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Rapp L, Gémar T, Lacoste-Ferré MH. Oral ulcer in SARS-CoV-2 infection: a case report. AME Case Rep 2024; 8:40. [PMID: 38711897 PMCID: PMC11071011 DOI: 10.21037/acr-23-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 05/08/2024]
Abstract
Background The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019 caused the global pandemic. Oral and dermatological manifestations of coronavirus disease 2019 (COVID-19) such as xerostomia, aphthous-like lesions, ulcers, tongue depapillation, necrotizing gingivitis, and taste disorders, including the loss of taste and salivary gland infections are being reported. This study aims to describe a case of oral ulcers following COVID-19 infection. Case Description We present the case of a 95-year-old male patient hospitalized in follow-up care and rehabilitation unit, of Minimes Geriatric Clinic, Toulouse, France. He had an alteration in his general health in the context of COVID-19 infection detected by reverse transcription polymerase chain reaction (RT-PCR). Six days after the admission, the patient complained of a strong burning sensation of the mouth, especially on the tongue and the lips' mucosa. Intraoral examination revealed painful erosive areas on the lateral edges of the tongue and the mucous side of the lower lip. The proposed treatment to reduce the burning sensation was based on general analgesics (morphine sulfate), mouthwash with sodium bicarbonate, the application of a lidocaine-based oral anesthetic and healing gel and a comfort-oriented diet. Thirteen days later, the patient reported a gradual improvement. Conclusions A diverse range of oral manifestations has been observed in patients with a history of COVID-19 infection. These oral ulcers significantly impact the quality of life of the individual, causing intense pain, stress, and difficulties in eating, with repercussions on nutritional status, especially in older individuals. Our case underscores the importance of oral examinations and the role of dentists in the management of patients with SARS-CoV-2.
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Affiliation(s)
- Lucie Rapp
- Dental Faculty and Hospital of Toulouse – Toulouse Institute of Oral Medicine and Science, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- CERPOP, UMR1295 (Maintain Aging Research Team), Université P. Sabatier, Toulouse, France
- Cancer Ageing and Rejuvenation (CARe) Graduate School, Toulouse, France
- Department of Geriatric Medicine, Clinique des Minimes, Toulouse, France
| | - Thomas Gémar
- Department of Geriatric Medicine, Clinique des Minimes, Toulouse, France
- Department of Geriatric Medicine, CHU Toulouse Purpan, Toulouse, France
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2
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Kot WY, Li JW, Chan AKY, Zheng LW. A reflection on COVID-19 and oral mucosal lesion: a systematic review. FRONTIERS IN ORAL HEALTH 2023; 4:1322458. [PMID: 38169876 PMCID: PMC10759230 DOI: 10.3389/froh.2023.1322458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The aim of this systematic review is to provide a clinical update of the current knowledge on COVID-19 and oral mucosal lesions, to analyze the types and prevalence of oral mucosal lesions in patients with COVID-19, and to clarify the potential association between COVID-19 and oral mucosal lesions. Methods The literature search was conducted using PubMed, Web of Science, Scopus and the Cochrane Library, as well as literatures via manual searches of the reference lists of included studies. Studies published in English that mentioned oral mucosal lesions in patients with COVID-19 were included, resulting in a total of 31 studies. Results Most of the included studies were considered to have a moderate to high risk of bias according to the Joanna Briggs Institute bias assessment tools. Based on COVID-19 severity, the characteristics and patterns of oral mucosal lesions in COVID-19 patients were described, analyzed and synthesized. Overall, ulcers without specific diagnosis had the highest prevalence in COVID-19 patients, followed by traumatic ulcers, candidiasis, petechiae and aphthous-like lesions. Homogeneity of data cannot be achieved in statical analysis, indicating randomness of outcome (ulcers without specific diagnosis, 95% CI: 28%-96%, I2 = 98.7%). Discussion Given the limited evidence from currently available studies, the association between COVID-19 and oral mucosal lesions remains difficult to clarify. Healthcare professionals should be aware of the possible association between COVID-19 and oral mucosal lesions, and we hereby discuss our findings.
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Affiliation(s)
- Wai Ying Kot
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jing Wen Li
- Division of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Alice Kit Ying Chan
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Li Wu Zheng
- Division of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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3
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Alhamed S, Aljohani S. Oral manifestations in hospital-admitted COVID-19 patients: a case control study. FRONTIERS IN ORAL HEALTH 2023; 4:1180017. [PMID: 37636481 PMCID: PMC10448403 DOI: 10.3389/froh.2023.1180017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
The oral cavity can present early manifestations of several systemic diseases. Since the emergence of the COVID-19 pandemic, there have been many published studies reporting the direct effect of the virus on orofacial structures. In the present study, oral signs and symptoms of 22 hospital-admitted COVID-19 patients were examined and compared to a matching control group. Loss of taste and smell was the most prevalent symptom (65%), followed by oral dryness (45%) and halitosis (30%). The most common oral lesions were candidal infections (68%). Other less common manifestations were oral ulcerations (36%) followed by the appearance of white patches (27.3%). There was a statistically significant association between candidal infection and age in the study group, where the p-value was 0.008. In the present study, 80% of those who had candida infections were aged 60 years or above. There was no significant association with comorbidities such as diabetes mellitus and hypertension.
