SARS-CoV-2 and Oral Manifestation: An Observational, Human Study

Frequency of Oral Lesions, Olfactory, and Gustatory Disorders and Xerostomia in Patients with COVID-19

COVID-19, a respiratory illness with a global impact on millions, has recently been linked to manifestations affecting various bodily systems, including the oral cavity. Studies highlight oral issues, like ulcers, blisters, and white patches, alongside olfactory and gustatory dysfunction, influencing an individual's quality of life. In this context, our study aimed to assess the frequency of oral lesions, olfactory and gustatory disorders, and xerostomia resulting from COVID-19. An observational study was conducted with 414 patients to evaluate the frequency of oral symptoms resulting from COVID-19. Patients were diagnosed with mild symptoms and evaluated through clinical examination of the oral cavity and a questionnaire to assess functional alterations. The findings showed that 139 out of 414 patients presented clinical manifestations, with oral lesions being the most prevalent (19.1%), followed by gustatory disorders (18.1%), xerostomia (14.2%), and olfactory dysfunction (14%). The most prevalent oral lesions were ulcerations (n = 51), candidiasis (n = 8), and erythema or red plaques (n = 7). Unfortunately, 50 (12.1%) patients died during this study. Therefore, oral lesions, olfactory and gustatory dysfunctions, and xerostomia are common symptoms associated with COVID-19.

Evidence of a Sjögren's disease-like phenotype following COVID-19 in mice and humans

Sjögren's Disease (SjD) is a systemic autoimmune disease characterized by lymphocytic inflammation of the lacrimal and salivary glands (SG), dry eyes and mouth, and systemic symptoms. SARS-CoV-2 may trigger the development or progression of autoimmune diseases. To test this, we used a mouse model of SARS-CoV-2 infection and convalescent patients' blood and SG in order to understand the development of SjD-like autoimmunity after infection. First, SARS-CoV-2-infected human angiotensin-converting enzyme 2 (ACE2) transgenic mice exhibited decreased salivation, elevated antinuclear antibodies (ANA), and lymphocytic infiltration in the lacrimal and SG. The sera from patients with COVID-19 sera showed increased ANA (i.e., anti-SSA [Sjögren's-syndrome-related antigen A]/anti-Ro52 and anti-SSB [SS-antigen B]/anti-La). Male patients showed elevated anti-SSA compared with female patients, and female patients exhibited diverse ANA patterns. SG biopsies from convalescent COVID-19 patients were microscopically similar to SjD SG with focal lymphocytic infiltrates in 4 of 6 patients and 2 of 6 patients exhibiting focus scores of at least 2. Lastly, monoclonal antibodies produced in recovered patients blocked ACE2/spike interaction and cross-reacted with nuclear antigens. Our study shows a direct association between SARS-CoV-2 and SjD. Hallmark features of SjD-affected SGs were histologically indistinguishable from convalescent COVID-19 patients. The results implicate that SARS-CoV-2 could be an environmental trigger for SjD.

Oral manifestations in patients with coronavirus disease 2019 (COVID-19) identified using text mining: an observational study

Text mining enables search, extraction, categorisation and information visualisation. This study aimed to identify oral manifestations in patients with COVID-19 using text mining to facilitate extracting relevant clinical information from a large set of publications. A list of publications from the open-access COVID-19 Open Research Dataset was downloaded using keywords related to oral health and dentistry. A total of 694,366 documents were retrieved. Filtering the articles using text mining yielded 1,554 oral health/dentistry papers. The list of articles was classified into five topics after applying a Latent Dirichlet Allocation (LDA) model. This classification was compared to the author's classification which yielded 17 categories. After a full-text review of articles in the category "Oral manifestations in patients with COVID-19", eight papers were selected to extract data. The most frequent oral manifestations were xerostomia (n = 405, 17.8%) and mouth pain or swelling (n = 289, 12.7%). These oral manifestations in patients with COVID-19 must be considered with other symptoms to diminish the risk of dentist-patient infection.

Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review

BACKGROUND

Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients.

METHODS

An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values <0.01 were considered statistically significant.

RESULTS

In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n=33), and Italy was the most common country (n=14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n=65), followed by the oral mucosa (n=37) and lips (n=19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively.

CONCLUSION

COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.

A New Model of Salivary Pacemaker-A Proof of Concept and First Clinical Use

Background and Objectives: Saliva is of utmost importance for maintaining oral health. Management of saliva flow rate deficiency recently includes salivary neuro-electrostimulation. The aim of this paper is to present a new model of salivary pacemaker-the MICROSAL device (MD), an intelligent, miniaturized, and implant-supported oral device used for salivary stimulation. Materials and Methods: This report presents the development, calibration, and first clinical tests which involved the MD. The novel features of this device are the pH sensor and the fact that it communicates with the patient's smartphone, where oral wetness and pH are graphically exposed. Saliva samples were taken before and after the MD was used on a 68-year-old patient suffering from post-irradiation xerostomia, and albumin and total protein were analyzed. Results: The device uses up to 3 V and time intervals of 2 s seconds for stimulation. The total volume of all saliva samples collected during the clinical trial was almost seven times higher after the device was used. Albumin decreased from a maximum of 0.15 g/dL to 0.04 g/dL, and total proteins from 0.65 g/dL to 0.21 g/dL, after salivary stimulation. Conclusions: The MD increased saliva secretion of the patient, and we are confident it will be a good solution for future management of salivary gland hypofunction.

Oral Changes in Hospitalized COVID-19 Patients: A Cross-Sectional Multicentric Study

Background

Coronavirus disease 2019 (COVID-19) has rapidly spread over the globe, and several oral symptoms have been documented. However, it is unclear whether these lesions are the result of coronavirus infection or are secondary symptoms of the patient's systemic illness. The aim of this study was to collect data from various hospitals on COVID-19 patients with oral involvement in order to highlight different oral changes that may be manifested in those patients.

Methods

This observational cross-sectional multicenter study used an online questionnaire covering oral signs and symptoms that were believed to be related to COVID-19 patients who were hospitalized in different hospitals in Egypt.

Results

94.3% of the 210 patients who participated in the current study developed oral symptoms. Altered taste sensation (56.2%), burning sensation (43.3%), and oral candidiasis (40%) were the most prevalent oral symptoms (34.4%) that were found in the studied sample.

Conclusions

COVID-19 has a major influence on the oral cavity, with numerous oral symptoms that may impair quality of life. Thus, considering the need for support, pain control, and management for a better prognosis, the clinical dental evaluation of hospitalized patients with infectious diseases like COVID-19 should be addressed.

