CLINICAL AND HISTOPATHOLOGIC FEATURES OF COVID-19 IN ORAL MUCOSA: A SYSTEMATIC REVIEW

Objectives To investigate the demographic, clinical, and histologic features of patients with COVID-19 who present oral lesions. Study design An electronic search was conducted by 2 reviewers in 6 databases. Absolute and relative frequencies were obtained by descriptive analysis. Results Three publications comprising 4 cases were included. Mean patient age was 54.75 (±14.7) years, and males (n = 3, 75.0%) were more often affected. All patients (100%) were White. All individuals presented comorbidities, with the most common being diabetes (n = 2, 28.6%), hypertension (n = 2, 28.6%), and coronary heart disease (n = 2, 28.6%). All lesions presented as symptomatic ulcers (n = 4, 100%). The mean evolution time was 5 days. Hard palate (n = 2, 28.6%), tongue (n = 2, 28.6%), buccal mucosa (n = 2, 28.6%), and lip (n = 1, 14.2) were the affected sites. Regarding histologic features, the most frequent were the following: koilocytes (n = 4, 100.0%), ulcer (n = 3, 75.0%), exocytosis (n = 3, 75.0%), acute inflammation (n = 3, 75.0%), chronic inflammation (n = 2, 50.0%), and thrombus (n = 1, 25.0%). Of informed immunohistochemical markers, HSV 1 /2, CD20, CD68, CD163, CD163, CD4, CD34, CD3, and CD8 showed positivity. The mean follow up was 11.7 days with total remission of 3 (75.0%) lesions. Conclusions There is still doubt as to whether intraoral manifestations of COVID-19 patients could be a typical pattern resulting from direct viral infection or from systemic deterioration. Further investigation is needed.

COMPARATIVE ANALYSIS OF DEMAND FOR ORAL DIAGNOSIS DURING THE FIRST YEAR OF COVID-19: A BRAZILIAN CENTER EXPERIENCE

Objectives To evaluate the number of benign and malignant conditions diagnosed in a Brazilian center of oral medicine during the first year of the pandemic. Study Design Biopsy records of specimens submitted for microscopic examination were evaluated from April 2019 to March 2020 (prepandemic period [PPP]) and from April 2020 to March 2021 (pandemic period [PP]). Data were evaluated descriptively. Results A total of 756 diagnoses were retrieved during the PPP. Of them, 684 were benign lesions (90.48%) and 72 were malignant conditions (9.52%). Regarding the PP, a total of 350 diagnoses were made. Of them, 295 were benign diagnoses (83.80%) and 57 were malignancies (16.20%). Conclusions The decrease in oral diagnosis is clearly associated with the pandemic scenario. Despite the reduction in the number of oral diagnoses, malignant lesions apparently did not fail to be diagnosed. Many benign injuries will be requiring attention at the end of the COVID-19 pandemic.

ORAL MUCOSAL LESIONS IN A COVID-19 PATIENT: A CASE REPORT

Because the oral health of patients with COVID-19 can be affected by the infection, there is doubt whether these manifestations could be a typical pattern resulting from the direct viral infection or result from systemic deterioration. A 24-year-old woman was referred to the general clinical doctor complaining about fever, headache, and shortness of breath lasting around 5 days. Medical history was unremarkable. A nasopharyngeal swab (reverse transcriptase polymerase chain reaction) for SARS-CoV-2 was positive. Azithromycin and supportive treatment were prescribed. On the fifth day after the onset of symptoms (2 days after the start of antibiotic) the patient complained about sores in the mouth. Intraoral examination showed several painful, red ulcers with irregular margins and varying sizes and a nonhemorrhagic background in the oropharyngeal region. Topical anesthetic mouthrinse was prescribed. Two weeks after the initial signs, the patient is symptom free with no evidence of local or systemic disease.

Morphological and tissue-based molecular characterization of oral lesions in patients with COVID-19: A living systematic review.

OBJECTIVE: This living systematic review aims to integrate the morphological and tissue-based molecular characterization of oral lesions occurring in individuals infected by COVID-19 (OLICs). MATERIALS AND DESIGN: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Scopus, Ovid, Embase, and LILACS were searched to identify reports on OLICs with morphological and/or tissue-based molecular data. RESULTS: Four studies reporting five cases were included. Three patients were male, and the mean age of the individuals was 47.6 years. The most reported anatomical location was the palate (n = 4), whereas ulcers were the most frequent clinical presentation (n = 3). Histopathologically, all cases revealed cell vacuolization and exocytosis in the epithelial layer. In the mesenchymal layer, inflammatory cell infiltrate and thrombi/microvascular thrombosis were observed in three cases. Immunohistochemical reactions were performed in two cases. Both cases were negative for HHV-1, HHV-2, and CMV. One case revealed positivity for SARS-CoV-2 spike protein. No other molecular tests were found for the characterization of OLIC. CONCLUSIONS: The pathological characteristics of OLICs are still unspecific. However, with the ongoing COVID-19 pandemic and well-documented new cases, whether OLICs are due to coinfections or has a primary origin can be determined.

Impact of the COVID-19 pandemic on public University laboratories of oral and maxillofacial pathology: A Brazilian multicenter study.

OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on the number of diagnoses of oral and maxillofacial lesions in public laboratories after one year of COVID-19 outbreak in Brazil. MATERIAL AND METHODS: This is a cross-sectional study. Biopsies submitted to histopathologic examination from March 2019 to February 2020 (pre-pandemic period) and from April 2020 to March 2021 (pandemic period) in nine Brazilian public oral pathology laboratories were retrieved and the number of diagnoses, types of lesion, and percentage changes during both periods were analyzed. RESULTS: There were 7389 diagnoses in the pre-pandemic period and 2728 in the pandemic era, indicating a reduction of 63.08%. The reduction was 64.23% for benign lesions and 49.48% for malignant lesions, with a 50.64% reduction in squamous cell carcinoma. The largest decreases were observed in April 2020 and January 2021. CONCLUSION: An important reduction in the diagnoses of benign and malignant lesions was noted in the Brazilian public oral pathology laboratories during the first year of the COVID-19 pandemic.

Reduced demand for oral diagnosis during COVID-19: a Brazilian center experience

Abstract Brazil represents the new epicenter of novel coronavirus disease 2019 (COVID-19), surpassing the mark of more than one million cases and 50,000 deaths. Despite these terrible numbers, experts estimate that the real size of the epidemic may be up to seven times higher (Hallal et al., 2020). Also, Brazilian people with mild symptoms rarely get tested. While the country and world engage in the fight against the pandemic of COVID-19, it remains vital for our health care system to continue caring for all patients.