Oral manifestations of COVID-19 and its management in pediatric patients: A systematic review and practical guideline

Immune Dysregulation in the Oral Cavity during Early SARS-CoV-2 Infection

Tissue-specific immune responses are critical determinants of health-maintaining homeostasis and disease-related dysbiosis. In the context of COVID-19, oral immune responses reflect local host-pathogen dynamics near the site of infection and serve as important "windows to the body," reflecting systemic responses to the invading SARS-CoV-2 virus. This study leveraged multiplex technology to characterize the salivary SARS-CoV-2-specific immunological landscape (37 cytokines/chemokines and 11 antibodies) during early infection. Cytokine/immune profiling was performed on unstimulated cleared whole saliva collected from 227 adult SARS-CoV-2+ participants and 37 controls. Statistical analysis and modeling revealed significant differential abundance of 25 cytokines (16 downregulated, 9 upregulated). Pathway analysis demonstrated early SARS-CoV-2 infection is associated with local suppression of oral type I/III interferon and blunted natural killer-/T-cell responses, reflecting a potential novel immune-evasion strategy enabling infection. This virus-associated immune suppression occurred concomitantly with significant upregulation of proinflammatory pathways including marked increases in the acute phase proteins pentraxin-3 and chitinase-3-like-1. Irrespective of SARS-CoV-2 infection, prior vaccination was associated with increased total α-SARS-CoV-2-spike (trimer), -S1 protein, -RBD, and -nucleocapsid salivary antibodies, highlighting the importance of COVID-19 vaccination in eliciting mucosal responses. Altogether, our findings highlight saliva as a stable and accessible biofluid for monitoring host responses to SARS-CoV-2 over time and suggest that oral-mucosal immune dysregulation is a hallmark of early SARS-CoV-2 infection, with possible implications for viral evasion mechanisms.

The Effect of Coronavirus Disease 2019 and Other Emerging Infections on Dentistry

The appearance of coronavirus disease 2019 (COVID-19) and other emerging infections has significantly impacted the field of dentistry, leading to widespread changes in practices and protocols. This has included the implementation of strict infection control measures, such as meticulous use of personal protective equipment, minimizing aerosol-generating procedures, and the adoption of teledentistry to reduce in-person contact. To date, the complete impact of delays in dental care caused by lockdowns has yet to be determined. The challenges faced during the COVID-19 pandemic have propelled innovation, shaping a new era of dentistry focused on safety against novel and re-emerging infections.

Impact of Fear of COVID-19, Depression, Anxiety and Stress on Temporomandibular Disorders in Peruvian Dental Students in the Post-Pandemic Period: A Multivariable Regression Analysis

Background: Dentists, who frequently encounter potentially infected patients, have experienced significant changes worldwide due to the COVID-19 pandemic. The aim of this study was to evaluate the impact of the fear of COVID-19, depression, anxiety and stress on the presence of temporomandibular disorders (TMD), taking into account possible confounding variables, in Peruvian dental students during the post-pandemic period. Methods: This analytical cross-sectional study assessed 607 Peruvian dental students from two regions of Peru. The study utilized the Depression Anxiety Stress Scales-21 (DASS-21), the Fear of COVID-19 Scale (FCV-19S) and the Short Form of the Fonseca Anamnestic Index (SFAI). Possible confounding variables were sex, age, year of study, marital status, place of origin, area of residence, history of mental illness and living with people vulnerable to COVID-19. For the multivariable analysis, we utilized a Poisson regression model with an adjusted robust variance. The significance level was set at p < 0.05. Results: The rates of depression, anxiety, stress, fear of COVID-19 and temporomandibular disorders were 47.0%, 50.4%, 35.9%, 30.6% and 54.2%, respectively. Moreover, the study revealed that students with depression and anxiety were 38% and 75% more likely to have temporomandibular disorders compared to those without depression (APR = 1.38, 95% CI: 1.15-1.66) and anxiety (APR = 1.75, 95% CI: 1.44-2.13), respectively. Similarly, the likelihood of presenting temporomandibular disorders was 55% higher in women than in men (APR = 1.55, 95% CI: 1.28-1.87). Furthermore, we found that stress and fear of COVID-19 did not determine the development of temporomandibular disorders (p > 0.05). Conclusions: Almost half of the dental students experienced depression, anxiety and TMD in the post-pandemic period. In addition, depression and anxiety were influential factors in the occurrence of TMDs, with the female gender being a risk factor. However, factors such as fear of COVID-19, stress, age, year of study, marital status, place of origin, area of residence, history of mental illness or living with people vulnerable to COVID-19 were not significant.

General and orofacial symptoms associated with acute and long COVID in 80- and 90-year-old Swedish COVID-19 survivors

OBJECTIVES

To describe acute and long COVID-19 symptoms among older elderly Swedes and to find predictive factors for the development symptoms associated with acute and long COVID.