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4
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Aldahlawi SA, Homeida L. YouTube as a Source of Patient Information on Oral Manifestations of COVID-19: A Cross-Sectional Evaluation of Its Utility, Dependability, and Content. Cureus 2023; 15:e42885. [PMID: 37664281 PMCID: PMC10474609 DOI: 10.7759/cureus.42885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives This study aims to assess the quality of the most viewed videos on the YouTube website describing the oral manifestations of COVID-19 and appraise the medical information in the content. Materials and methods The top 200 most-viewed videos on YouTube using the keywords "COVID-19 oral manifestation," "oral symptoms of COVID-19," "oral lesions of COVID-19," "coronavirus and oral findings," and "dental manifestation of COVID-19" were analyzed. Two independent reviewers classified the English-language videos as useful, misleading, or personal views and identified the source of the videos. Reliability was calculated on a 5-point scale adapted from the DISCERN tool. The global quality scale (GQS) was used to determine the quality of the videos. In addition, the completeness of the information regarding the clinical presentation, pathogenesis, diagnostic tests, and treatment of COVID-19 oral manifestations was evaluated. Results After excluding non-English and irrelevant videos, 55 videos were analyzed. Thirty-two videos were classified as useful. Independent users uploaded the most videos (19, 51%). The mean reliability and GQS scores for useful videos were (3.24+1.4) and (2+0.75), respectively. The GQS score was significantly related to the reliability score (p<0.01). Videos scoring high in GQS also show high-reliability scores. In addition, videos with high GQS scores showed more comprehensive content, scoring >9 in the content aspect. The COVID tongue was the most discussed topic, followed by oral ulcers and oral mucormycosis. Conclusions Most of the YouTube videos were useful and had moderate quality. However, they show low reliability and lack comprehensive medical information on the topic. Healthcare providers should play a more active role in the educational information given on social media (SM) during global disease outbreaks.
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Affiliation(s)
- Salwa A Aldahlawi
- Department of Basic and Clinical Oral Sciences, Umm Al-Qura University, Makkah, SAU
| | - Lujain Homeida
- Department of Basic and Clinical Oral Sciences, Umm Al-Qura University, Makkah, SAU
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5
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Sarasati A, Agustina D, Surboyo MDC. The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not? Infect Drug Resist 2023; 16:4357-4385. [PMID: 37424667 PMCID: PMC10329433 DOI: 10.2147/idr.s411615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Many previously reported publications mentioned that oral lesion in COVID-19 patients was varied. The term oral manifestations refer to pathognomonic features that are found consistently with a specific cause and effect. In this context, the oral manifestation of COVID-19 was inconclusive. This systematic review aimed to analyse previously reported publications related to oral lesions in COVID-19 patients to define as oral manifestations or not. The PRISMA guidelines were implemented in this review. Methods All umbrella reviews, systematic reviews, systematic reviews and meta-analyses, comprehensive reviews, and original and non-original studies were included. Twenty-one of systematic review, 32 original studies and 68 non-original studies reported the oral lesion in COVID-19 patients. Results Most of the publications mentioned that ulcers, macular, pseudomembranes and crusts were frequent oral lesions. The reported oral lesions in COVID-19 patients did not show any pathognomonic features and might be unrelated directly to COVID-19 infections, however, more likely due to gender, age, underlying diseases, and medication. Conclusion The oral lesions found in previous studies do not have pathognomonic features and are inconsistent. Therefore, the reported oral lesion, in present time, cannot be defined as an oral manifestation.
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Affiliation(s)
- Andari Sarasati
- Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Dewi Agustina
- Department of Oral Medicine, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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6
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Lin W, Gao F, Wang X, Qin N, Chen X, Tam KY, Zhang C, Zhang M, Sha O. The oral manifestations and related mechanisms of COVID-19 caused by SARS-CoV-2 infection. Front Cell Neurosci 2023; 16:1006977. [PMID: 36687524 PMCID: PMC9846147 DOI: 10.3389/fncel.2022.1006977] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was reported to be associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, and patients present mostly with respiratory symptoms. There have been an increasing number of reports on oral manifestations, and some of these signs are informative in terms of identifying SARS-CoV-2 infection. The goal of present study was to review and synthesize the clinical characteristics and underlying mechanisms of COVID-19 oral manifestations, as well as to evaluate the factors influencing SARS-CoV-2 infectivity, in order to conduct further in-depth investigations and help clinicians diagnose COVID-19 patients exhibiting oral symptoms.
