Conservative treatment with mouthwashes followed by tongue photo biomodulation therapy in Covid-19: a case report

Abstract

Background Oral manifestations of coronavirus disease 2019 (COVID-19), including ulcers, herpetiform lesions, macules, and petechiae, among others, are becoming increasingly recognized, but there is little guidance on their treatment. Reported cases have described treatment with various mouthwashes containing antivirals, antifungals, antibiotics, anesthetics, or steroids. Our case report is unique in that we provide guidance on the judicious use of these medications, followed by photobiomodulation therapy if the manifestations are treatment resistant. Case presentation We describe a 30-year-old Caucasian woman who tested positive for COVID-19 after developing nasal congestion and cough. Ten days after testing positive, she developed a systemic rash on her extremities and torso. At the same time, she developed swelling of the tongue lasting 1 hour, with subsequent appearance of oral lesions that resembled geographic tongue. She also had an irritable sensation on her tongue and some mild loss of sense of taste. We opted for conservative therapy, including mouth rinses containing lidocaine to be used every 6 hours. The patient used the mouth rinse therapy for 1 month and experienced a 90% improvement in her oral lesions and tongue sensitivity. However, she had repeated flares every 3 weeks over a 6-month period, and the steroid mouthwash achieved incomplete resolution. After three sessions of photobiomodulation therapy, she had no further flares or tongue sensitivity and the lesions healed. Conclusions The implication of our report is that we promote the judicious use of topical antibiotics, antivirals, antifungals, and steroids for when they are indicated. We propose lidocaine-containing mouth rinses and steroid mouthwash as an initial, symptomatic treatment regimen for ‘COVID-19 tongue.’ If there is failure of resolution, we recommend photobiomodulation therapy.

The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?

“…Oral lesions and skin lesions were also observed in the patient with COVID-19. The oral lesion was ulcer, 76 , 98 , 117 , 118 , 122 , 127 erosion and hemorrhagic crust, 98 blister, 98 depapilation, 72 desquamation 117 and erythema 76 , 117 —the skin lesion including the erythematous macula, urticaria, exanthema and perioral ulcer ( Table 10 ).…”

“… 38 , 41 , 42 , 47 , 55 , 56 , 60 , 61 , 80 , 94 , 96 , 98 , 125 , 127 , 132 Some studies also reported an occurrence of recurrent oral lesions, aphthous-like ulcers, 53 hemorrhagic ulcers 38 , 41 , 42 , 83 , 84 , 96 , 107 , 108 , 111 , 116 , 117 , 132 and macula (erythema). 42 , 55 , 56 , 76 , 80 , 81 , 91 While the findings often took place as an ulcer, other oral findings are also found in the form of plaques, 55 , 59 , 60 , 82 , 90 , 125 , 129 pseudomembrane, 38 , 39 , 42 , 46 , 55 , 59–62 , 77 , 81 , 91 , 92 , 94 , 111 , 127 , 129 depapilation, 38 , 39 , 41 , 72 , 74 , 113 , 127 or bleeding lesion. 37 , 94 , 95 , ...…”

“… 42 , 55 , 56 , 76 , 80 , 81 , 91 While the findings often took place as an ulcer, other oral findings are also found in the form of plaques, 55 , 59 , 60 , 82 , 90 , 125 , 129 pseudomembrane, 38 , 39 , 42 , 46 , 55 , 59–62 , 77 , 81 , 91 , 92 , 94 , 111 , 127 , 129 depapilation, 38 , 39 , 41 , 72 , 74 , 113 , 127 or bleeding lesion. 37 , 94 , 95 , 114 Most of these lesions were found in the tongue, 71 , 72 , 79 , 81 , 82 , 87 , 90–92 , 94 , 98 , 107 , 109–113 , 115 , 116 , 118 , 120 , 122 , 127–129 , 132 , 134 palate, 80 , 85 , 89–91 , 94 , 107 , 112 , 115 , 128 , 129 lip …”

“…42,55,56,76,80,81,91 While the findings often took place as an ulcer, other oral findings are also found in the form of plaques, 55,59,60,82,90,125,129 pseudomembrane, 38,39,42,46,55,[59][60][61][62]77,81,91,92,94,111,127,129 depapilation, 38,39,41,72,74,113,127 or bleeding lesion. 37,94,95,114 Most of these lesions were found in the tongue, 71,72,79,81,82,87,[90][91]…”

Photodynamic Therapy Applications in Cancer, Infections and Cardiovascular Disease

“…Photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT) is a photon-based therapy that uses light to mediate a variety of metabolic, analgesic, anti-inflammatory, and immunomodulatory effects [138]- [140]. PBM devices typically deliver 10mW -500mW (0.01 -> 0.01 Watts) with a power density ranging from 0.005 W/cm 2 to 5 W/cm 2 .…”