COVID-19-Related Burning Eye Syndrome and Burning Mouth Syndrome: A Systematic Review and Meta-analysis

BACKGROUND

Previous research highlights burning eye syndrome (BES) and burning mouth syndrome (BMS) as chronic complications of COVID-19 infection. The aim of this systematic review and meta-analysis is to establish the prevalence of COVID-19-related BES and COVID-19-related BMS and describe their phenomenology.

METHODOLOGY

A literature search in the PubMed database was performed, and seven papers (five on BES and two on BMS) were eligible to be included in this systematic review and meta-analysis.

RESULTS

The pooled prevalence of COVID-19-related BES was 9.9% (95% CI 3.4-25.4%). The frequency of COVID-19-related BMS is only reported in isolated cases and ranges from 4% in mild-to-moderate cases to 15% in severe, hospitalized cases, with female patients being mostly affected. COVID-19 severity is a potential risk factor for both BES and BMS. Neither syndrome occurs in isolation. COVID-19-related BES usually appears within the first week post-infection, persisting up to 9 weeks later. COVID-19-related BMS occurs during and after initial infection, and may also persist as a chronic disease.

CONCLUSIONS

Both BES and BMS are neuropathic COVID-19 infection complications, still under-studied and under-investigated, despite the fact that both are prevalent. Both COVID-19-related BES and COVID-19-related BMS could potentially be initial long COVID syndrome manifestations, and further research should be carried out in this field.

Impaired olfaction post-coronavirus disease 2019: a systematic review of smell recovery predictive factors

Background

The devastating coronavirus disease (COVID-19) pandemic seemed not yet to cease. Numerous studies regarding its typical sign and symptoms have been done, presenting one of the most promising predictors of the infection: olfactory dysfunction. Although not life-threatening, the symptom could decrease one’s quality of life, especially if persistent throughout their entire life. Among the countless literature regarding loss of smell, only limited studies denote predictors of smell recovery. This systematic review aimed to bridge the knowledge gap of olfactory impairment prevalence and recovery predictors in people with COVID-19.

Methods

This review was carried out through journal databases, including PubMed, Science Direct, Google Scholar, and medRxiv. Literature published from 2020 to 2022 that complied with the inclusion and exclusion criteria was retrieved, scanned for duplicates with Zotero, and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2020 (PRISMA) guidelines.

Results

Of the 2243 studies, seven were assessed with the Prediction model Risk Of Bias ASsessment Tool (PROBAST) to analyze the risk of bias, which five cohort studies deemed relevant. Olfactory dysfunction, olfactory recovery, and its predictive factors are noted. This review is registered in PROSPERO (Registration Number CRD42022318412).

Conclusions

No clinical markers predicted the recovery of olfactory dysfunction, but patients who are more likely to recover are associated with younger age, female sex, and having COVID-19-related symptoms such as nasal congestion and trigeminal sensation. Modifiable factors are still dubious in predicting the olfaction recovery.

Prevalence of oral manifestations in COVID-19: A systematic review

Coronavirus disease 2019 (COVID-19) is a novel disease caused by a newly identified virus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing diverse systemic manifestations. The oral cavity too is not spared and the symptoms appear either independently, concurrently, or sequentially. In view of the rising documented cases of oral lesions of COVID-19, this systematic review aims to assess the prevalence of oral manifestations in COVID-19 confirmed individuals. An extensive literature search was conducted in databases like Scopus, Pubmed/Medline, Livivo, Lilacs and Google Scholar and varied oral signs and symptoms were reported as per the PRISMA guidelines. Studies published in English language literature only were included and were subjected to the risk of bias using the Joana Briggs Institute Appraisal tools for prevalence studies, case series and case reports. In a two-phase selection, 34 studies were included: 21 observational, 3 case-series and 10 case reports. These observational studies included approximately 14,003 patients from 10 countries. In this review, we explored the most commonly encountered oral and dental manifestations in COVID-19 and identified that loss of taste acuity, xerostomia and anosmia were frequently reported. Elevated incidence of opportunistic infections like mucormycosis and aspergillosis were reported during the treatment due to prolonged intake of steroids. Immunosuppression and poor oral hygiene led to secondary manifestations like enanthematous lesions. However, it is not clear that oral signs and symptoms are due to COVID-19 infection itself or are the result of extensive treatment regimen followed [PROSPERO CRD42021258264].

Evidence of a Sjögren's disease-like phenotype following COVID-19

Objectives

Sjögren's Disease (SjD) is a chronic and systemic autoimmune disease characterized by lymphocytic infiltration and the development of dry eyes and dry mouth resulting from the secretory dysfunction of the exocrine glands. SARS-CoV-2 may trigger the development or progression of autoimmune diseases, as evidenced by increased autoantibodies in patients and the presentation of cardinal symptoms of SjD. The objective of the study was to determine whether SARS-CoV-2 induces the signature clinical symptoms of SjD.

Methods

The ACE2-transgenic mice were infected with SARS-CoV-2. SJD profiling was conducted. COVID-19 patients' sera were examined for autoantibodies. Clinical evaluations of convalescent COVID-19 subjects, including minor salivary gland (MSG) biopsies, were collected. Lastly, monoclonal antibodies generated from single B cells of patients were interrogated for ACE2/spike inhibition and nuclear antigens.

Results

Mice infected with the virus showed a decreased saliva flow rate, elevated antinuclear antibodies (ANAs) with anti-SSB/La, and lymphocyte infiltration in the lacrimal and salivary glands. Sera of COVID-19 patients showed an increase in ANA, anti-SSA/Ro52, and anti-SSB/La. The male patients showed elevated levels of anti-SSA/Ro52 compared to female patients, and female patients had more diverse ANA patterns. Minor salivary gland biopsies of convalescent COVID-19 subjects showed focal lymphocytic infiltrates in four of six subjects, and 2 of 6 subjects had focus scores >2. Lastly, we found monoclonal antibodies produced in recovered patients can both block ACE2/spike interaction and recognize nuclear antigens.

Conclusion

Overall, our study shows a direct association between SARS-CoV-2 and SjD. Hallmark features of SjD salivary glands were histologically indistinguishable from convalescent COVID-19 subjects. The results potentially implicate that SARS-CoV-2 could be an environmental trigger for SjD.

Key Messages

What is already known about this subject?SAR-CoV-2 has a tropism for the salivary glands. However, whether the virus can induce clinical phenotypes of Sjögren's disease is unknown.What does this study add?Mice infected with SAR-CoV-2 showed loss of secretory function, elevated autoantibodies, and lymphocyte infiltration in glands.COVID-19 patients showed an increase in autoantibodies. Monoclonal antibodies produced in recovered patients can block ACE2/spike interaction and recognize nuclear antigens.Minor salivary gland biopsies of some convalescent subjects showed focal lymphocytic infiltrates with focus scores.How might this impact on clinical practice or future developments?Our data provide strong evidence for the role of SARS-CoV-2 in inducing Sjögren's disease-like phenotypes.Our work has implications for how patients will be diagnosed and treated effectively.