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Affiliation(s)
- Weiming Lin
- Shenzhen University Medical School, Shenzhen, China
| | - Feng Gao
- School of Dentistry, Shenzhen University Medical School, Shenzhen, China
| | - Xia Wang
- Shenzhen University Medical School, Shenzhen, China
| | - Nianhong Qin
- Shenzhen University Medical School, Shenzhen, China
| | - Xianxiong Chen
- School of Dentistry, Shenzhen University Medical School, Shenzhen, China
| | - Kin Yip Tam
- Faculty of Health Sciences, University of Macau, Macau, Macau SAR, China
| | - Chengfei Zhang
- Shenzhen University Medical School, Shenzhen, China,School of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mingxia Zhang
- The Third People’s Hospital of Shenzhen, Shenzhen, China,Mingxia Zhang,
| | - Ou Sha
- School of Dentistry, Shenzhen University Medical School, Shenzhen, China,*Correspondence: Ou Sha,
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7
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Brahim Belhaouari D, Baudoin JP, Lagier JC, Monnet-Corti V, La Scola B, Antezack A. Microscopic observations of SARS-CoV-2 like particles in different oral samples. Eur J Oral Sci 2022; 130:e12903. [PMID: 36404273 PMCID: PMC10099536 DOI: 10.1111/eos.12903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/21/2022] [Indexed: 11/22/2022]
Abstract
The emerging coronavirus pneumonia epidemic caused by the SARS-CoV-2 infection has spread rapidly around the world. The main routes of transmission of SARS-CoV-2 are currently recognised as aerosol/droplet inhalation. However, the involvement of the oral cavity in coronavirus disease 2019 (COVID-19) is poorly known. The current data indicates the presence of viral RNA in oral samples, suggesting the implication of saliva in SARS-CoV-2 transmission, however, no direct observation of SARS-CoV-2 particles in different oral samples has been reported. In this study, we investigated whether particles of SARS-CoV-2 were present in oral samples collected from three symptomatic COVID-19 patients. Using scanning electron microscopy (SEM), the correlative strategy of light microscopy and electron microscopy and immunofluorescence staining, we showed the presence of SARS-like particles in RT-qPCR SARS-CoV-2-positive saliva, dental plaque and gingival crevicular fluid (GCF) samples. In the saliva samples, we demonstrated the presence of epithelial oral cells with morphogenetic features of SARS-CoV-2 infected cells. Inside those cells, vacuoles filled with nascent particles were observed, suggesting the potential infection and replication of SARS-CoV-2 in oral tissues. Our results corroborate previous studies and confirm that the oral cavity may be a potential niche for SARS-CoV-2 infection and a potential source of transmission.
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Affiliation(s)
- Djamal Brahim Belhaouari
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Department of Veterinary Pathobiology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jean-Pierre Baudoin
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France
| | - Jean-Christophe Lagier
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France
| | - Virginie Monnet-Corti
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France.,Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix Marseille Univ, Marseille, France
| | - Bernard La Scola
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France
| | - Angéline Antezack
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France.,Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix Marseille Univ, Marseille, France
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8
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Gebretsadik HG. An update on oral clinical courses among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: A clinical follow-up (a prospective prevalent cohort) study. PLoS One 2022; 17:e0275817. [PMID: 36269692 PMCID: PMC9586351 DOI: 10.1371/journal.pone.0275817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Contemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations. MATERIALS AND METHODS A prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted toat the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study consisted of two follow-up phases: Hospital and patient-home-based. RESULTS A total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n = 10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n = 6), xerostomia (n = 5), and thickening of saliva (n = 1). The oral mucosal lesions per se consisted of aphthous lesions (n = 3), candidiasis (n = 1), geographic tongue (n = 1), and localized gingivitis (n = 1). The four weeks' home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n = 10) to 29% (n = 16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up. DISCUSSION The study's findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.
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9
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Chaughtai S, Chaughtai Z, Asif A. Conservative treatment with mouthwashes followed by tongue photo biomodulation therapy in Covid-19: a case report. J Med Case Rep 2022; 16:367. [PMID: 36203211 PMCID: PMC9535946 DOI: 10.1186/s13256-022-03519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Oral manifestations of coronavirus disease 2019 (COVID-19), including ulcers, herpetiform lesions, macules, and petechiae, among others, are becoming increasingly recognized, but there is little guidance on their treatment. Reported cases have described treatment with various mouthwashes containing antivirals, antifungals, antibiotics, anesthetics, or steroids. Our case report is unique in that we provide guidance on the judicious use of these medications, followed by photobiomodulation therapy if the manifestations are treatment resistant. Case presentation We describe a 30-year-old Caucasian woman who tested positive for COVID-19 after developing nasal congestion and cough. Ten days after testing positive, she developed a systemic rash on her extremities and torso. At the same time, she developed swelling of the tongue lasting 1 hour, with subsequent appearance of oral lesions that resembled geographic tongue. She also had an irritable sensation on her tongue and some mild loss of sense of taste. We opted for conservative therapy, including mouth rinses containing lidocaine to be used every 6 hours. The patient used the mouth rinse therapy for 1 month and experienced a 90% improvement in her oral lesions and tongue sensitivity. However, she had repeated flares every 3 weeks over a 6-month period, and the steroid mouthwash achieved incomplete resolution. After three sessions of photobiomodulation therapy, she had no further flares or tongue sensitivity and the lesions healed. Conclusions The implication of our report is that we promote the judicious use of topical antibiotics, antivirals, antifungals, and steroids for when they are indicated. We propose lidocaine-containing mouth rinses and steroid mouthwash as an initial, symptomatic treatment regimen for ‘COVID-19 tongue.’ If there is failure of resolution, we recommend photobiomodulation therapy.
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Affiliation(s)
- Saira Chaughtai
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center-Hackensack-Meridian School of Medicine, Neptune, NJ, 07753, USA.
| | - Zeeshan Chaughtai
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center-Hackensack-Meridian School of Medicine, Neptune, NJ, 07753, USA
| | - Arif Asif
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center-Hackensack-Meridian School of Medicine, Neptune, NJ, 07753, USA
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10
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Oral mucosa lesions in confirmed and non-vaccinated cases for COVID-19: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e241-e250. [PMID: 35550190 PMCID: PMC9085350 DOI: 10.1016/j.jormas.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 12/23/2022]
Abstract
This systematic review purposed to investigate reports of oral lesions in confirmed COVID-19 patients summarizing clinical characteristics, histological findings, treatment and correlation of oral lesions and COVID-19 severity. Electronic search was conducted on November 2021 using seven databases to identify case reports/series describing lesions in oral mucosa in COVID-19 confirmed cases. A total of 5,179 studies were found, being 39 eligible from 19 countries, totalling 116 cases. It was observed only COVID-19 non-vaccinated cases and no sex or age predilection. The oral lesions presentation was mostly single location (69.8%), commonly in the tongue, lips, and palate, being ulcer the main clinical presentation. According to severity index for COVID-19, the reports were more frequent in patients with mild and moderate symptoms, being 75.8% in acute phase. The oral lesion appearance in post-acute COVID-19 were described after 14 to two months after patient recovery. Histologically, keratinocytes with perinuclear vacuolization, thrombosis and mononuclear inflammatory infiltrate were also described with the presence of the virus in keratinocytes, endothelial cells, and minor salivary glands. In conclusion, health care professionals should consider COVID-19 association when patient present ulcerated oral lesions and mild to moderate symptoms for COVID-19 or had acute-COVID-19.
