COVID‐19‐related oral mucosa lesions among confirmed SARS‐CoV‐2 patients: a systematic review

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is the virus responsible for coronavirus disease 2019 (COVID‐19), which manifests as a flu‐like respiratory infection affecting multiple organ systems, including the gastrointestinal system, central nervous system, cardiovascular system, skin, and mucosa. In this review, we investigated the literature on specific manifestations of COVID‐19 in the oral mucosa. An online literature search in PubMed, Scopus, Google Scholar, and Medline was conducted to retrieve relevant studies on confirmed COVID‐19 patients with oral mucosa findings published between December 31, 2019, and April 07, 2021. After an independent review by two authors, 39 articles considering 59 laboratory‐confirmed cases of SARS‐CoV‐2 infection were included in the final analysis. The most common finding, reported in 29 patients (43.9%), was Kawasaki‐like syndrome. In addition, oral ulcers including aphthous, hemorrhagic, and necrotic ulcers were reported in 24 patients (36.3%). Other lesions reported included pustules, macules, bullae, maculopapular enanthema, and erythema multiforme‐like lesions. Concomitant skin lesions were present in 60.6% of patients. Fever was reported in 86.2% of patients. Forty‐eight patients (76.1%) were hospitalized. Loss of taste and smell was present in 30.8% of the patients. A comprehensive understanding of the dermatologic manifestations of COVID‐19 can improve and facilitate patient management and referrals.

Prevalence, Features and Degree of Association of Oral Lesions in COVID-19: A Systematic Review of Systematic Reviews

“…After title/abstract screening, three records, one evaluating the risk of virus contamination during minimally invasive surgery [ 19 ], one limiting the investigation to oral manifestations in children [ 20 ] and one reporting lesions observed following COVID-19 vaccination [ 21 ], were excluded. Finally, 12 studies [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] compliant with the eligibility criteria were included in the present systematic review of systematic reviews.…”

“…Out of the twelve systematic reviews included in the present study, detailed in Table 1 , all resulted to have been published in the English language between 11 September 2020 and 27 April 2022; the full texts were all available, and two authors [ 30 , 32 ] declared funding. Two systematic reviews exclusively comprised case reports and case series [ 27 , 32 ], with one also including letters to the Editor and comments [ 33 ], whilst the remaining nine [ 22 , 23 , 24 , 25 , 26 , 28 , 29 , 30 , 31 ] also considered observational cross-sectional and/or retrospective and/or prospective studies. Three systematic reviews included a meta-analysis [ 23 , 28 , 30 ], and all resulted to be of a critically low quality, except for Doceda et al’s [ 26 ], Nijakowski et al’s [ 28 ] and Orilisi et al’s [ 29 ] studies, characterized by low quality, as per the AMSTAR2 tool assessment.…”

“…The gender ratio of the investigated population was specified in six studies [ 22 , 24 , 26 , 28 , 29 , 32 ], accounting for 4925 subjects, 3156 males and 1769 females (6792 study participants without reported gender). COVID-19 illness severity was defined, differentiating hospitalized and non-hospitalized subjects, in six systematic reviews [ 22 , 25 , 26 , 28 , 29 , 30 ]; in the systematic review conducted by Erbaş et al, 2022 [ 27 ], 76.1% of the overall population was declared to be hospitalized, but it was not definable from the reported findings if the involved subjects were ≥18 years old; therefore, such cases were not presently considered. Ongoing COVID-19 treatment, instead, was described in three studies [ 26 , 28 , 32 ], generally reporting the administration of paracetamol, dexamethasone, chloroquine, antibiotics and antivirals.…”

“…Oral candidiasis (10.74%), lichenoid (4.63%) and hemorrhagic (2.73%) lesions, as well as necrotizing periodontal disease (1.64%) and desquamative gingivitis (0.90%), were also reported. The affected locations were defined in six systematic reviews [ 22 , 24 , 26 , 27 , 28 , 32 ], reporting a total of 546 cases, and the tongue was found to be the most frequently affected site (18.58%), followed by buccal and labial (13.73%) and palatal (2.70%) mucosa, gingiva (2.83%) and diffuse lesions (2.33%). Microscopic features were detailed for two cases in Amorim Dos Santos et al’s [ 22 ] and for five cases in Silveira et al’s [ 32 ] systematic reviews; two of the seven described cases were reported in both studies and all five histopathological findings concerned oral ulcers.…”

Oral Manifestations of COVID-19: A Cross-Sectional Study of Their Prevalence and Association with Disease Severity

“…The most commonly reported affected sites were the tongue (38%), labial mucosa (26%), and palate (22%). Oral lesions were symptomatic in 68% of the cases [ 6 , 8 , 9 ].…”