Prevalence of physical and psychological impacts of wearing personal protective equipment (PPE) on health care workers during COVID-19; a systematic review and meta-analysis. (preprint)

Background: The COVID-19 pandemic has necessitated the use of personal protective equipment (PPE) among the frontline health care workers (HCWs). Although PPE offers a great deal of help in preventing infection, it poses significant physical and psychological impacts at varying levels. Correspondingly, multiple independent studies have brought out the PPE associated problems. However, there exists a lacuna on comprehensive information of global prevalence related to the same. Aims: To estimate the prevalence and risk factors of PPE among HCWs during COVID-19 across the globe. Design: Systematic review and Meta-analysis. Method: The review was undertaken as per the protocol registered in PROSPERO xxxxxx following PRISMA guidelines. Two independent reviewers have undertaken the search strategy, study selection and methodological quality assessment. Discrepancies were addressed by the third reviewer. Heterogeneity was addressed through I2 statistics and forest plots generated by open meta-software. Results: A total of 16 articles conducted across 6 different countries among 10,182 HCWs were included in the review. The pooled prevalence of skin lesions, headache, sweating, breathing difficulty, vision difficulty, thirst/dry mouth, fatigue and communication difficulty, anxiety, fear were 57(47-66%),51(37-64%),75(56-90%),44(23-68%),61(21-94%),54%(30-77%),67(58-76%),74%(47-94%),28(24-33%),14(10-17%) respectively. Moreover, the various risk factors included; the use of PPE greater than 6 Hrs. and young females. In addition, the medical management of new-onset problems created an additional burden on the frontline HCWs. Conclusion: The front-line HCWs encountered physical and psychological problems at varying levels as a result of wearing PPE which needs to be addressed to prevent the inadequate use of PPE leading to infections. Relevance to clinical practice: The review sheds light on the need to address the physical and psychological morbidity due to PPE use for ensuring the working morale and optimum health status of frontline HCWs to combat ongoing and future pandemics.

An Online Program of Seated Gentle Yoga & Yogic Breathing Improves Symptoms in Scleroderma: A Quality Improvement Study (preprint)

Importance Dry mouth is a common symptom experienced by scleroderma patients. Gentle yoga & yogic breathing improves salivation and other symptoms through parasympathetic dominance and may help scleroderma patients. Objective To conduct a pilot, feasibility study of an online Gentle Yoga and Yogic Breathing (GYYB) intervention for scleroderma patients during COVID-19 pandemic. Design, Setting, and participants A 60-minute GYYB exercise session was designed with consideration for the limitations of the scleroderma population and advertised in online communities. There were 99 participants registered over a seven week period. The sessions were led by certified Yoga Therapist weekly on Saturdays from 11 AM to 12 PM eastern time for seven weeks during COVID-19 pandemic (from 4/4/2020 to 5/16/2020) via the Zoom online teleconferencing tool. After each session participants had the opportunity to voluntarily complete feedback questionnaires about the session using Google Forms® designed for this purpose. Results Of 99 people that attended the sessions, 45 participants responded to the questionnaires. Over half (57.8%) respondents stated they would “Definitely” return to another session and participant satisfaction with the intervention was high (mean [SD] score 9.1 (1.3) on a scale of 1 [“Didn’t Like It at All”] to 10 [“Loved It”]). The majority reported liking both the yoga and breathing activities (75.6%) and 22.2% preferred the breathing activities. The majority (75.6%) found participation using computer or mobile phone “Very Easy”, with one participant reporting that it was “Very Difficult”. Most participants found doing yoga once daily (61.4%) for 30 minutes (56.6%) was most feasible. After one session, the majority (64.3%) reported they “Felt Better”, and no adverse effects were reported by any participant during the study. Conclusion and Relevance These data provide the first published evidence that an online yoga intervention may help address the need for low-cost, effective, non-pharmacological interventions to help people with scleroderma manage secondary symptoms and potentially improve their QoL.