Towards novel nano-based vaccine platforms for SARS-CoV-2 and its variants of concern: Advances, challenges and limitations

Vaccination is the most effective tool available for fighting the spread of COVID-19. Recently, emerging variants of SARS-CoV-2 have led to growing concerns about increased transmissibility and decreased vaccine effectiveness. Currently, many vaccines are approved for emergency use and more are under development. This review highlights the ongoing advances in the design and development of different nano-based vaccine platforms. The challenges, limitations, and ethical consideration imposed by these nanocarriers are also discussed. Further, the effectiveness of the leading vaccine candidates against all SARS-CoV-2 variants of concern are highlighted. The review also focuses on the possibility of using an alternative non-invasive routes of vaccine administration using micro and nanotechnologies to enhance vaccination compliance and coverage.

Self-Reported Periodontal Disease and Its Association with SARS-CoV-2 Infection

Introduction: Knowledge of the oral manifestations associated with SARS-CoV-2 infection, the new coronavirus causing the COVID-19 pandemic, was hindered due to the restrictions issued to avoid proximity between people and to stop the rapid spread of the disease, which ultimately results in a hyperinflammatory cytokine storm that can cause death. Because periodontal disease is one of the most frequent inflammatory diseases of the oral cavity, various theories have emerged postulating periodontal disease as a risk factor for developing severe complications associated with COVID-19. This motivated various studies to integrate questions related to periodontal status. For the present work, we used a previously validated self-report, which is a useful tool for facilitating epidemiological studies of periodontal disease on a large scale. Methodology: A blinded case-control study with participants matched 1:1 by mean age (37.7 years), sex, tobacco habits and diseases was conducted. After the diagnostic samples for SARS-CoV-2 detection were taken in an ad hoc location at Guadalajara University, the subjects were interviewed using structured questionnaires to gather demographic, epidemiological and COVID-19 symptom information. The self-reported periodontal disease (Self-RPD) questionnaire included six questions, and subjects who met the criteria with a score ≥ 2 were considered to have periodontal disease. Results: In total, 369 participants were recruited, with 117 participants included in each group. After indicating the subjects who had self-reported periodontal disease, a statistically significant difference (p value ≤ 0.001) was observed, showing that self-reported periodontal disease (n = 95, 85.1%) was higher in SARS-CoV-2-positive individuals than in controls (n = 66, 56.4%), with an OR of 3.3 (1.8-6.0) for SARS-CoV-2 infection in people with self-reported periodontal disease. Cases reported a statistically higher median of symptoms (median = 7.0, Q₁= 5.5, Q₃ = 10.0) than controls (p value ≤ 0.01), and cases with positive self-RPD had a significantly (p value ≤ 0.05) higher number of symptoms (median = 8.0, Q₁ = 6.0, Q₃ = 10.0) in comparison with those who did negative self-RPD (median = 6.0, Q₁ = 5.0, Q₃ = 8.0). Conclusions: According to this study, self-reported periodontal disease could be considered a risk factor for SARS-CoV-2 infection, and these individuals present more symptoms.

Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study

With the arrival of the highly transmissible Omicron variants (BA.4 and BA.5), dentistry faces another seasonal challenge to preserve the biosafety of dental care and education. With the aim of protecting patients, students, teachers and healthcare professionals, this paper introduces a prospective sustainable biosafety setting for everyday dental care and education. The setting developed by dental clinicians, epidemiologists, and teachers of dentistry consists of a combination of modern technologies focused on the air-borne part of the viral pathway. The introduced biosafety setting has been clinically evaluated after 18 months of application in the real clinical environment. The protocol has three fundamental pillars: (1) UVC air disinfection; (2) air saturation with certified virucidal essences with nebulizing diffusers; (3) complementary solutions including telehealth and 3D printing. A pseudonymous online smart form was used as the evaluation method. The protocol operates on the premise that everybody is a hypothetical asymptomatic carrier. The results of a clinical evaluation of 115 patient feedbacks imply that no virus transmission from patient to patient or from doctor to nurse was observed or reported using this protocol, and vice versa, although nine patients retrospectively admitted that the clinic visit is likely to be infectious. Despite these promising results, a larger clinical sample and exposition to the current mutated strains are needed for reliable conclusions about protocol virucidal efficiency in current dental environments.

COVID-19 Induced Taste Dysfunction and Recovery: Association with Smell Dysfunction and Oral Health Behaviour

Background and Objectives: Disruption to taste and smell are common symptoms of COVID-19 infection. The current literature overlooks taste symptoms and tends to focus on the sense of smell. Persisting cases (>28 days) of taste dysfunction are increasingly recognised as a major future healthcare challenge. This study focuses on the severity and recovery of COVID-19 induced taste loss and association with olfactory symptoms, lifestyle and oral health factors. Materials and Methods: This study was a cross-sectional survey comparing 182 rapid taste recovery participants (≤28 days) with 47 participants with prolonged taste recovery >28 days. Analyses of taste loss in association with smell loss, age, sex, illness severity, diet, BMI, vitamin-D supplementation, antidepressants, alcohol use, smoking, brushing frequency, flossing, missing teeth, appliances and number of dental restorations were conducted. Differences in the severity of the loss of sour, sweet, salt, bitter and umami tastes were explored. Results: Both the severity and the duration of taste and smell loss were closely correlated (p < 0.001). Salt taste was significantly less affected than all other taste qualities (p < 0.001). Persisting taste loss was associated with older age (mean ± 95% CI = 31.73 ± 1.23 years vs. 36.66 ± 3.59 years, p < 0.001) and reduced likelihood of using floss (odds ratio ± 95% CI = 2.22 (1.15−4.25), p = 0.047). Conclusions: Smell and taste loss in COVID-19 are closely related, although a minority of individuals can experience taste or smell dysfunction in the absence of the other. The taste of salt may be less severely affected than other taste qualities and future work exploring this finding objectively is indicated. The association of flossing with rapid taste recovery adds to the growing evidence of a link between good periodontal health and favourable COVID-19 outcomes.

Oral Manifestations in SARS-CoV-2 Positive Patients: A Systematic Review

The COVID-19 pandemic has severely affected the human population by revealing many health problems, including within the oral cavity. This systematic review was designed to answer the question "Is there a relationship between oral manifestations and SARS-CoV-2 infection?". Following the inclusion and exclusion criteria, twenty-seven studies were included (according to PRISMA statement guidelines). Based on the meta-analysis, nearly two-thirds of the SARS-CoV-2 positive patients reported oral symptoms, in particular taste alterations, xerostomia and ulcerations (54.73% [95% CI: 46.28-63.04%], 37.58% [95% CI: 26.35-49.53%], and 21.43% [95% CI: 13.17-31.06%], respectively). In conclusion, despite the conducted systematic review, the increased prevalence of oral manifestations in SARS-CoV-2 infection cannot be clearly established due to the possible association of other factors, e.g., individual or environmental factors.

