Oral Manifestations of COVID-19 or Coronavirus

COVID-19 or Coronavirus has affected the whole world for more than an year now, from its onset Dentists have been the most affected in terms of exposure to the virus along with the Oral Implications of it. Oral Manifestations of COVID-19 have been found to be one of the parameters which need to be dealt with. With many new things coming out everyday it is a constant process of updating ourselves of the new symptoms or Oral Manifestations of COVID-19. One symptom which is doing rounds is – “COVID Tongue” and other common symptoms such as loss of taste.

Published in an Article in pubmed.ncbi.nlm.nih.gov “Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding”

Common Oral Symptoms of Coronavirus or COVID-19 Infection:

Patients have reported to the Dental Clinic with the following symptoms either before being diagnosed or after testing negative for the Virus.

Pre-Symptomatic Symptoms: Symptoms which have preceded the COVID19 symptoms.

1 – Loss of Taste or Ageusia

2 – Loss of Smell or Anosmia

3 – Dryness of mouth or less Saliva production or Dry Mouth

4 – Dysgeusia has also been seen in some cases

Post-COVID Symptoms: Oral Symptoms which are being reported after being tested negative. It is not clear whether the symptoms have started during the Symptomatic phase of the infection or starting post Symptomatic phase as patients are being placed in quarantine.

1 – Desquamative Gingivitis

2 – Herpetiform ulcers on the Attached Gingiva

3 – Irregular Ulcers on the Dorsa Surface of tongue

4 – Lesions resembling herpetic stomatitis

5 – Blisters on Lip mucosa (inner side)

6 – Multiple painful ulcers on the entire hard palate

7 – Red and non-hemorrhagic on the anterior of the tongue

8 – Submandibular lymph nodes enlargement

9 – Cervical Lymph node enlargement

10 – Loss of Taste or Ageusia

11 – Loss of Smell or Anosmia

12 – Dryness of mouth or less Saliva production or Dry Mouth

There have been cases which were reported with Erythematous rash on the face or viral enanthema associated with the above mentioned Oral Manifestations.

Dysgeusia or Ageusia and Anosmia have been linked to the ACE2 receptors which are the target cells of SARS CoV-2 virus. Due to the higher number of ACE2 receptors present in the Oral and Nasal mucosa the above mentioned symptoms are being presented. As for the presence of Ulcers during or after the COVID-19 infection can be linked to Stress induced Apthous ulcers caused due to the stress or reactive response to the viral infection.

Oral Symptoms due to the COVID-19 Medication:

During the management of COVID-19 infection the use of combination of drugs and the intensive drug therapy has led to various side effects including the effect on Oral Mucosa. Most common is Apthous ulcers which can be secondary to Stress (mental and Physical) and also due to medical changes in the individual. Sub Mandibular Lymph Node enlargement. Candidiasis has also been seen in recovering patients who had severe COVID-19 disease, it can be attributed to the use of Steroids in the treatment.

 

References:

• jfpmc.com – Oral Manifestations and dental practice recommendations during COVID 19\
• pubmed.ncbi.nlm.nih.gov – Oral Manifestations of COVID-19 disease