Oral cavity manifestations in COVID-19 patients: A cross-sectional study (preprint)

Objective To determine the prevalence of oral manifestations in symptomatic patients in the ambulatory setting with suspected COVID-19. Methods This cross-sectional study evaluated oral manifestations in adults (aged ≥ 18 years) with suspected and confirmed SARS-CoV-2 infection. Chi-square and Fisher’s exact tests were used to compare data between the groups (RT-PCR-positive and RT-PCR-negative patients). Results One hundred and thirty-sixparticipants were included. Mostwere female (n = 79; 58.1%), mean age of 39.53 (± 14.17) years. Of these, 54 (39.7%) had a positive RT-PCR test, and 82 (60.3%) had negative RT-PCR results. Oral manifestations were observed in 40 participants (74.1%)in the RT-PCR-positive group and in 67 participants (81.7%) in the RT-PCR-negative group. The most common oral manifestations were xerostomia (n = 85; 62.5%) and dysgeusia/ageusia (n = 57; 41.9%). Different rates of gingivitis (n = 12; 22.2% vs n = 5; 6.1%) and halitosis (n = 7; 13.0% vs n = 1; 1.2%) were observed between the RT-PCR-positive and negative groups, respectively. Mouth ulcers, glossitis, tongue coating, and petechiae were reported in both groups, without significant differences. Conclusions A high prevalence of oral manifestations was observed in symptomatic patients with suspected or confirmed COVID-19. Clinical Relevance This study highlights the importance of routine oral examinations by dentists as part of the multidisciplinary care of COVID-19 patients.

Oral health related quality of life and the prevalence of ageusia and xerostomia in active and recovered COVID-19 Patients.

Background: Salivary disturbance is associated with patients who either have an active coronavirus disease 2019 (COVID-19) or have recovered from coronavirus infection along with loss of taste sensation. In addition, COVID-19 infection can drastically compromise quality of life of individuals. Objective: This study aimed to analyze xerostomia, ageusia and the oral health impact in coronavirus disease-19 patients utilizing the Xerostomia Inventory scale-(XI) and the Oral Health Impact Profile-14. Methods: In this cross-sectional survey-based study, data was collected from 301 patients who suffered and recovered from COVID-19. Using Google Forms, a questionnaire was developed and circulated amongst those who were infected and recovered from coronavirus infection. The Xerostomia Inventory (XI) and Oral Health Impact Profile-14 were used to assess the degree and quality of life. A paired T-test and Chi-square test were used to analyze the effect on xerostomia inventory scale-(XI) and OHIP-14 scale scores. A p-value of 0.05 was considered as statistically significant. Results: Among 301 participants, 54.8% were females. The prevalence of xerostomia in participants with active COVID-19 disease was 39.53% and after recovery 34.88%. The total OHIP-14 scores for patients in the active phase of infection was 12.09, while 12.68 in recovered patients. A significant difference was found between the mean scores of the xerostomia inventory scale-11 and OHIP-14 in active and recovered COVID patients. Conclusion: A higher prevalence of xerostomia was found in COVID-19 infected patients (39.53%) compared to recovered patients (34.88%). In addition, more than 70% reported aguesia. COVID-19 had a significantly higher compromising impact on oral function of active infected patients compared to recovered patients.

Treatments of COVID-19-Associated Taste and Saliva Secretory Disorders (preprint)