Psychological Impacts of COVID-19 in Dental Patients are Moderated and Mediated by Hospital-Infection-Control-Policy and Satisfaction-with-Life: A Prospective Observational Dental-COVID Study

Introduction

COVID-19 pandemic has imposed nation-wide lock-downs which severely impacted day-to-day lifestyle and caused anxiety, stress and fear among patients taking medical care including dental treatments. These psychological behaviors have also been observed during the strategic relaxation of social restrictions (Unlock). However, potential effect of these psychological behavior in endodontic cases have not been probed. Here, it is of great interest to explore the magnitude and buffering effect of two important psychological resources: satisfaction-with-life, and confidence in hospital-infection-control-policy in relation with COVID-19 risk perception on psychological impact due to fear for COVID-19.

Methods

Patients visiting Dental Clinic & Research Center for endodontic procedures were randomly asked to fill survey questionnaire, and were later enrolled as per the study criteria. The study carried out in two phases: from 15 Sept 2020 to 15 Dec 2020 (restrained confinement; Unlock 1.0); and from 16 Dec 2020 to 12 Feb 2021 (mild confinement; Unlock 2.0) with total sample size of 136. We used data collection tools such as fear-of-COVID-19 scale (FCV-19), perceived-stress-scale (PSS), modified-dental-anxiety-scale (MDAS), satisfaction-with-life scale (SWLS), COVID-19 risk perception, and confidence in hospital-infection-control-policy for COVID-19.

Results

A double moderation and dual moderated mediation structured model were used to establish the correlation of various parameters using SPSS (version 25.0) software suite. Confidence in hospital-infection-control-policy and SWLS were negatively correlated with FCV-19, MDAS, and PSS. Risk perception of COVID-19 was found to positively associated with FCV-19, MDAS, and PSS.

Discussion

Patient’s confidence in hospital-infection-control-policy for COVID-19 and SWLS acted as independent moderator for FCV-19 and mental distress. FCV-19 and risk perception were found to be lower during mild confinement (Unlock 2.0), and were also the positive predictors of PSS; and negative predictors of SWLS. The higher SWLS correlated very well with lower COVID-19 risk perception, concerning PSS and MDAS.

Oral health conditions and COVID-19: A systematic review and meta-analysis of the current evidence

Background

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of understanding the underlying conditions that lead to COVID-19. Oral health has systemic implications in the maintenance of a healthy state. This study aimed to summarize evidence on the prevalence of oral health conditions in participants with COVID-19 and assess the associations between oral health conditions and COVID-19 related outcomes.

Methods

Article searches were conducted in five databases and the gray literature from December 1, 2019 to March 1, 2021. Studies that reported oral health conditions for participants with COVID-19 and/or examined associations between oral health and COVID-19 were included.

Results

We identified 15 articles that encompassed 5,377 participants with COVID-19 from 10 countries. Dry mouth was the most common oral health condition reported (41.0%), followed by oral lesions (38.8%), orofacial pain (18.3%), and periodontal symptoms (11.7%). Based on the pooled odds ratios (ORs), periodontal symptoms were not associated with COVID-19 positivity (OR = 1.1; 95% confidence intervals [CI], 0.73-1.65) or mortality (OR = 2.71; 95% CI, 0.64-11.51), but were associated with COVID-19 severity (OR = 3.18; 95% CI, 1.81-5.58).

Conclusions

Oral health conditions are common in participants with COVID-19 and should be considered in both the onset and progression of this disease. Knowledge in this area is still limited, and the quality of the data extracted was low. Further longitudinal studies are needed to ascertain whether oral health conditions are a consequence of infection with SARS-CoV-2 or whether they predate infection and are risk factors for COVID-19.

Gustatory and Saliva Secretory Dysfunctions in COVID-19 Patients with Zinc Deficiency

Given the ever-progressing studies on coronavirus disease 2019 (COVID-19), it is critical to update our knowledge about COVID-19 symptomatology and pathophysiology. In the present narrative review, oral symptoms were overviewed using the latest data and their pathogenesis was hypothetically speculated. PubMed, LitCovid, ProQuest, and Google Scholar were searched for relevant studies from 1 April 2021 with a cutoff date of 31 January 2022. The literature search indicated that gustatory dysfunction and saliva secretory dysfunction are prevalent in COVID-19 patients and both dysfunctions persist after recovery from the disease, suggesting the pathogenic mechanism common to these cooccurring symptoms. COVID-19 patients are characterized by hypozincemia, in which zinc is possibly redistributed from blood to the liver at the expense of zinc in other tissues. If COVID-19 induces intracellular zinc deficiency, the activity of zinc-metalloenzyme carbonic anhydrase localized in taste buds and salivary glands may be influenced to adversely affect gustatory and saliva secretory functions. Zinc-binding metallothioneins and zinc transporters, which cooperatively control cellular zinc homeostasis, are expressed in oral tissues participating in taste and saliva secretion. Their expression dysregulation associated with COVID-19-induced zinc deficiency may have some effect on oral functions. Zinc supplementation is expected to improve oral symptoms in COVID-19 patients.

Relationship between Recovery from COVID-19-Induced Smell Loss and General and Oral Health Factors

Background and Objectives: Loss of smell is one of the strongest predictors of coronavirus disease 2019 (COVID-19) and can persist long after other symptoms have resolved. “Long” cases (>28 days) of smell dysfunction present future challenges to medical and dental professionals, as there is a lack of evidence on the causes and any exacerbating or relieving factors. This study aimed to explore the persistence of COVID-19-induced smell loss and association with physical, lifestyle and oral health factors. Materials and Methods: This study was a cross-sectional survey of 235 participants. Recovery of smell was explored, comparing rapid recovery (≤28 days) with prolonged recovery (>28 days). Associative factors included age, sex, illness severity, diet, BMI, vitamin D supplementation, antidepressants, alcohol use, smoking, brushing frequency, flossing, missing teeth, appliances and number of dental restorations. Results: Smell loss showed 87% resolution within 30 days. Prolonged smell loss was significantly associated with older age (mean ± 95%, CI = 31.53 ± 1.36 years for rapid recovery vs. mean ± 95%, CI = 36.0 ± 3 years for prolonged recovery, p = 0.003) and increased self-reported illness severity (mean ± 95%, CI = 4.39 ± 0.27 for rapid recovery vs. 5.01 ± 0.54 for prolonged recovery, p = 0.016). Fisher’s exact test revealed flossing was associated with rapid recovery, with flossers comprising 75% of the rapid-recovery group, compared to 56% in the prolonged-recovery group (odds ratio ± 95%, CI = 2.26 (1.23–4.15), p = 0.01). All other factors were not significantly associated (p > 0.05). Conclusions: Increased age and illness severity were associated with prolonged smell recovery. Use of floss was the only modifiable factor associated with rapid recovery of smell loss. As 87% of cases resolve within 30 days, future studies may benefit from targeted recruitment of individuals experiencing prolonged sense loss. This would increase statistical confidence when declaring no association with the other factors assessed, avoiding type II errors.

