Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis

Ajith

et al. 2022

Preprint

Introduction & Objectives: The COVID-19 pandemic has been raging across the globe since early January 2020. India has reported over 27 million cases and more than 3, 00,000 deaths. This study was planned to analyze the differences in demographic, clinical features, and oral manifestations of COVID 19 patients hospitalized during the COVID-19 pandemic. Methods: This observational pilot study had a total of 36 participants, 12 each of mild, moderate, and severe RT-PCR positive COVID cases hospitalized during the COVID 19 pandemic. All demographic, clinical features, treatment details, and oral manifestations were noted from the first day of admission to the hospital till treatment completion with a follow-up of a minimum of 7 days. Results: Mean age of the patients was 39.44 years with M: F ratio of 5:4. Most common clinical presentation was fever, shortness of breath, and treatment involved was symptomatic with supplemental oxygen & mechanical ventilation. The most common oral site involved was the tongue & oral lesions observed were herpes labialis, mucositis, burning sensation, dryness of oral cavity, angular cheilitis, aphthous ulcers, geographic tongue, fissuring of the tongue, candidiasis, coated tongue, sublingual varicosity, & scalloped tongue. Interpretation and Conclusion: All demographic, clinical, and oral manifestations were significantly different in mild, moderate, and severe cases of covid hospitalized patients. Though clinical symptoms were improved, oral lesions were worsened. Oral Lesions seen in covid patients were associated with multiple drug therapy for illness along with poor oral hygiene, but further etiology for lesions needs to be evaluated. Sublingual varicosity was observed in our hospitalized covid patients, but a large sample observation is required for confirmation of findings and maybe an early oral feature for covid detection. Prevention is always better than cure, so all patients positive for Covid should have a full mouth examination. Oral health should be a priority during the overall management of COVID patients and dentists should be a part of the Covid management team. Key Words: Oral Lesions, COVID 19, Sublingual varicosity, Candidiasis, Tongue.

Section: Discussionsupporting

confidence: 86%

Comparative evaluation of Oral lesions: “Tale - the Covid 19 Tells”

Ajith

et al. 2022

Preprint

Journal of Oral Microbiology

“…Months following the advance of the pandemic caused by the novel Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), combined with the efforts of health care professionals and researchers, it was rapidly revealed that the mechanism of invasion of human cells by SARS-CoV-2 occurs through interaction with angiotensin-converting enzyme 2 receptors (ACE2) [ 1 ]. ACE2 receptors are found in several human tissues [ 2 ], which explains the extra-pulmonary extension of COVID-19 affecting other organs such as kidneys, brain, heart, gastrointestinal tract and blood vessels [ 3 ]. In the oral cavity, these receptors were also identified in tongue, periodontal tissue and salivary gland ducts [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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

Schwab

Palmieri

Zerbinati

et al. 2022

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.

“…The present study is a narrative literature review that may potentially be biased. Aragoneses et al [12] assessed the risk of bias in prevalence of oral symptoms of COVID-19. In their assessment of prevalence studies, including COVID-19 xerostomia cited in the present study [7,14,16,17], the risk of bias was determined as low or moderate.…”

Section: Resultsmentioning

confidence: 99%

“…However, there have been neither comprehensive studies of saliva secretion disorders in COVID-19 patients nor studies to elucidate the pathogenic mechanisms underlying such symptoms except for recent systematic reviews and meta-analyses of oral manifestations conducted by Aragoneses et al [12] and Amorim dos Asantos et al [13], which included xerostomia in COVID-19 patients. When the author previously reported oral symptoms associated with COVID-19 [4], only a small number of studies were found to deal with changes in saliva secretion of patients infected with SARS-CoV-2.…”

Section: Introductionmentioning

confidence: 99%

Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review

Tsuchiya

2021

Dentistry Journal

Patients with coronavirus disease 2019 (COVID-19) have become known to present with different oral symptoms. However, xerostomia remains poorly recognized compared with taste dysfunction. For better understanding of COVID-19 symptomatology, xerostomia associated withCOVID-19 was characterized and its possible pathogenesis was speculated by a narrative literature review. Scientific articles were retrieved by searching PubMed, LitCovid, ProQuest, Google Scholar, medRxiv and bioRxiv from 1 April 2020 with a cutoff date of 30 September 2021. Results of the literature search indicated that xerostomia is one of prevalent and persistent oral symptoms associated with COVID-19. In contrast to taste dysfunction, the prevalence and persistence of xerostomia do not necessarily depend on ethnicity, age, gender and disease severity of patients. COVID-19 xerostomia is pathogenically related to viral cellular entry-relevant protein expression, renin-angiotensin system disturbance, salivary gland inflammation, zinc deficiency, cranial neuropathy, intercurrent taste dysfunction, comorbidities and medications. Despite a close association with COVID-19, xerostomia, dry mouth and hyposalivation tend to be overlooked unlike ageusia, dysgeusia and hypogeusia. Although mouth dryness per se is not life-threating, it has an impact on the oral health-related quality of life. More attention should be paid to xerostomia in COVID-19 patients and survivors.