Since the worldwide spread of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), treating taste and saliva secretory disorders associated with coronavirus disease 2019 (COVID-19) has become one of the most critical issues in the COVID-19 era. The aim of the present study was to update information on treatments being applicable to such oral symptoms and discuss their pathogenic mechanisms. Promising treatments include different types of methods using tetracycline, corticosteroid, zinc, stellate ganglion block, phytochemical curcumin, traditional herbal medicine, nutraceutical vitamin D, photobiomodulation, antiviral drug, malic acid sialagogue, chewing gum, acupuncture, and/or moxibustion. At present, however, fully validated treatments are still lacking for COVID-19-associated ageusia/dysgeusia/hypogeusia and xerostomia/dry mouth/hyposalivation. An appropriately selected treatment and oral healthcare should be provided to COVID-19 patients and survivors suffering from taste and saliva secretory disorders. Understanding of currently available treatment options is required for dental profes-sionals because they not only experience patients who were infected with SARS-CoV-2 or recov-ered from COVID-19 but first become aware of their abnormal taste and salivary secretion. By doing so, dentists and dental hygienists can play a crucial role in managing COVID-19-associated oral symptoms and contribute to improving the oral health-related quality of life of the relevant dental patients.

Oral manifestations of long COVID and the views of healthcare professionals. (preprint)

Aims Oral manifestations have been observed with this condition, however, little is known about their impact on the healthcare professionals routinely managing these patients. To investigate the prevalence of the oral manifestations of long COVID and the healthcare professionals' views, experiences and practices for managing these conditions. Materials and methods A cross-sectional mixed-methods study, including a self-reported online questionnaire (n=104) and healthcare professionals’ (n=7) semi-structured interviews, was conducted. Descriptive statistics and reflexive thematic analysis were used to analyse the data. Results 78% of respondents reported one or more oral conditions associated with COVID. Changes in the sense of taste and/or smell (58%), dry mouth (48.1%) and mouth sores (45.7%) were frequently reported. Themes identified from healthcare professionals’ interviews were areas for research, management and interdisciplinary collaboration. Discussion Allied healthcare professionals may assist dental professionals with managing oral manifestations of long COVID. Inadequate access to NHS dentistry is deterring patients worried about their oral symptoms and the limited oral knowledge of healthcare professionals affects their ability to manage patients. Conclusion Oral manifestations of long COVID have been observed by healthcare professionals, however, further information and training on this topic would assist them with managing patients and increasing awareness among clinicians.

Comparison of the 1 and 2% pilocarpine mouthwash in a xerostomic population: a randomized clinical trial.

AIMS & BACKGROUND: Pilocarpine is an accepted treatment for xerostomia, but limited research has been conducted on the oral, topical form. The present study aimed to compare the effects of 1 and 2% pilocarpine mouthwash on xerostomic participants. METHODS: In this double-blind clinical trial study, 48 subjects with xerostomia were randomly divided into three groups to measure the effects of 1 and 2% pilocarpine and placebo mouthwashes on saliva levels. The amount of saliva in the 1st and 14th days was measured at 0, 45, 60, and 75 mins, while participants used their mouthwash three times a day for 14 days. On the 1st and 14th days, they filled out the information forms on xerostomia and the medicine's side effects before and after the intervention. RESULTS: On the 1st day, the mean salivary flow at 45, 60, and 75 mins in the 2 and 1% pilocarpine mouthwash were significantly higher than in the placebo mouthwash group (p < 0.05). On the 14th day, the mean salivary flow time at 45 mins in the 2% pilocarpine mouthwash group was significantly higher than in the placebo mouthwash group (p = 0.007). Furthermore, the mean salivary flow at 60 and 75 mins in the 2% (p < 0.001) and 1% pilocarpine mouthwash (p = 0.028) was significantly higher than in the placebo group. Moreover, the salivary flow in the 2% pilocarpine mouthwash group was significantly higher than the 1% pilocarpine mouthwash (p < 0.05) during these two times. No side effects were observed in any of the subjects. CONCLUSIONS: The study showed that 5 ml of 2 and 1% pilocarpine mouthwash for 2 weeks increased salivary flow in xerostomic participants compared to placebo without any side effects.