Oral manifestations in COVID-19 patients: An observational study

Background:

Viral diseases continue to emerge as a threat to mankind and are a serious concern to public health. The latest lethal SARS-CoV-2 or COVID-19 is a highly contagious disease, which propagated quickly across the globe. Similar to other influenza-like viral infections, symptoms such as fever, dry cough, myalgia, arthralgia, headache, diarrhea, dyspnea, and fatigue were reported among COVID-19 patients. Evidence suggests that the oral cavity is affected by this virus either directly or indirectly.

Aim:

The aim of this observational study was to determine the oral manifestations among COVID-19 patients.

Materials and Methods:

A cross-sectional, questionnaire-based study was carried out among COVID-19 recovered patients. A sample of 100 subjects, diagnosed as mild and moderate cases of COVID-19 disease were selected based on inclusion and exclusion criteria.

Results:

The study comprised an almost equal number of male (51%) and female (49%) participants and among them, 48% belong to the health professional group. A total of 54% of subjects were aged above 35 years and 46% below 35 years. Oral manifestations among study subjects during and after the disease illness included xerostomia being the commonest symptom (44%), followed by swallowing difficulty (16%), mouth ulcerations (10%), chewing problem (7%), gum bleeding (6%), and burning sensation (4%).

Conclusion:

Xerostomia, frequent aphthous ulcers, swallowing difficulty, and burning mouth were the most frequently encountered symptoms in study subjects during the disease and post recovery. Early identification of oral symptoms in COVID-19 recovered or suspected cases can help a dentist or a general physician to diagnose high-risk groups, mitigate transmission, and promote overall health.

COVID-19 and its manifestations in the oral cavity: A systematic review

BACKGROUND

SARS-CoV-2 is the virus responsible for coronavirus disease-19 (COVID-19) disease, which has been shown to trigger multiple affectations. One of the first tissue areas to come into contact with the virus is the oral cavity, which develops various alterations. Hence, the objective of this systematic review was to identify the main signs and symptoms of this disease in the oral cavity, and the following research question was established: What are the main oral signs and symptoms in COVID-19-positive persons?

METHODS

The electronic databases of PUBMED, SCOPUS, and SCIENCE DIRECT were analyzed, the keywords "ORAL DISEASES," "ORAL MANIFESTACTIONS," and "COVID-19" were used taking into account the following inclusion criteria: studies whose main objective was oral manifestations secondary to the confirmation of COVID-19, plus clinical cases, case series, and retrospective or prospective studies. For the assessment of the risk of bias the JBI Critical Appraisal Checklist for Case Series tool was used.

RESULTS

A total of 18 studies were included, the most common initial signs/symptoms after contagion of SARS-CoV-2 were dysgeusia, dry mouth, and burning mouth, and the main signs/symptoms were the presence of ulcerative lesions, dysgeusia, and Candida albicans infections.

CONCLUSIONS

It is very important to detect any alteration in the mucosa in patients with COVID-19 and to provide assertive treatment to avoid complications, and try to maintain adequate oral hygiene throughout the course of the disease to avoid the colonization of opportunistic microorganisms and to avoid complications both orally and systemically.

Covid-19: Signs and symptoms related to the feeding behavior

COVID-19 reached pandemic level in March 2020 and the number of confirmed cases continued to increase worldwide. The clinical course of the disease has not yet been fully characterized, and some specific symptoms related to smell, taste, and feeding behavior require further examination. The present study aimed to assess the presence of symptoms related to the feeding behavior occurred during and/or after COVID-19 in adults residing in Portugal and to link them to disease severity using a multivariate approach. Data were collected from May to September 2020, through a questionnaire answered online containing questions about general and specific symptoms before, during and after COVID-19. 362 participants were included: 201 were symptomatic, being 15 hospitalized and 186 non-hospitalized. Cluster analysis grouped the symptomatic non-hospitalized participants as mild and severe cases. For these patients, the most frequent symptoms related to the feeding process were smell disorders in 40% and 62%, taste disorders in 37% and 60%, and dry mouth, in 23% and 48% of the mild and severe cases, respectively. Dry mouth was significantly associated with difficulty to swallow, pain during swallow, choking when eating or drinking, and preference for mushy/pasty foods (p < 0.01; Chi-squared test). Among the severe cases, the incidence of coughing during the meal (31%), difficulty (19%) and pain during swallow (17%), preference for mushy/pasty foods (10%) and choking when eating or drinking (6%) were clinically relevant and may indicate the presence of swallowing disorders. This group also showed a higher frequency of general symptoms, such as fever, headache, abdominal pain, tiredness, diarrhea, nausea, and shortness of breath (p < 0.05; Chi-squared test). Smell disorders, taste disorders and dry mouth were the most frequent symptoms related to the feeding behavior for both mild and severe cases. Dry mouth was significantly associated with swallowing difficulties and future research should investigate it as a frequent symptom and as a predictive of the presence of eating and swallowing disorders in COVID-19 cases.

Palatal petechiae: an uncommon oral adverse effect of COVID-19 vaccine

Background

The authors present an unusual, unreported oral adverse effect of COVID-19 vaccine as palatal petechiae lesions.

Case presentation

COVID-19 disease caused by severe acute respiratory syndrome coronavirus 2 has become a global health crisis and has caused millions of deaths worldwide. Vaccination programs have been initiated in many countries for COVID-19 prevention. The ChAdOx-nCoV-19 vaccine has been shown to provide a robust immune response in various clinical trials. It is well tolerated by recipients and has been associated with minor adverse effects. The COVISHIELD (ChAdOx-nCoV-19) vaccine developed by AstraZeneca/Oxford University is approved by the Government of India to be administered in a phased manner. We present the case of twin subjects who suffered various adverse effects after receiving the COVISHIELD vaccine; one of the twins presented with palatal petechiae lesions presumably caused by the vaccine. The lesions were self-limiting and required no treatment.

