Examining The Clinical Symptoms Of The Oral Cavity And Its Severity In Patients With COVID-19 Referred To Imam Reza Hospital In 2019

Introduction: COVID-19 is a viral infection caused by the acute respiratory syndrome virus (SARS-CoV-2), which clinically affects several human body organs. The present study aims to investigate the clinical symptoms of the oral cavity and its severity in patients with COVID-19 referred to Imam Reza Hospital in Tabriz in 1401. Materials and methods: In this descriptive cross-sectional study, 89 patients with COVID-19 positive PCR tests and 89 healthy individuals who met the conditions for inclusion were examined. Patient demographic information, including age, gender, history of underlying diseases, and use of toothbrushes, was recorded. Then the patients were examined by a dentist, and various oral lesions were recorded. Saliva flow rate, lesion intensity, and gingival inflammation rate (based on BOP) were recorded. The results were analyzed by SPSS24 statistical analysis software and the Marie Chi-square test. Results: Oral lesions, including painful and non-painful ulcers in the mucosa, small blisters in the oral mucosa, the presence of petechiae, and the amount of taste disorder in patients with COVID-19 were significantly higher than in healthy individuals. The severity of gingivitis in patients with COVID-19 was significantly higher than in healthy people. The difference in the frequency of oral lesions was observed in both the sick and healthy groups in both men and women and different age groups. Conclusion: COVID-19 can cause aggravation of oral lesions. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Reactivated herpetic gingivostomatitis with secondary herpes-associated erythema multiforme and oral candidiasis post-COVID infection: A case report.

The presence and reactivation of oral lesions such as herpetic gingivostomatitis, erythema multiforme, and candidiasis in a COVID-19 recovered patient could be related to COVID-19s profound role in immune dysregulation or related therapies.

Oral hemorrhagic blister and its possible related factors: Analyzes of reported cases in the literature

Objective: Oral blood blister, also known as angina bullosa hemorrhagica (ABH), is a rare lesion involving the oral cavity and agitates patients due to its dreadful appearance. This review aims to summarize oral blood blister cases in the literature. Methods: This study is based on the PRISMA guideline. An online search was conducted in PubMed/MEDLINE and Scopus databases without any restriction, and 45 articles were included. Results: Oral blood blister was slightly more prevalent in women, with a ratio of 1.09. The patients' average age was 59.93, and more than half of them were in their lives fourth to sixth decades. Half of the lesions were located on the palate, whereas the tongue, buccal mucosa, lips, the floor of the mouth, and uvula were the other common sites, respectively. Almost one-third of the cases were asymptomatic;however, pain, bleeding, and burning sensation were common symptoms in others. Eating trauma was the most relevant causative factor of this entity (57 %), yet no admissible cause was mentioned in 25 % of the cases. Hypertension, diabetes mellitus, and endocrine disease were among the most frequently reported underlying disorders. COVID-19 has been reported in a confined number of cases. In 60 % of cases, no therapeutic intervention was mentioned, while using mouthwash (6.2 %) and topical analgesics (5.1 %) as means of medicament were also mentioned in the literature. Conclusion: Oral blood blister is more common in middle-aged and elderly patients and is slightly more frequent in women. Physical trauma is the major cause of this lesion. © 2023 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI

Case Series of HIV-Associated Oral Lesions Among Antiretroviral-Naive Patients During the COVID-19 Pandemic.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has a serious impact on HIV-infected individuals due to limited access to treatment services. This report aimed to describe four cases of oral lesions in HIV-infected antiretroviral-naive patients found during the COVID-19 pandemic. Case: Four patients, males, with an age ranged from 29 to 53 years, came to Oral Medicine Department with chief complaints of lesions on their mouth. They had postponed their visit to healthcare services due to limited access during pandemic. Three patients had just been diagnosed with HIV and had not yet received anti-retrovirus, while 1 patient had not yet been detected with HIV. From the clinical examination and laboratory findings, we diagnosed the lesions with mucous patches, chronic atrophic candidiasis, angular cheilitis, necrotizing ulcerative gingivitis, linear gingival erythema, cytomegalovirus-associated ulcers, and oral hairy leukoplakia. Case Management: We gave chlorhexidine gluconate 0.2% mouthwash for mucous patches, nystatin oral suspension for chronic atrophic candidiasis, miconazole cream 2% for angular cheilitis, debridement with hydrogen peroxide 1.5% and rinsed with normal saline for necrotizing ulcerative gingivitis, and diphenhydramine hydrochloride and 0.2% chlorhexidine gluconate for CMV ulcers. All patients showed good clinical improvement after the treatments. Conclusion: Oral lesions are still commonly found in HIV-infected patients during COVID-19 pandemic. Dentists remain to have a crucial role in the early diagnosis and treatment of HIV-associated oral lesions during COVID-19 pandemic that will have an impact on HIV treatments, also in implementing the Bali Declaration on oral health in HIV/AIDS 2019 to support UNAIDS goal to end AIDS by 2030.