Oral manifestations of COVID-19 correlated to medical and drug history, a survey on infected medical doctors. (preprint)

Objective Reporting the oral symptoms of COVID-19 and correlate the occurrence of these symptoms with various possible etiologic factors. Methods A cross-sectional web-based survey targeted Medical doctors infected with COVID-19. The survey questioned the diagnosis of the disease, the severity of the disease symptoms, the oral symptoms along with drug and medical history. A total sample of 312 response were analyzed and correlated with various factors including the patients’ age, sex, medical history, drug history, hospitalization and severity of COVID-19 symptoms. Results Oral manifestations were reported in 72.5% of the participants. The most common oral manifestations were dysgeusia in 76% of patients which was partial in 64% of the participants. Xerostomia was reported in 41.6% of cases. Aphthous stomatitis and recurrent herpetic infections were also reported. The occurrence of oral symptoms was increased among population with previous medical history with no evidence of correlation with any other factors regarding gender, certain medications or oral hygiene. Conclusion The most common oral manifestations of COVID-19 are dysgeusia and xerostomia and the occurrence of oral manifestations is increased in patients with previous medical condition. Clinical relevance: awareness of the possible symptoms and medical conditions that may potentiate the severity of oral symptoms during COVID-19 infection allows targeting the precise mechanism to treat the oral symptoms.

Prolonged mask wearing does not alter the oral microbiome, salivary flow rate or gingival health status - A pilot study.

The COVID-19 pandemic has resulted in the widespread use of N95 respirators and surgical masks, with anecdotal reports among healthcare providers and the public of xerostomia, halitosis, and gingivitis, a consortium of symptoms colloquially termed "mask mouth". However, this has not been scientifically verified. The aim of this study was to assess changes in salivary flow rate, gingival health status and oral microbiome associated with prolonged mask use. A total of 25 dental students (mean age = 26.36 ± 1.58) were included in the study and evaluated at three time points: T1, at the end of at least 2 months of full-day mask wear (7.26 ± 1.56 hours/day); T2, at the end of a period of minimal mask use (1.13 ± 1.13 hours/day); and T3, at the end of 2-3 weeks of resuming full-day mask wear (6.93 ± 1.80 hours/day). Unstimulated whole saliva (UWS) flow rate, xerostomia (on a quantitative scale of 10), gingival index (GI) and plaque index (PI) were assessed at each time point. The salivary microbiome was characterized using 16S rRNA gene sequencing. Overall, UWS flow rates were normal (mean of 0.679 ml/min) and xerostomia, PI and GI scores were low (Mean of 3.11, 0.33 and 0.69, respectively) with no significant differences as a result of prolonged mask wearing. Similarly, there were no significant microbial changes at a false discovery rate (FDR) ≤ 0.05. However, some trends were identified using a nominal p-value cut-off of ≤ 0.01, namely Gemella sanguinis, Streptococcus sp. Oral taxon 066 and Oral taxon 058 were associated with prolonged mask wear. Trends were also seen by gender, race and age, for example an increase in P. gingivalis and P. intermedia with age. In conclusion, we found no evidence that prolonged mask wear adversely affects oral health. The findings support that the oral microbiome of healthy individuals is resilient.

A multi-country study on the impact of sex and age on oral features of COVID-19 infection in adolescents and young adults.

BACKGROUND: Oral diseases are features of COVID-19 infection. There is, however, little known about oral diseases associated with COVID-19 in adolescents and young adults (AYA). Therefore, the aim of this study was to assess oral lesions' association with COVID-19 infection in AYA; and to identify if sex and age will modify these associations. METHODOLOGY: Data was collected for this cross-sectional study between August 2020 and January 2021 from 11-to-23 years old participants in 43-countries using an electronic validated questionnaire developed in five languages. Data collected included information on the dependent variables (the presence of oral conditions- gingival inflammation, dry mouth, change in taste and oral ulcers), independent variable (COVID-19 infection) and confounders (age, sex, history of medical problems and parents' educational level). Multilevel binary logistic regression was used for analysis. RESULTS: Complete data were available for 7164 AYA, with 7.5% reporting a history of COVID-19 infection. A significantly higher percentage of participants with a history of COVID-19 infection than those without COVID-19 infection reported having dry mouth (10.6% vs 7.3%, AOR = 1.31) and taste changes (11.1% vs 2.7%, AOR = 4.11). There was a significant effect modification in the association between COVID-19 infection and the presence of dry mouth and change in taste by age and sex (P = 0.02 and < 0.001). CONCLUSION: COVID-19 infection was associated with dry mouth and change in taste among AYA and the strength of this association differed by age and sex. These oral conditions may help serve as an index for suspicion of COVID-19 infection in AYA.