Conclusion

Oral lesions reported first time in our case should be correlated with similar lesions found post-COVID vaccines globally. There is a further need to ascertain a high level of scientific evidence and explore the biological plausibility underlying oral complications and COVID vaccinations.

Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review

Background: COVID-19 disease first appeared in 2019 and quickly spread worldwide, causing a global pandemic. The oral cavity represents a target of SARS-CoV-2, and oral lesions are observed in both non-hospitalized and hospitalized patients. This systematic review aims to investigate the frequency of oral manifestations in COVID-19 hospitalized patients. Methods: An electronic search was conducted in PubMed, Scopus, and Web of Science databases, including articles published up to September 2021. The review protocol was based on PRISMA-P. The risk of bias of the studies was assessed using the Joana Briggs Institute. The certainty of evidence was assessed using the GRADE instrument. Results: Fifty-nine articles were included: 19 case reports, 17 case series, 2 case-control studies, 13 cross-sectional studies, 4 observational studies, and 4 retrospective studies. Oral ulcers, cheilitis, and tongue lesions were more common in patients before hospitalization, while perioral pressure ulcers, macroglossia, blisters, and oral candidiasis were more recurrent in patients during hospitalization. The first could be related directly to COVID-19, while the latter could be caused by medical devices, treatments, prone position, and immunological impairment. Conclusions: An accurate oral examination during the hospital admission of all confirmed COVID-19 cases is encouraged to recognize oral early manifestations and to apply appropriate treatments.

Revealing Distress and Perceived Stress among Dentists at the Outset of the COVID-19 Pandemic: A Cross-Sectional Factor Analytic Study

Dentists' perceptions about the stressfulness of clinical practice are well-documented, but literature on perceived stress and psychological distress experienced during the COVID-19 pandemic is scarce. This study aims to explore the emotions and attitudes, and the socio-demographic, dental, and COVID-related factors that are associated with the emergence of perceived stress and psychological distress that have been experienced by dentists during the COVID-19 pandemic. General demographic and dental-related data, and specific questions measuring the potential factors regarding dental professionals' concerns and opinions about their professional circumstances during the pandemic, were electronically collected from 182 dental practitioners. Exploratory and confirmatory factor analyses were used to assess whether dentists' emotions and attitudes during the pandemic measure the same construct: psychological distress, while linear regression models were built on the exploration of the effects of COVID-related factors on perceived stress and psychological distress. Facets of impulsiveness, lack of interest in social connections, emotional disengagement, mood swings, and acknowledgment of emotional exhaustion due to the pandemic, were measurements of the same construct and manifested in a singular factor: psychological distress. Two aspects, the fear of aerosol propagation and insecurities of financial status, increased the likelihood of the emergence of heightened levels of perceived stress and distress, while years spent in dental practice and age seemed to be protective factors against perceived stress and distress.

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

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.

COVID-19 manifestation in the oral cavity - a narrative literature review

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a recently discovered coronavirus, which in 2020 led to a global pandemic. Clinical manifestations of COVID-19 are very diverse and symptoms range from mild to severe. Correlated symptoms might also manifest in the oral cavity, which is a potential pathway for viral infection, and therefore might be a potential pathway for SARS-CoV-2. In recent research among patients with SARS-CoV-2 infection, taste and olfactory disorders, dry mouth, drones and inflammation of mouth, bitter taste in mouth, difficulty in swallowing and burning sensations have been reported. There have been cases of oral mucosal lesions in patients diagnosed with COVID-19 disease. Some correlations between periodontitis and severity of COVID-19 disease have also been observed. Oral mucosa, due to occurrence of ACE2 receptors, is highly susceptible to SARS-CoV-2 infection. The occurrence of changes on oral mucosa should increase the alertness of dental practitioners. However, knowledge in this area is still limited and in the field of oral manifestations of COVID-19 more research and patient observations are required.

COVID-19 and Its Repercussions on Oral Health: A Review

In 2019, a new type of coronavirus, SARS-CoV-2, the causing agent of COVID-19, was first detected in Wuhan, China. On 11 March 2020, the World Health Organization declared a pandemic. The manifestations of COVID-19 are mostly age-dependent and potentially more severe in cases with involved co-morbidities. The gravity of the symptoms depends on the clinical stage of the infection. The most common symptoms include runny nose and nasal congestion, anosmia, dysgeusia or hypogeusia, diarrhea, nausea/vomiting, respiratory distress, fatigue, ocular symptoms, diarrhea, vomiting, and abdominal pain. These systemic conditions are often accompanied by skin and mucosal lesions. Oral lesions reported in patients with COVID-19 include: herpex simplex, candidiasis, geographic tongue, aphthous-like ulcers, hemorrhagic ulcerations, necrotic ulcerations, white hairy tongue, reddish macules, erythematous surfaces, petechiae, and pustular enanthema. It is still unclear if these manifestations are a direct result of the viral infection, a consequence of systemic deterioration, or adverse reactions to treatments. Poor oral hygiene in hospitalized or quarantined COVID-19 patients should also be considered as an aggravating condition. This narrative review is focused on presenting the most relevant data from the literature regarding oral manifestations related to SARS-CoV-2, as well as the challenges faced by the dental system during this pandemic. A routine intraoral examination is recommended in COVID-19 patients, either suspected or confirmed, as, in certain cases, oral manifestations represent a sign of severe infection or even of a life-threatening condition. It is our belief that extensive knowledge of all possible manifestations, including oral lesions, in cases of COVID-19 is of great importance in the present uncertain context, including new, currently emerging viral variants with unknown future impact.

Effects of COVID-19 Pandemic on Working Conditions of Dentists in Poland and Turkey

Background and Objectives: Due to the specific working conditions dental professionals represent a group of high risk of infection and COVID-19 pandemic in many ways have influenced their working environment. The aim of this study was to evaluate effects of COVID-19 pandemic on working conditions of dentists in Poland and Turkey. Materials and Methods: The study was an anonymous online questionnaire conducted among thedentists in two countries: Poland and Turkey. The survey consisted of general questions, COVID-19 pandemic infection and working history as well as working conditions before and during pandemic. Chi-square test, Fisher’s Exact test, Fisher Freeman Halton test and Continuity (Yates) Correction were used to compare qualitative data. Results: The study was conducted with a total of 400 participants, 162 (40.5%) men and 238 (59.5%) women, aged between 23 and 67. The mean age of the participants was 42.39 ± 9.99 years. Positive COVID-19 test results among dentists in Poland were found to be significantly higher than in Turkey. Time of dental procedures during the COVID-19 pandemic in Poland and Turkey was significantly increased. The usage of N95/FFP2 or N99/FFP3 masks and surgical gowns during COVID-19 pandemic compared to pre-COVID-19 periods was clearly higher (p < 0.05). Reusable full-face and half-face elastomeric respirators are increasingly used in Turkey. During the COVID-19 pandemic a 25% decrease in dentists’ income in Poland (81%) was significantly high than in Turkey (47.5%). Conclusions: COVID-19 pandemic has influenced working conditions of dentists. Many dentists got infected during the pandemic, dental procedures’ time has increased, and protective equipment usage has become higher. Further studies analyzing the working conditions of dentists during COVID-19 pandemic should be conducted for better planning of future decisions taken by governments and authorities.