Relationship between oral lesions and severe SARS-CoV-2 infection in intensive care unit patients.

OBJECTIVE: Oral lesions received increased attention as likely new signs or secondary manifestations of COVID-19. Therefore, we clinically examined oral cavity of patients with COVID-19 and investigated oral lesions and patient comorbidities as possible risk factors of COVID-19 disease outcome. METHODS: From January to March 2022, a prospective study was conducted by recruiting all COVID-19 patients admitted to the Intensive Care Unit and Respiratory Intensive Care Unit of Maxi-Emergencies Hospital in Bari, Italy. RESULTS: From the enrolled 103 COVID-19 patients, 46.6% were females and 53.4% were males. Findings show that risk of presenting with severe COVID-19 disease was higher in patients who developed oral lesions related to COVID-19 than those with no oral lesions (RR = 7.998, p = .002). Next, patients with concomitant autoimmune diseases were at higher risk of a negative COVID-19 disease outcome than those without comorbidities (OR = 8.838, p = .026). CONCLUSIONS: COVID-19-related lesions of oral mucosa should not be ignored as they can be early and easily detectable signs of severe COVID-19 disease condition, thus, serving as a prevention measure for any potential unfortunate event. Findings of this study, without implying causation, offer a direction for future investigations that aim to confirm the presence of specific oral lesions in COVID-19 patients as signs of severe disease progression.

Covid-19 and oral manifestations

The last two and a half years our life has been marked by the COVID-19 pandemic. Within a few months, COVID-19 became a global pandemic that affected all age groups with millions of deaths and serious socioeconomic consequences. The clinical symptoms of the disease may be completely absent, resembling those of the flu or severe, leading to the onset of severe respiratory disease. The most common symptoms are (from low to high) fever, headache, sore throat, dry cough, fatigue. Severely ill patients may develop pneumonia and acute respiratory distress syndrome. Various cutaneous manifestations of COVID-19 have been described, as well as manifestations from the oral cavity. The etiology of oral lesions in patients with COVID-19 appears to be multifactorial. Oral manifestations may be caused due to the action of the SARSCoV-2 virus itself in the tissues of the oral cavity, as well as to the increase in stress and the decline of the immune system caused by the disease, to the medication for COVID-19 and hospital conditions. Oral manifestations include distaste, hyposalivation, burning sensation, oral lesions such as canker sores, recurrent herpes infection, candidiasis and others, while the possibility of a bilateral correlation between COVID-19 and periodontal disease is under investigation. In any case, it is taken for granted that it is necessary that a dentist should monitor as well severely ill COVID-19 patients, to enhance patient support and to contribute to pain control and relief. A better understanding of the oral manifestations of COVID-19 can help clarify the pathological processes involved in the disease and guide the dentist in the direction of more effective treatment of its oral manifestations.

Differences in Oral Lesions Associated with Tobacco Smoking, E-Cigarette Use and COVID-19 Infection among Adolescents and Young People in Nigeria.