Paxlovid administration in elderly patient with COVID-19 caused by Omicron BA.2.0: A case report.

RATIONALE: Paxlovid has shown the potential decreasing the hospitalization rate of mild or moderate coronavirus disease 2019 (COVID-19) and death in few of clinical trials, and is expected to the most promising medicine targeting Severe Acute Respiratory Syndrome Coronavirus 2 (SRAS-COV-2). However, there are no enough evidences to show it effectiveness for all patients with SARS-COV-2, especially among elderly patients and newest Omicron variant. PATIENT CONCERNS AND DIAGNOSIS: A 79 year's old female patient was admitted to hospital because of the moderate COVID-19 caused by the Omicron variant BA2.0. He presented the initial syndromes including Xerostomia, cough and fever. Chest computed tomography (CT) scanning at admission showed the exudation lesions on lung. The laboratory examination revealed that there are increased C-reactive protein (CRP), Ferritin and erythrocytesedimentationrate (ESR) and decreased white blood cells. INTERVENTIONS: The oral Paxlovid (Nirmatrelvir/Ritonavir) was administrated on second day after admission. OUTCOMES: The syndromes of Xerostomia, cough and fever was improved on third day after use of Paxlovid. The levels of CRP, ESR and counts of white blood cells returned the normal after three days of admission. The chest CT scanned on the third and sixth day after Paxlovid used showed the absorption of lesions. The examination of SARS-COVS viral nucleic acid turned negative at fifth day of admission. LESSONS: As a result, we would consider that Paxlovid is a suitable oral drug for elderly patients with SARS-COV2 even Omicron variant, it's benefit to improve patient's symptom and signs and can prevents COVID-19 with the high-risk factors from severe disease, although it didn't shorten the time for viral nucleic acid to turn negative.

An update on oral clinical courses among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: A clinical follow-up (a prospective prevalent cohort) study.

INTRODUCTION: Contemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations. MATERIALS AND METHODS: A prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted toat the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study consisted of two follow-up phases: Hospital and patient-home-based. RESULTS: A total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n = 10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n = 6), xerostomia (n = 5), and thickening of saliva (n = 1). The oral mucosal lesions per se consisted of aphthous lesions (n = 3), candidiasis (n = 1), geographic tongue (n = 1), and localized gingivitis (n = 1). The four weeks' home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n = 10) to 29% (n = 16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up. DISCUSSION: The study's findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.

Association between COVID-19 stress, coping mechanisms and stress-related oral conditions among Egyptian adults: a cross-sectional study.