Beware of pharyngeal Fusobacterium nucleatum in COVID-19

BACKGROUND

Fusobacterium nucleatum (F. n) is an important opportunistic pathogen causing oral and gastrointestinal disease. Faecalibacterium prausnitzii (F. p) is a next-generation probiotic and could serve as a biomarker of gut eubiosis/dysbiosis to some extent. Alterations in the human oral and gut microbiomes are associated with viral respiratory infection. The aim of this study was to characterise the oral and fecal bacterial biomarker (i.e., F. n and F. p) in COVID-19 patients by qPCR and investigate the pharyngeal microbiome of COVID-19 patients through metagenomic next-generation sequencing (mNGS).

RESULTS

Pharyngeal F. n was significantly increased in COVID-19 patients, and it was higher in male than female patients. Increased abundance of pharyngeal F. n was associated with a higher risk of a positive SARS-CoV-2 test (adjusted OR = 1.32, 95% CI = 1.06 ~ 1.65, P < 0.05). A classifier to distinguish COVID-19 patients from the healthy controls based on the pharyngeal F. n was constructed and achieved an area under the curve (AUC) of 0.843 (95% CI = 0.688 ~ 0.940, P < 0.001). However, the level of fecal F. n and fecal F. p remained unaltered between groups. Besides, mNGS showed that the pharyngeal swabs of COVID-19 patients were dominated by opportunistic pathogens.

CONCLUSIONS

Pharyngeal but not fecal F. n was significantly increased in COVID-19 patients, clinicians should pay careful attention to potential coinfection. Pharyngeal F. n may serve as a promising candidate indicator for COVID-19.

A Review on Current COVID-19 Vaccines and Evaluation of Particulate Vaccine Delivery Systems

First detected in Wuhan, China, a highly contagious coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), also known as COVID-19, spread globally in December of 2019. As of 19 September 2021, approximately 4.5 million people have died globally, and 215 million active cases have been reported. To date, six vaccines have been developed and approved for human use. However, current production and supply capabilities are unable to meet global demands to immunize the entire world population. Only a few countries have been able to successfully vaccinate many of their residents. Therefore, an alternative vaccine that can be prepared in an easy and cost-effective manner is urgently needed. A vaccine that could be prepared in this manner, as well as can be preserved and transported at room temperature, would be of great benefit to public health. It is possible to develop such an alternative vaccine by using nano- or microparticle platforms. These platforms address most of the existing vaccine limitations as they are stable at room temperature, are inexpensive to produce and distribute, can be administered orally, and do not require cold chain storage for transportation or preservation. Particulate vaccines can be administered as either oral solutions or in sublingual or buccal film dosage forms. Besides improved patient compliance, the major advantage of oral, sublingual, and buccal routes of administration is that they can elicit mucosal immunity. Mucosal immunity, along with systemic immunity, can be a strong defense against SARS-CoV-2 as the virus enters the system through inhalation or saliva. This review discusses the possibility to produce a particulate COVID vaccine by using nano- or microparticles as platforms for oral administration or in sublingual or buccal film dosage forms in order to accelerate global vaccination.

Oral Manifestations in Patients with COVID-19: A 6-Month Update

This is the first update of the previously published living systematic review that summarized evidence on the prevalence of oral signs and symptoms in patients with COVID-19. Hitherto, 183 studies were included, reporting data from 64,876 patients with COVID-19 worldwide. The overall prevalence of taste disorders was 38% (95% CI = 22% to 56%, I² = 98%). Hypogeusia, dysgeusia, and ageusia were also evaluated by a meta-analysis, and the pooled prevalence was 34% for hypogeusia, 33% for dysgeusia, and 26% for ageusia. Taste disorders were associated with a positive COVID-19 test (odds ratio [OR] = 7.54, 95% CI = 5.24 to 10.86, I² = 93%, P < 0.00001), showing high certainty of evidence. However, the association between taste disorders and mild/moderate severity of COVID-19 (OR = 1.63, 95% CI = 1.33 to 1.99, I² = 69%, P < 0.0001) and female patients with COVID-19 (OR = 1.77, 95% CI = 1.26 to 2.48, I² = 79%, P = 0.001) presented low certainty of evidence. Xerostomia was a new feature of this update, and the pooled data demonstrated a prevalence of 43% (95% CI = 36% to 50%, I² = 71%) in patients with COVID-19. Regarding oral mucosal lesions, the most common clinical pattern was aphthous like, followed by herpes-like lesions, candidiasis, glossitis/depapillation/geographic tongue, parotitis, and angular cheilitis. Oral lesions were more frequent in the tongue, lips, and palate, presenting miscellaneous clinical aspects that are more likely to represent coinfections. Therefore, the reanalysis of current evidence suggests the triad xerostomia, taste dysfunction, and oral mucosal lesions as common manifestations in patients with COVID-19. However, these outcomes are under discussion, and more studies will be necessary to confirm their association with direct SARS-CoV-2 infection in the oral cavity.

Is RAS the Link Between COVID-19 and Increased Stress in Head and Neck Cancer Patients?

The COVID-19 pandemic emerged as a largely unexplained outbreak of pneumonia cases, in Wuhan City, China and rapidly spread across the world. By 11th March 2020, WHO declared it as a global pandemic. The resulting restrictions, to contain its spread, demanded a momentous change in the lifestyle of the general population as well as cancer patients. This augmented negative effects on the mental health of patients with head and neck cancer (HNC), who already battle with the stress of cancer diagnosis and treatment. The causative agent of COVID-19, SARS-CoV2, gains entry through the Angiotensin converting enzyme 2 (ACE2) receptor, which is a component of the Renin Angiotensin System (RAS). RAS has been shown to influence cancer and stress such that it can have progressive and suppressive effects on both. This review provides an overview of SARS-CoV2, looks at how the RAS provides a mechanistic link between stress, cancer and COVID-19 and the probable activation of the RAS axis that increase stress (anxiogenic) and tumor progression (tumorigenic), when ACE2 is hijacked by SARS-CoV2. The mental health crises brought about by this pandemic have been highlighted in many studies. The emerging links between cancer and stress make it more important than ever before to assess the stress burden of cancer patients and expand the strategies for its management.

