Oral mucosal lesions in patients with COVID-19: a systematic review

Abstract

COVID-19 is a new disease which mainly presents with respiratory symptoms, however can present with a multitude of signs and symptoms affecting various body systems. Several oral manifestations related to COVID-19 have also been reported. We carried out a systematic review to explore the types of oral mucosal lesions that have been reported in COVID-19 related literature up to the date of 25th of March 2021. A structured electronic databases search using Medline, Embase and CINAHL as well as gray literature search using Google Scholar revealed a total of 322 studies. After removal of duplicates and the primary and secondary filtering process, 12 studies were included for final appraisal. We have identified several different types of oral mucosal lesions in patients with COVID-19 infection, present at various locations within the oral cavity. Most of the studies appraised in this review were of high risk of bias according to the Joanna Briggs Institute checklist. The current published literature does not allow differentiation as to whether the oral lesions are caused by the viral infection itself or instead related to oral manifestations secondary to existing patient comorbidities or treatment instigated to combat the disease. It is important for healthcare professionals to be aware of the possible link between COVID-19 and oral mucosal lesions, and we hereby discuss our findings.

Oral lesions in paediatric patients with COVID-19 and Paediatric Inflammatory Multisystem Syndrome: a review

“…The studies also identified ‘oral mucosal changes’ in a large number of the study population, however the specific changes were not mentioned and therefore cannot be compared to the rest of the data [ 11 ]. Two of the five studies included in this review were systematic reviews, the first reported on oral lesions in patients with COVID-19 [ 3 ] and the second one reported on PIMS-TS [ 10 ].…”

“…The incidence of oral mucosal lesions in this paper were cheilitis in 32.6% and tongue swelling in 4.7% of the sample. Bhujel et al [ 3 ] reported on oral mucosal lesions in both adult and paediatric patients with SARS-CoV-2 infection. Of the 12 studies appraised in this systematic review, a total of 84 paediatric patients were reported.…”

“…Of the 12 studies appraised in this systematic review, a total of 84 paediatric patients were reported. The most common oral mucosal lesions in the paediatric patients from this systematic review were red or swollen lips reported in 27.3% and unspecified oral cavity changes in 19% [ 3 ].…”

“…Oral manifestations are an important feature and may play a part in the diagnosis and management of the disease. A recent systematic review of the literature highlighted several oral mucosal lesions in SARS-Cov-2 infected patient [ 3 ]. The pathophysiology of oral manifestations of SARS-Cov-2 infection is currently unknown.…”

“…The World Health Organisation (WHO) published the criteria for a diagnosis of PIMS-TS in children and adolescents [ 9 ]. Several case reports and cohort studies suggest that patients can present with oral and facial symptoms before, during and after a diagnosis of PIMS-TS [ 3 ].…”