The present study investigated the association between COVID-19 stresses and oral conditions including gingivitis, oral hygiene, oral ulcers, and dry mouth. This was a cross-sectional study that collected data from adults in community settings in Alexandria, Egypt, between October 2021, and February 2022. Gingival condition and oral hygiene were assessed using the gingival and plaque indices. Participants were asked if they experienced oral ulcers during the past week and dry mouth during the past year. COVID-19 fears and coping were assessed using the COVID Stress Scale (CSS), and the Brief Resilience Coping Scale (BRCS), respectively. Oral health behaviors were assessed using the World Health Organization questionnaire. Regression analyses were used to assess the association between the dependent variables (clinically assessed gingival and plaque indices, reported presence of oral ulcers, and dry mouth) and explanatory variables (CSS and BRCS) after adjusting for confounders (COVID-19 status, oral health behaviors, smoking, age in years, sex, and highest educational level). The response rate was 88.8% (373/420). The mean (SD) age = 39.26 (11.45) with 74.3% females and 49.3% reporting completing high school or higher education. The mean (SD) plaque and gingival indices were 1.59 (0.66) and 1.39 (0.59), respectively. Only 20.1% reported the presence of oral ulcers and 41.6% reported xerostomia. Lower plaque score was associated with higher COVID-19 contamination fears (B = - 0.03, 95% CI - 0.05, - 0.02) and higher compulsive checking and reassurance-seeking (B = - 0.02, 95% CI - 0.03, - 0.009). Lower gingival score was associated with higher COVID-19 contamination fears (B = - 0.02, 95% CI - 0.03, - 0.002). Higher odds of reporting dry mouth were associated with greater fear of COVID-19 socioeconomic consequences (AOR = 1.05, 95% CI 1.001, 1.09), and lower coping scores (AOR = 0.93, 95% CI 0.88, 0.99). The findings suggest an association between COVID-19 specific stresses and stress-related oral conditions and shed light on the possible link between mental and oral health, emphasizing the importance of integrated planning of care services.

Evidence of a Sjogrens disease-like phenotype following COVID-19 (preprint)

Objectives: Sjogrens 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 patient 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.

Candidiasis and Other Bacterial Infections among Patients Diagnosed with Burning Mouth Syndrome.

Background and Objectives: Burning mouth syndrome (BMS) is a state in which a patient experiences intraoral burning or a dysesthetic sensation without clinically evident causative lesions in the oropharyngeal area. The disorder is linked to a variety of conditions, including dry mouth, Candida, and bacterial infections. The aim of this study was to determine the incidence of oral Candida and/or bacterial infections among patients with BMS and whether they have an effect on pain/burning and salivary flow levels. Objectives: (1) Gather patient data regarding the presence of oral infections, dry mouth, and pain levels in the morning, afternoon, and evening periods; (2) data analysis and assessment to determine medians, means, frequencies, correlations, and statistically significant differences between patient groups. Materials and Methods: Overall, 173 patients (23 males and 150 females) with BMS and 13 controls (five males and eight females) took part in the study. We measured pain/burning levels, unstimulated and stimulated salivary flow, the percentage of patients infected with Candida species and/or bacterial species, and the said species growth in Petri dishes. Results: Candida albicans was the most commonly found infection among patients with BMS (n = 28, 16.2%). Overall, 21.4% patients with BMS were diagnosed with either C. albicans or another Candida species. Enterobacter had the richest growth among patients with BMS (7.5% out of the infected 10.4% BMS patients). No statistical significance could be noted between the existence of either Candida species or bacterial species infections and changes in pain/burning and salivary flow levels. Negative correlations were noted between age and unstimulated and stimulated salivary flow, and positive correlations were noted between age and Candida andspecific bacteria species' growth levels. Conclusions: Although patients with present bacterial or Candida infections showed a marginal increase in pain/burning levels, no direct statistically significant associations could be made between the presence of Candida species or other bacteria and the symptoms among patients with BMS.

Unusual Case of Painful Glossitis and Xerostomia Following Vaccination with Pfizer-BioNTech SARS-CoV-2 (BNT162b2).

BACKGROUND Adverse events following immunization (AEFIs) remain under recognized, particularly when the symptoms experienced are uncommon and mimic natural disease. In the context of the worldwide effort to provide protection against SARS-CoV-2 using multiple doses of vaccination and with the availability of multiple vaccines, the early recognition and prompt treatment of AEFIs has increased importance, as does the ability to carefully select an alternative after an AEFI occurs. CASE REPORT A 60-year-old woman presented for clinical immunology review with a 9-month history of glossitis and xerostomia. Onset of symptoms occurred following her first vaccination with a COVID-19 vaccine (BNT162b2). After partial interval improvement, her symptoms progressively worsened after a second vaccination and third booster vaccination with BNT162b2. While undergoing reviews from multiple specialists for possible underlying connective tissue disease, and with other causes of her symptoms being excluded, the patient's symptoms progressed, with worsening tongue swelling with new fissuring and xerostomia. The patient experienced an unintentional weight loss of 8 kg due to oral discomfort. It was only after this time that an AEFI was considered the cause of her presentation, after all other diagnostic considerations were considered unlikely. Targeted, symptomatic, localized treatment with topical oral corticosteroids was initiated, followed by a gradual tapering regimen, with excellent response. CONCLUSIONS This case highlights the need to consider AEFIs early in the differential diagnosis of unusual presentations and the importance of considering a trial of targeted symptomatic treatment for patients, even if diagnostic uncertainty remains.