COVID-19 infection is associated with oral lesions which may be exacerbated by tobacco smoking or e-cigarette use. This study assessed the oral lesions associated with the use of e-cigarettes, tobacco smoking, and COVID-19 among adolescents and young people in Nigeria. A national survey recruited 11-23-year-old participants from the 36 States of Nigeria and the Federal Capital Territory, Abuja. Data were collected using Survey Monkey®. Binary logistic regression analysis was conducted. Statistical significance was set at p-value less than 0.05. There were 2870 participants, of which 386 (13.4%) were tobacco smokers, 167 (5.8%) e-cigarette users, and 401 (14.0%) were both e-cigarette and tobacco users; and 344 (12.0%) had ever tested positive to COVID-19. Adolescents and young people who smoked tobacco had more than twice the odds of reporting gingival inflammation, oral ulcers, dry mouth, and changes in taste than those who did not smoke. Those who used e-cigarettes had 1.5 times higher odds of reporting oral lesions. Respondents who had COVID-19 infection had higher odds of reporting gingival inflammation and lower odds of reporting dry mouth than those who did not have COVID-19 infection. These findings were significant, and may help clinicians to screen for tobacco use and COVID-19 among adolescents and young people in Nigeria.

Oral Lesions Following Anti-SARS-CoV-2 Vaccination: A Systematic Review.

Increasing evidence relate anti-SARS-CoV-2 vaccinations to orofacial adverse reactions, therefore, the present systematic review aimed to evaluate primary oral lesions diagnosed in adult subjects, following the WHO Emergency Use Listing approved and EMA authorized vaccines, also in relation to cases' age, gender, comorbidities, and history of COVID-19, and in relation to vaccine type and doses. The study protocol, registered on PROSPERO (CRD42022339032) and compliant with the PRISMA statement, included an electronic search across Scopus, MEDLINE/PubMed, BioMed Central databases, and PROSPERO, ended on 18 June 2022 and succeeded by a manual search, an independent data extraction, and arisk of bias evaluation through ROBINS-I tool. Qualitatively synthesized data from the 13studies included showed an overall low prevalence (16 cases), though higher in females (68.8%), of oral lesions, mainly erosions and ulcers (34.5%). Nine cases were diagnosed following Pfizer-BioNTech, two Moderna, and one AstraZeneca, Serum Institute of India, Sinopharm, and Johnson&Johnson vaccines, respectively; specifically, eight after the first dose and seven after the second. In one case, vaccine type and dose were not specified. Considering newly developing vaccines, presented findings may be updated and further studies needed to highlight factors affecting oral lesion occurrence and specific macro-microscopic phenotypes in relation to cases' and vaccines' characteristics.

Prevalence, Features and Degree of Association of Oral Lesions in COVID-19: A Systematic Review of Systematic Reviews.

Regardless of rapidly emerging findings on oral lesions described in adult SARS-CoV-2-positive subjects, the evidence level remains quite low and rather contrasting; therefore, the present systematic review of systematic reviews primarily aims to point out the overall prevalence of diagnosed cases. Secondary aims are to estimate the degree of association between oral lesions and SARS-CoV-2 infection and to grade, based on the reported frequency, the primary oral lesions, with related clinical presentations and microscopic features, in relation to COVID-19 forms. A study protocol compliant with the PRISMA statement was developed. Twelve studies were included, reporting highly heterogeneous and incomplete findings, thus precluding a meta-analysis. Further studies should be conducted to assess the overall prevalence of cases diagnosed with oral lesions among adult SARS-CoV-2-positive subjects, especially considering novel viral variants, and to determine their degree of association with SARS-CoV-2 infection and COVID-19 forms. Moreover, the reported findings noticed the need to evaluate the putative role both of SARS-CoV-2 in oral lesions genesis and of periodontitis and periodontal microbiome in COVID-19 worsening and re-activations. Deeper insights into oral lesions in adult SARS-CoV-2-positive subjects could enhance the comprehension of illness pathogenesis, natural history and clinical presentation, thus improving the preparedness of health professionals in the inter-disciplinary management of COVID-19.

Oral manifestations in young adults infected with COVID-19 and impact of smoking: a multi-country cross-sectional study.

