue, lips, palate, and oropharynx was published recently 8 …”

Section: Discussionmentioning

confidence: 99%

Increased odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis

Katz

Yue

2020

J Oral Pathology Medicine

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The ACE2 receptor, the binding sites for the COVID‐19, is expressed abundantly in the oral cavity, raising the question of whether the mouth is a target for the virus in addition to organs such as kidneys and lungs. Recently, a flurry of individual case reports on oral manifestation of COVID‐19 including ulceration, blistering lesions, and stomatitis were published. However, it is not clear whether the oral presentations that are not unique to the virus are indeed related to the virus and appear at a higher prevalence than in the general population. We used the i2b2 platform of hospital patient's registry to determine the odds ratio for COVID‐19 in patients that were diagnosed with recurrent aphthous stomatitis, an entity restricted to the oral cavity. The overall odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis before adjustments was 14 and after adjustment for gender, race, and age was 13.9, 6.5, and 2.93, respectively. The odds ratio remained increased after adjustments of the comorbidities such as respiratory disease, endocrine disease, obesity, diabetes, circulatory disease, and smoking and was 3.66, 7.46, 4.6, 10.54, 7.37, and 7.52, respectively. When adjusted for recurrent aphthous stomatitis, the respiratory disease had an odd ratio of 8.56 to be associated with COVID‐19. African American race and age‐group 18‐34 were additional significant risk factors. The present study has demonstrated a significant association between COVID‐19 and RAS; however, additional longitudinal and laboratory studies are necessary to establish a cause and effect relationship between these 2 conditions.

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“…Recent studies showed that oral manifestations are commonly noticed in about 45% of COVID-19 patients [ 24 , 25 , 26 ]. Salivary glands, tonsils, and tongue are highly sensitive for SARS-CoV-2 infection [ 27 , 28 , 29 ]. The development of infection causes loss of taste, smell, and blisters on the tongue in COVID-19 patients [ 30 , 31 ].…”

Section: Mechanism Of Infection In Oral and Overall Body Healthmentioning

confidence: 99%

SARS-CoV-2 Infection and Oral Health: Therapeutic Opportunities and Challenges

Coke

Davison

Fields

et al. 2021

JCM

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The novel corona virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and the disease it causes, COVID-19 (Coronavirus Disease-2019) have had multi-faceted effects on a number of lives on a global scale both directly and indirectly. A growing body of evidence suggest that COVID-19 patients experience several oral health problems such as dry mouth, mucosal blistering, mouth rash, lip necrosis, and loss of taste and smell. Periodontal disease (PD), a severe inflammatory gum disease, may worsen the symptoms associated with COVID-19. Routine dental and periodontal treatment may help decrease the symptoms of COVID-19. PD is more prevalent among patients experiencing metabolic diseases such as obesity, diabetes mellitus and cardiovascular risk. Studies have shown that these patients are highly susceptible for SARS-CoV-2 infection. Pro-inflammatory cytokines and oxidative stress known to contribute to the development of PD and other metabolic diseases are highly elevated among COVID-19 patients. Periodontal health may help to determine the severity of COVID-19 infection. Accumulating evidence shows that African-Americans (AAs) and vulnerable populations are disproportionately susceptible to PD, metabolic diseases and COVID-19 compared to other ethnicities in the United States. Dentistry and dental healthcare professionals are particularly susceptible to this virus due to the transferability via the oral cavity and the use of aerosol creating instruments that are ubiquitous in this field. In this review, we attempt to provide a comprehensive and updated source of information about SARS-CoV-2/COVID-19 and the various effects it has had on the dental profession and patients visits to dental clinics. Finally, this review is a valuable resource for the management of oral hygiene and reduction of the severity of infection.

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Oral lesions in patients with SARS-CoV-2 infection: could the oral cavity be a target organ?

Cited by 217 publications

References 16 publications

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

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

Increased odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis

SARS-CoV-2 Infection and Oral Health: Therapeutic Opportunities and Challenges

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