Oral manifestations in mild-to-moderate cases of COVID-19 viral infection in the adult population.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a serious worldwide threat presented by a broad range of symptoms, from mild flu to severe pneumonia. A rising number of atypical infections have been reported. Thus, scientists and clinicians are doing hard work to unravel scientific knowledge about this novel pandemic. OBJECTIVES: The aim of the present work was to highlight the oral manifestations which could be observed in mild-to-moderate cases of COVID-19. MATERIAL AND METHODS: A questionnaire survey was performed on 665 Egyptian patients who were confirmed COVID-19-positive based on the polymerase chain reaction (PCR) test. After applying the exclusion criteria, cases with mild-to-moderate symptoms were included in the study. The questionnaire consisted of 4 sections. The 1st section included demographic data, smoking, alcohol consumption, and general health status. The 2nd section contained questions regarding the oral hygiene status of the patients, and additionally a question about the hygienic measures they took while being infected with COVID-19. The 3rd section included questions about the most commonly reported COVID-19 symptoms the patients suffered from. The 4th section included questions that referred to the oral manifestations the patients complained of while being infected with COVID-19. RESULTS: A total of 573 patients were included in this survey. It was reported that 71.7% of COVID-19 patients presented with some oral manifestations at a level of significance, with variable incidence - oral or dental pain (23%), pain in jaw bones or joint (12.0%), halitosis (10.5%), ulcerations (20.4%), and xerostomia (47.6%). Some patients (28.3%) showed 2 or 3 manifestations simultaneously. CONCLUSIONS: It was proven that mild-to-moderate cases of COVID-19 infection are associated with oral symptoms, and thus the significance of dental examination of patients with communicable diseases should be emphasized.

The impact of oral health status on COVID-19 severity, recovery period and C-reactive protein values.

Objectives The oral cavity is a potential reservoir for respiratory pathogens which can predispose patients to bacterial super-infection. Several trials have correlated poor oral hygiene with hyper-inflammation. Similarly, COVID-19 severity has been linked to hyper-inflammatory responses. Hence, in this study, we assumed that increased COVID-19 severity may be linked to poor oral health status. This was achieved through assessing oral health status, severity of COVID-19 symptoms, C-reactive protein (CRP) levels and duration of recovery.Methods Cross-sectional study based on a questionnaire; 308 Egyptian patients with confirmed positive polymerase chain reaction (PCR) tests were included in the study after exclusion criteria. The questionnaire was designed with two sections: the first section for oral health evaluation and the second section for COVID-19 severity evaluation. Assessment of the effect of oral health on COVID-19 severity was performed using an oral health score. The effect of oral health on CRP and recovery period were evaluated as secondary endpoints. Data of CRP levels and COVID-19 PCR tests were collected via the questionnaire and confirmed by reviewing medical records.Results The correlation between oral health and COVID-19 severity showed a significant inverse correlation (p <0.001, r = -0.512). Moreover, the correlation between oral health with recovery period and CRP values also revealed a significant inverse correlation (p <0.001, -0.449 and p <0.001, -0.190, respectively), showing that poor oral health was correlated to increased values of CRP and delayed recovery period.Conclusions Our study provided some evidence that oral health could have a potential impact on the severity of COVID-19. However, the correlation is limited by the study design. A more substantial research project is required to address this relation.

Salivary exosomes as a new therapy to ameliorate diabetes mellitus and combat xerostomia and submandibular salivary glands dysfunction in diabetic rats.

Diabetes mellitus (DM) is one of the major metabolic diseases. Xerostomia and salivary gland dysfunction are of its common oral complications. Exosomes, as a new therapeutic potential containing nucleic acids, proteins and lipids, act as effective vehicles for target molecules delivery. Accordingly, their therapeutic use is gaining much interest. Therefore, this work aimed to assess the therapeutic efficacy of salivary exosomes in ameliorating DM and combating xerostomia as a complication of salivary gland dysfunction in diabetic rats. In the current study, salivary exosomes were injected intravenously to rats of group II (Salivary Exo-treated group) one week after diabetes induction. Group I (Diabetic group) was left untreated. Blood sugar level was checked weekly. Water intake, salivary flow rate, salivary amylase and serum nitric oxide were assessed before and after diabetes induction and at the end of the study. After 5 weeks from the beginning of the study, salivary gland tissues were dissected and examined histologically and ultrastructurally. Gene expression of the inflammatory markers NFκB/p65 and TNFα was assessed by polymerase chain reaction. The results showed that salivary exosomes reduced blood glucose levels and enhanced salivary glands' function. This was indicated by a decrease in water intake, salivary amylase and serum nitric oxide in addition to an increase in salivary flow rate. This was confirmed histologically, ultrastructurally and via downregulation of NFκB/p65 and TNFα gene expression. Our results concluded that salivary exosomes could be considered as a novel cell free based therapy in treatment of xerostomia and salivary gland dysfunction in DM.

Effect of smoking on the proliferation capacity and osteogenic potential of human dental pulp stem cells (DPSCs).

BACKGROUND: Recently, mesenchymal stem cells (MSCs) have proven to have a high potentiality in tissue regeneration. However, genetic diseases or certain environmental risk factors, such as smoking, may compromise the functioning of MSCs, thus leading to a change in the expected clinical outcomes. OBJECTIVES: The aim of this study was to investigate the proliferation capacity and osteogenic potential of dental pulp stem cells (DPSCs) in smokers in comparison with non-smokers. MATERIAL AND METHODS: Mesenchymal stem cells were isolated from the cultured dental pulp tissue from the third molars of 5 smokers and 5 non-smokers. The proliferation capacity of DPSCs derived from both groups was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) proliferation assay. Alizarin red staining and the gene expression analysis of the alkaline phosphatase (ALP) and osteocalcin (OC) genes were performed in order to assess osteogenic differentiation. RESULTS: The MTT proliferation assay revealed that the mean absorbance rate of the DPSCs of the nonsmokers was significantly higher than that of the group of smokers (p < 0.0001). When stained with alizarin red after 21 days of osteogenic induction, fewer calcium deposits were observed among the smokers. Moreover, the ALP and OC gene expression was significantly higher in the differentiated DPSCs of the nonsmokers (p < 0.05). CONCLUSIONS: The group of smokers showed a reduced cell viability. The expression of the ALP and OC genes was lower in the DPSCs of the smokers. Therefore, smoking has a negative impact on the proliferation and regenerative potential of human MSCs.