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11
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Trukhan DI, Sulimov AF, Trukhan LY. Changes in the organs and tissues of the oral cavity in the new coronavirus infection (COVID-19): A review. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.5.201755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
SARS-CoV-2 infection can cause changes in the organs and tissues of the oral cavity, which is associated with a wide distribution of angiotensin-converting enzyme type 2 in the oral cavity, mainly epithelial cells of the oral mucosa, gums and fibroblasts of the periodontal ligament. Thus, the oral mucosa is susceptible to SARS-CoV-2 infection and may act as a gateway for the virus, as well as a reservoir for SARS-CoV-2. We searched the literature for the period from the beginning of the pandemic until May 30, 2022, devoted to the study of changes in the organs and tissues of the oral cavity with a new coronavirus infection (COVID-19) in the electronic search engines PubMed/MEDLINE and Scopus. A special place in the study of changes in the organs and tissues of the oral cavity with a new coronavirus infection (COVID-19) is occupied by periodontal pathology. A number of reviews and clinical studies conclude the importance of good oral hygiene and periodontal health as an important aspect of COVID-19 prevention and management. Oral probiotics can be considered as a promising direction for correcting changes in organs and tissues of the oral cavity in COVID-19.
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12
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Pedrazini MC, da Silva MH, Groppo FC. L-lysine: its antagonism with L-arginine in controlling viral infection. Narrative Literature Review. Br J Clin Pharmacol 2022; 88:4708-4723. [PMID: 35723628 DOI: 10.1111/bcp.15444] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
Knowledge about viral characteristics, mechanisms of entry into the host cell and multiplication/dissemination can help in the control and treatment of viral pathologies. Several nutritional factors linked to the host may favor viral multiplication and their control, may lead to new prophylactic alternatives and/or antiviral therapies. The objective of this review is to discuss the relationship between the amino acid L-lysine and the control of viral infections, aiming at a possible therapeutic property. This research used databases such as PubMed, Web of Science, Scielo, Medline and Google Scholar, as well as searching for references cited by journals. The time frame covered the period between 1964 and January 2022. The observed studies have shown that the usual antiviral therapies are not able to interfere with the viruses in their latent state, however, they can interfere with the adhesion and fusion of viral particles or the production of proteins, which play an important role in viral epidemiology and control, particularly in the initial moment and in the reactivation. Lysine is an amino acid that can interfere mainly in the formation of capsid proteins and DNA by a competitive antagonism with amino acid arginine, which is an essential amino acid for some viruses and also by promoting the increase of arginase, increasing the catabolism of arginine. Although there is evidence of the importance of L-lysine in viral control, more studies are needed, with a view to new antiviral therapies.
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Affiliation(s)
- Maria Cristina Pedrazini
- Department of Biosciences, Piracicaba Dental School, FOP, UNICAMP, Campinas, São Paulo State, Brazil.,Department of Dental Sciences, São Leopoldo Mandic Research Center Campinas, São Paulo State, Brazil
| | - Mariliza Henrique da Silva
- Department of Infectology Diagnosis, IST/AIDS State Program, ITD/AIDS Reference and Training Center, São Paulo, São Paulo State, Brazil
| | - Francisco Carlos Groppo
- Department of Biosciences, Piracicaba Dental School, FOP, UNICAMP, Campinas, São Paulo State, Brazil
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13
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Palaia G, Pernice E, Pergolini D, Impellizzeri A, Migliau G, Gambarini G, Romeo U, Polimeni A. Erythema Multiforme as Early Manifestation of COVID-19: A Case Report. Pathogens 2022; 11:pathogens11060654. [PMID: 35745508 PMCID: PMC9229542 DOI: 10.3390/pathogens11060654] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a viral infection involving multi-organ manifestations. The main oral symptoms of COVID-19 associated are taste loss and xerostomia, but literature has reported other oral manifestation, such as oral blisters, ulcers, vesicles and other immunological lesions. This case report showed an Erythema Multiforme (EM) manifesting as oral mucosa lesions in a patient with a late diagnosis of COVID-19 infection. Case Presentation: A 30 years-old Caucasian woman was sent to an oral medicine office, in order to manage painful and oral mucosa lesions associated with target symmetrical skin lesions. Oral examination revealed extensive ulcers in the mouth and crusts on the lips. Based on clinical examinations, a diagnosis of Erythema Multiforme major was made and a drug therapy with steroids was administered. Five days after the specialist visit, the patient discovered that she was positive for COVID-19. The complete recovery occurred in 3 weeks. Conclusion: Confirming the literature studies, EM is an early disease associated with COVID-19 infection.