Effects of Natural Ventilation and Saliva Standard Ejectors during the COVID-19 Pandemic: A Quantitative Analysis of Aerosol Produced during Dental Procedures

The novel Coronavirus Disease 2019 (COVID-19) pandemic has renewed attention to aerosol-generating procedures (AGPs). Dental-care workers are at high risk of contamination by SARS-CoV-2. The aim of this study was to evaluate the efficacy of standard saliva ejectors and natural ventilation in reducing particulate matter (PM) concentration during different routine dental procedures in the pandemic period. The DustTrak monitor was used to measure PM1, PM2.5, PM10, and breathable (<4 microns) total dust during 14 procedures performed with and without the presence of natural ventilation in a dental unit. Moreover, measurements were performed near the practitioners or near the standard saliva ejectors during the different procedures. In the latter condition, reduced levels of PM10 were recorded (82.40 ± 9.65 μg/m³ vs. 50.52 ± 0.23 μg/m³). Moreover, higher levels of PM (53.95 ± 2.29 μg/m³ vs. 27.85 ± 0.14 μg/m³) were produced when the dental unit's windows were open. At the same time, the total level of PM were higher during scaling than during other procedures (data suggest not to adopt natural ventilation-both window and door opened-during dental procedures). It was also demonstrated that the use of standard saliva ejectors can considerably reduce the total released amount of PM10.

Pathogenesis of taste impairment and salivary dysfunction in COVID-19 patients

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.

Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU-An observational clinical study

Background

Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive care unit (ICU) is still limited.

Objectives

The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19.

Method

A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings.

Results

Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%.

Conclusion

Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.

Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital

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.

Future Challenges of Covid-19 and Oral Manifestations in Daily Dental Practice: A Literature Review

OBJECTIVE

Some patients reportedly present with oral manifestations of coronavirus disease 2019 (Covid-19). It is unknown if this is due to the virus itself or a side effect of treatment; however, severe acute respiratory syndrome coronavirus 2 has been shown to have a predilection for angiotensin-converting enzyme receptors that are present in the respiratory tract, oral mucosa, tongue, and salivary glands, causing alterations in taste and smell. Therefore, the objective of this review was to present the future challenges of Covid-19 and oral manifestations in daily dental practice through a literature review.

MATERIALS AND METHODS

Scientific evidence in the databases Scopus and PubMed was searched using the Boolean operators. Articles published in Spanish and English between January and December 2020 were included.

RESULTS

Of the 89 articles found in Scopus, 69 were of the open access type and 20 were in the "others" category; only 22 scientific articles were found in PubMed.

CONCLUSION

It is important to take into account these clinical manifestations such as loss of taste and smell in order to detect the disease. Good oral hygiene is also recommended as a preventive measure to reduce viral load, which considerably reduces the probability of infecting other people who are in contact with the infected patient.

Oral Mucosa, Saliva, and COVID-19 Infection in Oral Health Care

The SARS-CoV-2 virus has shaken the globe with an ongoing pandemic of COVID-19 and has set challenges to every corner of the modern health care setting. The oral mucosa and saliva are high risk sites for higher viral loads and dental health care professionals are considered a high risk group. COVID-19-induced oral lesions and loss of taste and smell are common clinical complaints in the dental health care setting. The SARS-CoV-2 virus has been found to cause a wide range of non-specific oral mucosal lesions, but the specific diagnosis of these mucocutaneous lesions as COVID-19 lesions will facilitate the prevention of SARS-CoV-2 in dental health care settings and aid in proper patient management. The reported loss of taste and smell needs further investigation at the receptor level as it will give new insights into SARS-CoV-2 pathogenicity. The high yield of virus in the salivary secretion is a common finding in this infection and ongoing research is focusing on developing saliva as a rapid diagnostic fluid in COVID-19. In this review, we discuss the significance of oral mucosa, saliva and the relevance of the COVID-19 pandemic in dentistry.

Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital

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.

COVID-19 and Dentistry in 72 Questions: An Overview of the Literature

The outbreak of Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has significantly affected the dental care sector. Dental professionals are at high risk of being infected, and therefore transmitting SARS-CoV-2, due to the nature of their profession, with close proximity to the patient's oropharyngeal and nasal regions and the use of aerosol-generating procedures. The aim of this article is to provide an update on different issues regarding SARS-CoV-2 and COVID-19 that may be relevant for dentists. Members of the French National College of Oral Biology Lecturers ("Collège National des EnseignantS en Biologie Orale"; CNESBO-COVID19 Task Force) answered seventy-two questions related to various topics, including epidemiology, virology, immunology, diagnosis and testing, SARS-CoV-2 transmission and oral cavity, COVID-19 clinical presentation, current treatment options, vaccine strategies, as well as infection prevention and control in dental practice. The questions were selected based on their relevance for dental practitioners. Authors independently extracted and gathered scientific data related to COVID-19, SARS-CoV-2 and the specific topics using scientific databases. With this review, the dental practitioners will have a general overview of the COVID-19 pandemic and its impact on their practice.

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

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.

[Key dental challenges during COVID-19 pandemic: oral health monitoring in patients with chronic oral mucosal diseases]

OBJECTIVE

To develop an effective system of an interactive dynamic telemonitoring of oral health in patients with oral lichen planus (LP) during the COVID-19 pandemic.

MATERIAL AND METHODS

The observational longitudinal prospective cohort study (follow-up for 12 months) involved 53 patients (19 men and 34 women aged 49-65 years) with various forms of LP in persistent remission. During the entire observation period dentists carried out telemonitoring (through a Telegram group) of oral health of patients with LP registering the preservation/coming out from remission, as well as the causes of exacerbation of LP.

RESULTS

The developed interactive monitoring system based on the use of available video feedback communication technologies (via Telegram, WhatsApp, Viber messengers) provided stable remission in 28.3% of patients with LP (mainly typical and hyperkeratotic forms) and effective relief of exacerbations (mainly erosive-ulcerative forms) associated with the new coronavirus infection COVID-19 in 35.8% of cases, exacerbation of concomitant systemic pathology (excluding COVID-19) in 16.9%, local traumatic risk factors in 15.1%, development of post-vaccination reactions in 3.9%. COVID-19-associated exacerbation of LP is a polymorphic symptom complex manifested by a change in classical clinical picture and heavier course of skin-mucosal dermatosis due to the addition of new, atypical for LP, manifested COVID-19-associated intraoral symptoms and generalization of skin lesions. Periods of exacerbation of LP in COVID-19 patients are significantly longer, with shorter remissions than in the prepandemic period.

CONCLUSION

Interactive telemonitoring of oral health in patients with chronic oral mucosal diseases is a safe and effective tool for dispensary observation, management and maintenance of social communications during periods of social isolation.