Oral Manifestations of COVID-19

The COVID-19 pandemic has brought unprecedented challenges for health authorities worldwide. The way of contagion through direct contact has facilitated the rapid spread worldwide. Most systemic infections whether it be bacterial viral or fungal will often be manifested in the oral cavity early in the disease process. Knowledge about oral manifestations is essential for early diagnoses and management.

The reasons for the absence of sufficient scientific evidence reporting oral lesions may be due to the confinement situation, lack of access to tests, and the fact that most dentists, as a result of the high‐risk contagion, have been out of the health systems and working remotely. Nevertheless, telemedicine has been a useful tool to establish triage and primary diagnosis. It is important to consider that an exhaustive intraoral examination is performed in patients that were diagnosed with COVID‐19 in order to find any oral manifestation that might be related.

SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) infection could be accelerated through dental plaque and gum inflammation. SARS‐CoV‐2 has been detected from the saliva of patients. Angiotensin-converting enzyme 2 (ACE 2) is the target receptor for SARS-CoV-2 and is highly enriched in the tongue and oral mucosa, the portal of entry into the human cell.

Although coronavirus affects the respiratory tract, salivary glands are considered a potential reservoir for salivary gland infections. Changes in the quantity and composition of saliva can contribute to taste disturbances. Loss of smell has been attributed to patients with mild or no constitutional symptoms. Survivors of COVID-19 describe oral problems they’re experiencing such as “teeth cracking and turning grey and sensitive gums. Other oral manifestations included ulcer, erosion, bulla, vesicle, fissured tongue, halitosis, dryness, and spontaneous bleeding. These symptoms appear before the systemic symptoms. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), palate (22%), gingiva (8%), buccal mucosa (5%), oropharynx (4%), and tonsils (1%).

Oral lesions were nearly equal in both genders. Latency time between the appearance of systemic symptoms and oral lesions is between 4 days before up to 12 weeks after onset of systemic symptoms. These lesions on average heal between 3 and 28 days after appearance and with different therapies including chlorhexidine mouthwash, nystatin, oral fluconazole, topical or systemic corticosteroids, systemic antibiotics, systemic acyclovir, artificial saliva, and photobiomodulation therapy. Regression of oral lesions was is in parallel association with improvement of systemic disease. Given the multi-system vascular damage, oral manifestation is inevitable. However, it seems too early to validate most symptoms as the oral manifestation of COVID and warrants larger epidemiological studies to verify the etiology and prevalence.