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14
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Petruzzi M, Galleggiante S, Messina S, Della Vella F. Oral erythema multiforme after Pfizer-BioNTech COVID-19 vaccination: a report of four cases. BMC Oral Health 2022; 22:90. [PMID: 35331228 PMCID: PMC8943505 DOI: 10.1186/s12903-022-02124-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/16/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The 2019 Coronavirus disease (Covid-19) has affected thousands of people worldwide. To date, vaccines appear to be the only method to prevent and reduce mortality. Four vaccinations have been outwardly approved by European Medicine Agency (EMA) in Europe: BNT162b2 (Comirnaty-BioNTech/Pfizer), mRNA-1273 (Spikevax-Moderna), ChAdOx1 (VaxzevriaAstrazeneca), and Ad26.COV2-S (Janssen-Johnson&Johnson). After vaccination, local and systemic adverse effects can occur. Cutaneous reactions like urticaria, local injection site pain, morbilliform rash have been documented after vaccination. CASES PRESENTATION We report four cases of oral erythema multiforme flare arising after BNT162b2 vaccination administration. All the patients denied previous erythema-like and herpetic manifestations history. Two of the reported cases (number 1 and 2) presented with both oral and cutaneous lesions, while cases 3 and 4 showed only oral manifestations. Three of the cases presented the erythema after the first vaccination dosage administration, only one case reported lesions after the second vaccination dosage administration. All the cases were treated with prednisone via oral administration and topical 0.05% clobetasol ointment. CONCLUSIONS The present reports represent some of the few cases of erythema multiforme occurring as a side effect of the BNT162b2 COVID-19 vaccination. The causal role of the vaccine for the erythema multiforme has not been proven yet; nevertheless, it is not uncommon for medications to trigger this disease. The vaccine could surface a silent herpes virus infection, which would induce the erythema multiforme instead.
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Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy.,Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Sara Galleggiante
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Sabrina Messina
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy.
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15
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Boyapati R, Duddukuri H, Dhulipalla R, Kolaparthy L, Polepalle T, Katuri KK. Perceptions and Preparedness of Dental Professionals toward COVID-19-Related Oral Manifestations in India. Indian J Community Med 2022; 47:39-44. [PMID: 35368498 PMCID: PMC8971885 DOI: 10.4103/ijcm.ijcm_704_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/29/2021] [Indexed: 11/09/2022] Open
Abstract
Background: With the reports of oral manifestations observed in coronavirus disease 2019 (COVID-19) patients snowballing day-by-day, it calls for the attention of dental professionals to keep themselves updated regarding these manifestations and how to prevent and manage them in COVID-infected patients. Aims and Objectives: The aim of this study is to assess the perceptions and preparedness of dental professionals in India toward the COVID-19-related oral manifestations. Materials and Methods: A cross-sectional, web-based survey was conducted on dental professionals using a pretested and validated questionnaire. Six hundred and twenty-three responses obtained from January 23, 2021 to February 15, 2021 were included in the study. Results: Mean knowledge scores regarding COVID-19-related oral manifestations were noted to be significantly high among males (13.5 ± 4.9), having a PhD (18.3 ± 5.8), belonging to the specialty of oral medicine and radiology (15.6 ± 4.7), with more than 15 years of clinical experience (15.4 ± 4.7) and practicing in metropolitan areas (13.7 ± 5.03). Tele-consultation and advising palliative care (65.5%) were the most preferred ways of managing COVID-19-related oral manifestations. Ninety-one percentage of the participants felt that inclusion of dentists in the intensive care unit multiprofessional teams, would contribute toward early diagnosis and management of oral manifestations. Conclusion: Study noted lower knowledge scores pertaining to COVID-19-related oral manifestations among BDS graduates with <5 years of clinical experience calling for the implementation of continuing dental education on the oral manifestations occurring in COVID-19 patients.
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Affiliation(s)
- Ramanarayana Boyapati
- Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India
| | - Hema Duddukuri
- Department of Periodontics, Mamata Dental College, Khammam, Telangana, India
| | - Ravindranath Dhulipalla
- Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India
| | - Lakshmikanth Kolaparthy
- Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India
| | - Tejaswin Polepalle
- Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India
| | - Kishore Kumar Katuri
- Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India
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16
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Tsuchiya H. Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review. Dent J (Basel) 2021; 9:dj9110130. [PMID: 34821594 PMCID: PMC8625834 DOI: 10.3390/dj9110130] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
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.
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17
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Chetboul V, Foulex P, Kartout K, Klein AM, Sailleau C, Dumarest M, Delaplace M, Gouilh MA, Mortier J, Le Poder S. Myocarditis and Subclinical-Like Infection Associated With SARS-CoV-2 in Two Cats Living in the Same Household in France: A Case Report With Literature Review. Front Vet Sci 2021; 8:748869. [PMID: 34746286 PMCID: PMC8566889 DOI: 10.3389/fvets.2021.748869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
This report provides the first clinical, radiographic, echocardiographic, and biological description of SARS-CoV-2-associated myocarditis with a 6-month follow-up in a 5-year-old obese male domestic shorthair cat (Cat-1) presented for refractory congestive heart failure, with high cardiac troponin-I level (5.24 ng/ml), and a large lingual ulcer. The animal was SARS-CoV-2 positive on serology. The other cat living in the same household (Cat-2) never showed any clinical sign but was also confirmed SARS-CoV-2 positive on serology. Both cats were SARS-CoV-2 PCR negative. Cat-1 had closer contact than Cat-2 with their owner, who had been in close contact with a coworker tested PCR positive for COVID-19 (Alpha (B.1.1.7) variant) 4 weeks before Cat-1's first episode of congestive heart failure. A focused point-of-care echocardiography at presentation revealed for Cat-1 numerous B-lines, pleural effusion, severe left atrial dilation and dysfunction, and hypertrophic cardiomyopathy phenotype associated with focal pulmonary consolidations. Both myocarditis and pneumonia were suspected, leading to the prescription of cardiac medications and antibiotics. One month later, Cat-1 recovered, with normalization of left atrial size and function, and radiographic and echocardiography disappearance of heart failure signs and pulmonary lesions. An extensive literature review of SARS-CoV-2-related cardiac injury in pets in comparison with human pathology is discussed.