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 Manifestations of COVID-19: A Questionnaire-Based Survey of the Mild and Moderate Cases in the Turkish Population (preprint)

BACKGROUND A myriad of symptoms associated with COVID-19 have been reported in the literature. It's currently unclear if these symptoms are part of a normal clinical pattern directly induced by SARS-CoV-2 infection or are secondary to the patient's compromised systemic condition, given the probability of coinfections, immunosuppression, and treatment-related adverse effects (4). The aim of this research was to find answers to the question"What is the prevalence of oral symptoms in COVID-19 patients?“. METHODS A questionnaire was designed to detect and identify changes in the oral mucosa in patients with COVID-19 infection. During their follow-up at the Gölcük State Hospital COVID Outpatient Clinic, clinicians and an academic specialist performed a face-to-face survey of the patients. Participants were informed about the purpose of the study and their consent to participate in the study was obtained along with their signatures on the questionnaire form. The data was collected between April 12 and May 22, 2020, and it was analyzed, archived, and processed anonymously. RESULTS This survey included 306 COVID-19 patients in total. The results revealed that only 29.4% of respondents had complaints of oral aphthae and ulcers and 18.94% experienced oral pain; with the most commonly reported symptom being xerostomia (67,6%). There was a widespread distribution of reported symptoms with varying incidences and locations. CONCLUSION Analyzing the data this study procured, one still can’t conclusively determine whether the oral manifestations develop secondary to COVID-19.

Oral manifestations in SARS-CoV-2 infection.

BACKGROUND: We aimed to evaluate the prevalence of predisposing factors and oral manifestations in SARS-CoV-2 infection. MATERIAL AND METHODS: 204 SARS-CoV-2 positive patients were included in the study. Questions regarding the systemic, periodontal health, oral hygiene habits, common symptoms and, oral manifestations of COVID-19 such as oral lesions, and dry mouth were included in the survey. The Visual Analogue Scale (VAS) was used. RESULTS: 47.5% of individuals had various systemic diseases. Dry mouth (44.2%) and oral lesions (22.4%) were the most common oral manifestations in COVID-19 patients. Also, dry mouth had the highest VAS score. The most common oral lesion locations were buccal mucosa (15.2%) and tongue (10.8%). The majority of participants (142 patients) were affected by taste disorders. Patients who received periodontal treatment before SARS-CoV-2 infection reported fewer oral complaint and manifestations than those who did not receive periodontal therapy (p=0.032). There was no statistically significant difference between males and females on the presence of any oral manifestations, and taste disorders. CONCLUSIONS: Our results showed that SARS-CoV-2 could cause oral manifestations. However various predisposing factors may be part of the etiology and promote oral findings.

An update on oral clinical courses among patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection: A clinical follow-up (a prospective prevalent cohort) study (preprint)

Abstract Introduction Contemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations. Materials and Methods A prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted at the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study had two follow-up phases: Hospital and patient-home-based. Results A total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n=10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n=6), xerostomia (n=5), and thickening of saliva (n=1). The oral mucosal lesions per se consisted of aphthous lesions (n=3), candidiasis (n=1), geographic tongue (n=1), and localized gingivitis (n=1). On the other hand, the four weeks home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n=10) to 29% (n=16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up. Discussion The study's findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.