Covid‐19 and oral diseases: Crosstalk, synergy or association?

Abstract

Summary The coronavirus disease 2019 (Covid‐19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) that clinically affects multiple organs of the human body. Cells in the oral cavity express viral entry receptor angiotensin‐converting enzyme 2 that allows viral replication and may cause tissue inflammation and destruction. Recent studies have reported that Covid‐19 patients present oral manifestations with multiple clinical aspects. In this review, we aim to summarise main signs and symptoms of Covid‐19 in the oral cavity, its possible association with oral diseases, and the plausible underlying mechanisms of hyperinflammation reflecting crosstalk between Covid‐19 and oral diseases. Ulcers, blisters, necrotising gingivitis, opportunistic coinfections, salivary gland alterations, white and erythematous plaques and gustatory dysfunction were the most reported clinical oral manifestations in patients with Covid‐19. In general, the lesions appear concomitant with the loss of smell and taste. Multiple reports show evidences of necrotic/ulcerative gingiva, oral blisters and hypergrowth of opportunistic oral pathogens. SARS‐CoV‐2 exhibits tropism for endothelial cells and Covid‐19‐mediated endotheliitis can not only promote inflammation in oral tissues but can also facilitate virus spread. In addition, elevated levels of proinflammatory mediators in patients with Covid‐19 and oral infectious disease can impair tissue homeostasis and cause delayed disease resolution. This suggests potential crosstalk of immune‐mediated pathways underlying pathogenesis. Interestingly, few reports suggest recurrent herpetic lesions and higher bacterial growth in Covid‐19 subjects, indicating SARS‐CoV‐2 and oral virus/bacteria interaction. Larger cohort studies comparing SARS‐CoV‐2 negative and positive subjects will reveal oral manifestation of the virus on oral health and its role in exacerbating oral infection.

Establishing the prevalence of common tissue-specific autoantibodies following severe acute respiratory syndrome coronavirus 2 infection

“…One interesting possibility is the desmoglein (DSG) family, and DSG1 and 3 are found in the autoimmune blistering pemphigus disorders. While oral ulceration and blistering has been described in COVID-19 (16,17)) it is by no means a commonly reported feature in large clinical studies such as ISARIC4C (Coronavirus Clinical Characterisation Consortium) (18).…”

Associations between psychological wellbeing, depression, general anxiety, perceived social support, tooth brushing frequency and oral ulcers among adults resident in Nigeria during the first wave of the COVID-19 pandemic

“…Prior studies had shown that SARS-CoV-2 infection is a risk factor for ageusia. There are case reports of COVID-19 being associated with necrotizing periodontal disease, oral ulcers, blisters, salivary gland alterations, white and erythematous plaques, and recurrent herpetic lesions [ 42 – 44 ]. The suggested pathways for these COVID-19 related oral lesions was mediation by SARS-CoV-2-associated tropism of endothelial cells and COVID-19-mediated endothelitis that promotes inflammation of oral tissues [ 45 ].…”

Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis

“…Numerous oral lesions have been reported in patients with COVID-19 (3)(4)(5)(6)(7)(8). These manifestations include a wide and varied range, from the inflammation of the papillae of Wharton's duct to plaques on the tongue; however, the exact relationship between many of these lesions and pathologic processes of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is still a subject of investigation (9). Some of these lesions can clearly be attributed to causes other than the direct effects of SARS-CoV-2 infection.…”