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Affiliation(s)
- Valérie Chetboul
- École Nationale Vétérinaire d'Alfort, CHUVA, Unité de Cardiologie d'Alfort (UCA), Maisons-Alfort, France.,Université Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Pierre Foulex
- École Nationale Vétérinaire d'Alfort, CHUVA, Unité de Cardiologie d'Alfort (UCA), Maisons-Alfort, France
| | - Kahina Kartout
- École Nationale Vétérinaire d'Alfort, CHUVA, Unité de Cardiologie d'Alfort (UCA), Maisons-Alfort, France
| | | | - Corinne Sailleau
- École Nationale Vétérinaire d'Alfort, UMR VIROLOGIE, INRAE, ANSES, Laboratoire de santé animale, Université Paris-Est, Maisons-Alfort, France
| | - Marine Dumarest
- École Nationale Vétérinaire d'Alfort, UMR VIROLOGIE, INRAE, ANSES, Laboratoire de santé animale, Université Paris-Est, Maisons-Alfort, France
| | - Manon Delaplace
- École Nationale Vétérinaire d'Alfort, UMR VIROLOGIE, INRAE, ANSES, Laboratoire de santé animale, Université Paris-Est, Maisons-Alfort, France
| | - Meriadeg Ar Gouilh
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN, 13 UNIROUEN, Caen, France
| | - Jeremy Mortier
- École Nationale Vétérinaire d'Alfort, CHUVA, Service d'Imagerie Médicale, Maisons-Alfort, France
| | - Sophie Le Poder
- École Nationale Vétérinaire d'Alfort, UMR VIROLOGIE, INRAE, ANSES, Laboratoire de santé animale, Université Paris-Est, Maisons-Alfort, France
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18
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Aragoneses J, Suárez A, Algar J, Rodríguez C, López-Valverde N, Aragoneses JM. Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis. Front Med (Lausanne) 2021; 8:726753. [PMID: 34513886 PMCID: PMC8424005 DOI: 10.3389/fmed.2021.726753] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
There is increasing evidence for oral lesions and manifestations of COVID-19. The aim of this meta-analysis was to investigate the types of oral manifestations of COVID-19 and their prevalence. PubMed/Medline, Scopus, Web of Science, and Google Scholar databases were used to search for publications on oral manifestations in patients with PCR-confirmed COVID-19. A total of 310 records were selected, and 74 were included. Oral lesions in COVID-19 were classified according to their etiologies, including iatrogenic lesions caused by intubation and opportunistic infections. Of the included studies, 35 reported oral lesions probably caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection. Meta-analysis of prevalence data on oral manifestations and aphthous lesions indicated high heterogeneity, while meta-analysis of xerostomia prevalence data revealed a pooled prevalence, with considerable heterogeneity. In conclusion, the meta-analysis yielded high heterogeneity between studies: oral lesions yielded a prevalence of 0.33 (95% CI 0.11-0.60), xerostomia lesions a prevalence of 0.44 (95% CI 0.36-0.52) and aphthous lesions 0.10 (95% CI 0.01-0.24). In addition, a gap in the evidence regarding the prevalence of oral lesions in COVID-19 was identified and the need for further observational studies focusing on this issue and on the causal relationships between oral lesions and COVID-19 was highlighted.
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Affiliation(s)
- Javier Aragoneses
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Ana Suárez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Cinthia Rodríguez
- Department of Dentistry, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Nansi López-Valverde
- Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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19
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Affiliation(s)
- Yasuhiro Kano
- Department of Internal Medicine, National Hospital Organisation Tochigi Medical Center, Utsunomiya, Tochigi, Japan .,Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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20
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Wu YH, Wu YC, Lang MJ, Lee YP, Jin YT, Chiang CP. Review of oral ulcerative lesions in COVID-19 patients: A comprehensive study of 51 cases. J Dent Sci 2021; 16:1066-1073. [PMID: 34306539 PMCID: PMC8279930 DOI: 10.1016/j.jds.2021.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 01/21/2023] Open
Abstract
Numerous oral manifestations of COVID-19 have been reported in the literatures. Common oral lesions in COVID-19 patients included ulcerations, xerostomia, dysgeusia, gingival inflammation, and erythema. Among them, oral ulceration is the most frequent finding and is present as various but distinct patterns. Thus, we conducted a comprehensive review of 51 COVID-19 patients with oral ulcerative lesions to further analyze the various oral ulcerative lesions in COVID-19 patients. There were a median age of 41.4 years and a slight female predilection in these patients. Most oral lesions manifested as an aphtha-like ulceration but lack of an evidence of recurrent aphthous stomatitis. Some of them were present as herpetiform ulcerations without HSV infection. Widespread ulcerations accompanied with necrosis were observed in the more severe and immunosuppressed older patients. Although some reported patients were asymptomatic, most of them had systemic symptoms concurring or slightly preceding the oral ulcerative lesions and the latency from the onset of systemic symptoms to oral ulcerative lesions were under 10 days, suggesting that oral ulceration was one of the early symptoms of COVID-19. Therefore, the oral ulcerative lesions may be considered as oral markers for early diagnosis of the underlying COVID-19 infection in the asymptomatic patients.