Background: Oral manifestations and lesions could adversely impact the quality of people's lives. COVID-19 infection may interact with smoking and the impact on oral manifestations is yet to be discovered. Objectives: The aim of this study was to assess the self-reported presence of oral lesions by COVID-19-infected young adults and the differences in the association between oral lesions and COVID-19 infection in smokers and non-smokers. Methods: This cross-sectional multi-country study recruited 18-to-23-year-old adults. A validated questionnaire was used to collect data on COVID-19-infection status, smoking and the presence of oral lesions (dry mouth, change in taste, and others) using an online platform. Multi-level logistic regression was used to assess the associations between the oral lesions and COVID-19 infection; the modifying effect of smoking on the associations. Results: Data was available from 5,342 respondents from 43 countries. Of these, 8.1% reported COVID-19-infection, 42.7% had oral manifestations and 12.3% were smokers. A significantly greater percentage of participants with COVID-19-infection reported dry mouth and change in taste than non-infected participants. Dry mouth (AOR=, 9=xxx) and changed taste (AOR=, 9=xxx) were associated with COVID-19- infection. The association between COVID-19-infection and dry mouth was stronger among smokers than non-smokers (AOR = 1.26 and 1.03, p = 0.09) while the association with change in taste was stronger among non-smokers (AOR = 1.22 and 1.13, p = 0.86). Conclusion: Dry mouth and changed taste may be used as an indicator for COVID-19 infection in low COVID-19-testing environments. Smoking may modify the association between some oral lesions and COVID-19-infection.

Oral lesions and saliva alterations of COVID-19 patients in an intensive care unit: A retrospective study.

AIM: To detect the type and frequency of oral lesions and clinical conditions suggestive of saliva alterations in COVID-19 patients in an intensive care unit (ICU), as well as to describe the patient´s management in each case METHODS: Information about oral conditions and mechanical ventilation was collected from oral medicine records of COVID-19 patients in an ICU (n = 519) RESULTS: From the total collected, 472 patients (90.9%) were examined by the oral medicine staff. In 242/472 patients (51.3%), alterations in the oral cavity were noted. The most frequent changes were mechanical trauma (18.1%, derived mainly from intubation), vascular/coagulation disturbances (24.1%, petechiae, bruises, varicoses, and oral bleeding), and saliva alterations (24.4%, dry mouth, and sialorrhea). Infectious lesions were mentioned in the oral medicine records (16.9%), most associated with a viral infection (15.7%), mainly herpesvirus. Improved oral change protocols included oral hygiene, use of specific medications, and laser therapy CONCLUSION: COVID-19 patients in the ICU often showed dryness in the oral and mucosa oral lesions related to vascular/coagulation disturbances, and mechanical trauma derived from orotracheal tube. An oral medicine staff must be aligned with the ICU multidisciplinary team to manage COVID-19 patients, as well as to establish diagnoses and oral cavity treatments.

Oral mucosal lesions during SARS-CoV-2 infection: a case series and literature review

Background: The most common manifestations of infection with COVID-19 are fever, sore throat, dry cough, headache, and body aches. The available evidence for successful and safe pharmacological therapy against COVID-19 has not yet been identified, and the possible evidence relates to many adverse reactions. Taste disorders, petechiae, desquamative gingivitis, unspecific oral ulcerations, xerostomia, and candidiasis are the oral manifestations related to SARS-CoV-2 infection. Main body of the : We reviewed the literature regarding the reported oral mucosal lesions in cases with confirmed COVID-19 infection together with presenting five cases with oral mucosal lesions associated with COVID-19 infection. Direct causal association between COVID-19 infection and oral mucosal lesions is still vague, hence further research is required. Conclusion: Oral examination is mandatory in cases with suspected or confirmed COVID-19 infection.

Prevalence of Oral Lesions in COVID-19 Egyptian Patients.

OBJECTIVES: The aim of this article is to detect whether oral lesions affect the tongue mainly due to higher cells expressing angiotensin-converting enzyme 2 (ACE2) than in other oral sites in COVID-19 patients. Moreover, the etiology of oral lesions was evaluated either resulting from SARS-CoV-2 sequelae or from adverse effects of drugs used for COVID-19 treatment. MATERIALS AND METHODS: One hundred and twenty-four patients were admitted to the study. All patients' data were obtained including age and gender, laboratory testing, drug administration, respiratory and systemic conditions, signs and symptoms, and oral manifestations. RESULTS: Oral manifestations were seen in 112 (90.3%) of all patients. Oral ulcers represented the most prevalent lesions in the oral cavity in 104 patients (92.8%). Lip, tongue, and labial mucosa showed the most common sites for oral ulcers. Most of oral lesions were displayed in the tongue in 96 patients (85.7%). Various medications were used in the treatment of patients. CONCLUSION: The tongue represented the most common site of oral lesions in COVID-19 patients followed by the labial mucosa. No correlation was found between the oral lesions and the drugs used for the treatment of SARS-CoV-2 infection. The systemic health and the severity of the disease were not related to the spread of the oral lesions.