MATERIAL AND METHODS

A questionnaire about general and oral health was mailed to all 80-year-olds (born 1942, n = 6299) and 90-year-olds (born 1932, n = 1904) in two Swedish counties. Participants reporting COVID-19 were asked to complete an additional questionnaire.

RESULTS

Overall response rate was 66 % (n = 5375). Affirmative responses to having been sick/tested positive for COVID-19 were reported by 577 persons. Response rate to the COVID-19 questionnaire was 49 %. The majority (88 %) reported some general symptoms during the acute stage while 44 % reported orofacial symptom/s. Reporting of any form of long-COVID general symptoms was 37 and 35 % for orofacial symptoms. Predictive factors for contracting COVID-19 (based on self-report from 2017) were living in elderly housing/senior care facility (OR 1.6, CI 1.0-2.3), large number (>10) of weekly social contacts (OR 1.5, CI 1.3-1.9), being married (OR 1.4, CI 1.1-1.7) and high school/university education (OR 1.3 CI 1.1-1-6). The highest odds ratio for general symptoms of long-COVID were a single complete denture (OR 5.0, CI 2.0-12.3), reporting bad breath (OR 3.7, CI 1.9-7.2) and daytime dry mouth (OR 2.2, CI 1.1-4.2). Regarding long-COVID orofacial symptoms, the highest risk factors were bad breath (OR 3.8, CI 1.9-7.5) and a single complete denture in one jaw (OR 3.4, CI 1.2-9.8).

CONCLUSION

Long-COVID general and orofacial symptoms are common among older elderly COVID-19 survivors CLINICAL SIGNIFICANCE: Oral microorganisms may be responsible for development of long-COVID symptoms. Health personnel managing COVID-19 patients should carefully examine dental status, especially in those having acrylic-based removable dentures, for oral signs and symptoms. If found, rigorous oral hygiene procedures should be carried out including cleaning/disinfection of the denture.

Awareness of undergraduate dental students, interns, and freshly graduated dentists about oral manifestation associated with COVID-19

OBJECTIVE

There is growing evidence supporting the presence of oral manifestations associated with COVID-19. The study investigates the knowledge of dental undergraduates and recently graduated dentists concerning oral presentations related to COVID-19.

METHODS

A cross-sectional descriptive study in Saudi Arabia comprised 305 individuals, including undergraduate dental students, interns, and freshly graduated dentists. Data were collected using a questionnaire disseminated to approximately 500 subjects via WhatsApp groups and other applications. The questionnaire was tested in a pilot study for validity, edited, and validated by 2 supervisors at the College of Dentistry, Qassim University, Buraydah, Saudi Arabia. The questionnaire consisted of questions regarding sociodemographic attributes, the level of expertise of dental practitioners, and their knowledge and perspectives regarding COVID-19 and the implementation of oral lesions interrelated to it. The data was subjected to analysis through the utilization of descriptive statistics and chi-square tests, employing the statistical software SPSS (version 24).

RESULTS

About 43.9% of subjects stated that COVID-19 causes oral symptoms. Respondents most frequently reported COVID-19-related dry mouth. Oral ulcers, Candida infection, Hyperpigmentation, tongue coating, atrophy, Petechiae, Herpes, white lesions, Gingivitis, and Periodontitis are further symptoms. COVID-19's oral manifestation was unknown to 41.0% of subjects, and 37.7% of respondents lacked knowledge regarding the most impacted locations of oral manifestations. Oral signs and COVID-19 symptoms are debated and significantly associated with higher educational levels.

CONCLUSION

The dental students and freshly graduated dentists in this study have proper knowledge of COVID-19 and its symptoms. Also, most dental students and newly graduated dentists recognize the potential correlation between COVID-19 and oral manifestations with an average to excellent knowledge of the types and sites commonly affected. The level of awareness was associated with higher educational levels.

Juvenile Recurrent Parotitis: Video-Documented Sialendoscopy

Juvenile recurrent parotitis (JRP) is characterised by recurrent episodes of painful parotid swelling in children. JRP is the second most common cause of parotitis in childhood, behind only paramyxovirus. The prevention of recurrent attacks represents the most dramatic and serious aspect of this pathology. Since 2004, different authors have evaluated sialendoscopy for the diagnostic and therapeutic management of JRP. In this paper, we share our clinical experience of the use of sialendoscopy for the treatment of JRP. We document with video sialendoscopy the glandular pathology in four children with a mean age of 11.5 years, who had suffered from 3-6 episodes/year of inflammation prior to treatment. The use of sialendoscopy in our patients was effective in preventing recurrences. For the first time, the videosialendoscopy of a series of children diagnosed with JRP is documented in the literature.