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Affiliation(s)
- Yu-Hsueh Wu
- Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Oral Medicine, School of Dentistry, National Cheng Kung University, Tainan, Taiwan
| | - Yang-Che Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ming-Jane Lang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yi-Pang Lee
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ying-Tai Jin
- Department of Pathology, Taiwan Adventist Hospital, Taipei, Taiwan
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
- Corresponding author. Department of Pathology, Taiwan Adventist Hospital, No. 424, Section 2, Bade Road, Taipei 10556, Taiwan.
| | - Chun-Pin Chiang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Corresponding author. Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan.
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21
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Okada Y, Yoshimura K, Toya S, Tsuchimochi M. Pathogenesis of taste impairment and salivary dysfunction in COVID-19 patients. JAPANESE DENTAL SCIENCE REVIEW 2021; 57:111-122. [PMID: 34257762 PMCID: PMC8266517 DOI: 10.1016/j.jdsr.2021.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly transmissible pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of the disease include a broad range of symptoms from mild to serious to death, with mild pneumonia to acute respiratory distress syndrome and complications in extrapulmonary organs. Taste impairment and salivary dysfunction are common early symptoms in COVID-19 patients. The mouth is a significant entry route for SARS-COV-2, similar to the nose and eyes. The cells of the oral epithelium, taste buds, and minor and major salivary glands express cell entry factors for SARS-COV-2, such as ACE2, TMPRSS2, and Furin. We describe the occurrence of taste impairment and salivary dysfunction in COVID-19 patients and show immunohistochemical findings regarding the cell entry factors in the oral tissue. We review and describe the pathogeneses of taste impairment and salivary dysfunction. Treatment for the oral disease is also described. Recently, it was reported that some people experience persistent and prolonged taste impairment and salivary dysfunction, described as post-COVID-19 syndrome or long COVID-19, after the acute illness of the infection has healed. To resolve these problems, it is important to understand the pathogenesis of oral complications. Recently, important advances have been reported in the understanding of gustatory impairment and salivary dysfunction. Although some progress has been made, considerable effort is still required for in-depth elucidation of the pathogenesis.
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Affiliation(s)
- Yasuo Okada
- Department of Pathology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Ken Yoshimura
- Department of Anatomy, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Shuji Toya
- Oral and Maxillofacial Surgery, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Makoto Tsuchimochi
- The Nippon Dental University (Emeritus Professor), 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
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22
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Abstract
Data sources Medline (using PubMed) and Google Scholar. Also, a case was reported by the authors. Study selection Case reports dealing with oral manifestations of COVID-19. Data extraction and synthesis Two reviewers independently reviewed articles and papers which reported any oral lesions in patients with COVID-19 and summarised the data. In addition, they collated all relevant information about each case. Results The authors described a case history in which oral symptoms were observed which included dry mouth, acute dysgeusia, mild pain and burning sensation in lower lip mucosa, then after two days, vesicles appeared in the same region with simultaneous systemic symptoms of COVID-19. The patient reported a previous history of herpetic infections. After seven days, oral lesions were healed and systemic symptoms regressed on day 14. Literature review Seventeen studies reporting 226 confirmed cases, and the case reported by the review authors, were included. The age range was between 9-90 years. More than 170 cases developed oral manifestations. The most common oral manifestations were dry mouth (n = 75), dysgeusia (n = 71) and pseudomembranous fungal structure (n = 67). Changes in tongue sensation (n = 48) and ulceration (n = 28), muscle pain during mastication (n = 15), swelling in the oral cavity (n = 10) and herpetic lesions (n = 6) were other common symptoms. The mean onset time of the oral manifestation was 7.21 days after systemic symptoms (range: 10-42 days). In 42 cases, oral lesions resolved spontaneously or with some basic treatment within three weeks. Conclusions Some patients with COVID-19 may present oral manifestations during their course of the disease; however, we do not know if there is a causal relationship between COVID-19 and these manifestations or not.
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23
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Farid H, Khan M, Jamal S, Ghafoor R. Oral manifestations of Covid-19-A literature review. Rev Med Virol 2021; 32:e2248. [PMID: 34028129 PMCID: PMC8209937 DOI: 10.1002/rmv.2248] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022]
Abstract
Initially, it was reported that coronavirus 2019 disease (Covid-19) affects respiratory, gastrointestinal and neurological systems, but the oral, olfactory and integumentary systems are also involved. This review discusses various oral manifestations of Covid-19 reported in the literature along with possible underlying mechanisms. The reported manifestations include taste impairment, oral mucosal changes (petechiae, ulcers, plaque-like lesions, reactivation of herpes simplex virus 1(HSV1), geographical tongue and desquamative gingivitis) and dry mouth. The prominent location for mucosal lesions are tongue, palate and labial mucosa. The exact pathogenesis of these oral symptoms is not known. Angiotensin-converting enzyme 2 (ACE2) cell receptors are expressed in abundance on oral mucosa allowing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) to infect them. Gustatory impairment along with olfactory changes is now listed as a symptom of Covid-19 by the World Health Organization, but further research is needed to confirm a link between reported additional oral symptoms and Covid-19. Dental professionals may encounter individuals with Covid-19 and be called upon to identify various oral manifestations of this disease.