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.

Oral Findings in Patients With COVID-19.

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms.

El propósito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19. Para ello se evaluaron 55 pacientes hospitalizados, confirmados COVID-19 en distintos estadios de severidad. Previo consentimiento informado, se examinó la cavidad oral y se registraron los hallazgos clínicos. El grupo de estudio estuvo conformado por 25 mujeres (45,5%) y 30 hombres (54,5%), con edades comprendidas entre 1 y 89 años. Un 40% de los pacientes mostraron alguna lesión bucal. Las lesiones más comunes fueron candidiasis y ulceraciones (7 pacientes cada uno) y en dos pacientes se observó enantema. También se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales. Asimismo, se registraron alteraciones del gusto, xerostomía y dolor/ardor bucal en el 60%, 27,3% y 36,4% respectivamente. En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal. Finalmente, la disgeusia y el dolor y/o el ardor oral fueron síntomas comunes en estos pacientes.

Estimating the viral loads of SARS-CoV-2 in the oral cavity when complicated with periapical lesions.

BACKGROUND: The oral cavity represents a main entrance of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Angiotensin-converting enzyme 2 (ACE-2), neuropilin-1 (NRP-1), and transmembrane serine protease 2 (TMPRSS2) are essential for the entry of SARS-CoV-2 to the host cells. Both ACE-2 and NRP-1 receptors and TMPRSS2 have been identified in the oral cavity. However, there is limited knowledge about the impact of periapical lesions and their metabolites on the expression of these critical genes. This study aims to measure the impact of periapical lesions and their unique fatty acids (FAs) metabolites on the expression of the aforementioned genes, in addition to interleukin 6 (IL-6) gene and hence SARS-CoV-2 infection loads can be estimated. METHODS: Gene expression of ACE-2, NRP-1, TMPRSS2, and IL-6 was performed in periapical lesions in comparison to healthy oral cavity. Since FAs are important immunomodulators required for the lipid synthesis essential for receptors synthesis and viral replication, comparative FAs profiling was determined in oral lesions and healthy pulp tissues using gas chromatography-mass spectrometry (GC-MS). The effect of major identified and unique FAs was tested on mammalian cells known to express ACE-2, NRP-1, and TMPRSS2 genes. RESULTS: Gene expression analysis indicated that ACE-2, NRP-1, and TMPRSS2 were significantly upregulated in healthy clinical samples compared to oral lesions, while the reverse was true with IL-6 gene expression. Saturated and monounsaturated FAs were the major identified shared and unique FAs, respectively. Major shared FAs included palmitic, stearic and myristic acids with the highest percentage in the healthy oral cavity, while unique FAs included 17-octadecynoic acid in periapical abscess, petroselinic acid and L-lactic acid in periapical granuloma, and 1-nonadecene in the radicular cyst. Computational prediction showed that the binding affinity of identified FAs to ACE-2, TMPRSS2 and S protein were insignificant. Further, FA-treated mammalian cells showed significant overexpression of ACE-2, NRP-1 and TMPRSS2 genes except with L-lactic acid and oleic acid caused downregulation of NRP-1 gene, while 17-octadecynoic acid caused insignificant effect. CONCLUSION: Collectively, a healthy oral cavity is more susceptible to viral infection when compared to that complicated with periapical lesions. FAs play important role in viral infection and their balance can affect the viral loads. Shifting the balance towards higher levels of palmitic, stearic and 1-nonadecene caused significant upregulation of the aforementioned genes and hence higher viral loads. On the other hand, there is a reverse correlation between inflammation and expression of SARS-CoV-2 receptors. Therefore, a mouth preparation that can reduce the levels of palmitic, stearic and 1-nonadecene, while maintaining an immunomodulatory effect can be employed as a future protection strategy against viral infection.