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Affiliation(s)
- Huma Farid
- Margalla Institute of Health Sciences, Rawalpindi, Pakistan
| | - Madiha Khan
- Aga Khan University Hospital, Karachi, Pakistan
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24
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Nejabi MB, Noor NAS, Raufi N, Essar MY, Ehsan E, Shah J, Shah A, Nemat A. Tongue ulcer in a patient with COVID-19: a case presentation. BMC Oral Health 2021; 21:273. [PMID: 34016110 PMCID: PMC8135170 DOI: 10.1186/s12903-021-01635-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The emergence of COVID-19 has devastated many parts of the world. From asymptomatic to symptomatic, the virus causes a wide spectrum of presentations. COVID-19 patients may present with oral manifestations. In Afghanistan, where COVID-19 has severely strained the health care system, much of the population lacks proper oral hygiene. This makes the oral cavity a perfect site for SARS-CoV-2 to manifest clinical signs. CASE PRESENTATION A 62-year-old male was evaluated in the Dentistry Teaching Clinic of Kabul University of Medical Sciences for a painful erosive lesion on dorsal surface of his tongue. He also complained of fever, cough, and taste alteration. He was referred to Afghan Japan Hospital for COVID-19 testing and tested positive. He was followed on for the treatment of SARS-CoV2. After 2 weeks, the patient tested negative and returned to the dentistry clinic for follow-up. Although there were no other signs of COVID-19, the painful erosive lesion on his tongue persisted. Oral evaluation were performed and the patient was advised to practice good hygiene. After 10 days, we observed an asymptomatic geographic tongue without fever and myalgias and the lesion of dorsal surface of tongue improved from severe condition to moderate. CONCLUSION In conclusion, patients with suspected or confirmed SARS-CoV-2 should be screened for symptoms and physical findings in the oral mucosa To prevent such an outcome, awareness programs need to be implemented for the diagnosis and management of clinical symptoms among patients.
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Affiliation(s)
| | | | - Nahid Raufi
- Department of Dermatology, Kabul University of Medical Sciences, Kabul, Afghanistan.,Department of Dermatology, Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Mohammad Yasir Essar
- Faculty of Dentistry, Kabul University of Medical Sciences, Kabul, Afghanistan.,Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Ehsanullah Ehsan
- Department of Dermatology, Alberoni University, Kapisa, Afghanistan
| | - Jaffer Shah
- Medical Research Center, Kateb University, Kabul, Afghanistan.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Asghar Shah
- Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Arash Nemat
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China. .,Department of Microbiology, Kabul University of Medical Sciences, University Road, Ali Abad, Jamal Mina, 3rd District, Kabul, 1001, Afghanistan.
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25
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Nuño González A, Magaletskyy K, Martín Carrillo P, Lozano Masdemont B, Mayor Ibarguren A, Feito Rodríguez M, Herranz Pinto P. Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital. ACTAS DERMO-SIFILIOGRAFICAS 2021. [PMID: 34053898 PMCID: PMC8113105 DOI: 10.1016/j.adengl.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. PATIENTS AND METHODS We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. RESULTS Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. CONCLUSIONS COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19.
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Affiliation(s)
- A Nuño González
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain.
| | - K Magaletskyy
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
| | | | - B Lozano Masdemont
- Servicio de Dermatología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - A Mayor Ibarguren
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
| | - M Feito Rodríguez
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
| | - P Herranz Pinto
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
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Nuño González A, Magaletskyy K, Martín Carrillo P, Lozano Masdemont B, Mayor Ibarguren A, Feito Rodríguez M, Herranz Pinto P. Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00107-1. [PMID: 33652010 PMCID: PMC7910660 DOI: 10.1016/j.ad.2021.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. PATIENTS AND METHODS We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. RESULTS Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. CONCLUSION COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19.
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Affiliation(s)
- A Nuño González
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España.
| | - K Magaletskyy
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | | | - B Lozano Masdemont
- Servicio de Dermatología, Hospital Universitario de Móstoles , Móstoles, Madrid, España
| | - A Mayor Ibarguren
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - M Feito Rodríguez
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - P Herranz Pinto
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
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Živković-Marinkov E, Milisavljević D, Stanković M, Filipović G, Bojanović M, Nikolić N, Babac S. Oral manifestations in patients infected with COVID-19. ACTA STOMATOLOGICA NAISSI 2021. [DOI: 10.5937/asn2184334z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction:In addition to the characteristic clinical picture of respiratory infection, patients with COVID-19 can also be diagnosed with oral manifestations. Aim: The aim of this study was to review current literature for the prevalence of changes in the oral cavity i.e., the presence of oral symptoms in patients with COVID-19, in order to indicate that oral manifestations may occur due to viral infection with SARS-CoV-2. Methods: Important information relevant to the study was obtained by searching the available electronic PubMed and Google Scholar database. Results: Oral lesions were found in different locations in patients with COVID-19: tongue mucosa (dorsum and lateral sides of the tongue), buccal mucosa, hard and soft palate, inner lip and gingiva. The most common were ulcerations in different parts of the oral cavity. It is still unclear whether oral lesions in SARS-CoV-2 virus infection were a consequence of the primary effect of the virus itself or a secondary manifestation of the infection. The high presence of angiotensin-converting enzyme 2 in oral epithelial cells of the tongue and salivary glands indicates that the oral cavity may be particularly susceptible to SARS-CoV-2 infection. Taste disorder is the most common oral symptom in patients with COVID-19. Conclusion: Oral lesions, xerostomia, taste disorders can occur in patients diagnosed with COVID-19. Therefore, a comprehensive intraoral examination is necessary in order to determine changes in the oral cavity and apply proper treatment.
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