Oral Lesions Following Anti-SARS-CoV-2 Vaccination: A Systematic Review

Abstract

Increasing evidence relate anti-SARS-CoV-2 vaccinations to orofacial adverse reactions, therefore, the present systematic review aimed to evaluate primary oral lesions diagnosed in adult subjects, following the WHO Emergency Use Listing approved and EMA authorized vaccines, also in relation to cases’ age, gender, comorbidities, and history of COVID-19, and in relation to vaccine type and doses. The study protocol, registered on PROSPERO (CRD42022339032) and compliant with the PRISMA statement, included an electronic search across Scopus, MEDLINE/PubMed, BioMed Central databases, and PROSPERO, ended on 18 June 2022 and succeeded by a manual search, an independent data extraction, and arisk of bias evaluation through ROBINS-I tool. Qualitatively synthesized data from the 13studies included showed an overall low prevalence (16 cases), though higher in females (68.8%), of oral lesions, mainly erosions and ulcers (34.5%). Nine cases were diagnosed following Pfizer-BioNTech, two Moderna, and one AstraZeneca, Serum Institute of India, Sinopharm, and Johnson&Johnson vaccines, respectively; specifically, eight after the first dose and seven after the second. In one case, vaccine type and dose were not specified. Considering newly developing vaccines, presented findings may be updated and further studies needed to highlight factors affecting oral lesion occurrence and specific macro-microscopic phenotypes in relation to cases’ and vaccines’ characteristics.

COVID-19 Related Information on Pediatric Dental Care including the Use of Teledentistry: A Narrative Review

“…Given the fortunately low but possible occurrence of oral lesions after anti-SARS-CoV-2 vaccination, pediatric dentists should be alert to such possible additional oral needs [ 22 , 62 ].…”

Smoking Cessation on Periodontal and Peri-Implant Health Status: A Systematic Review

“…A similar estimate might also be computed for the progression of such diseases in periodontal subjects. Personalized prevention strategies may be even more relevant in those subjects considered at higher risk of periodontitis and peri-implantitis onset and progression, such as those suffering from comorbidities [ 4 , 10 , 14 , 15 , 30 , 33 , 78 , 79 , 80 ], especially diabetes [ 17 ].…”

COVID‐19 vaccine and oral lesions: Putative pathogenic mechanisms

“…Among them, polysorbate 80 (PS80), a vaccine excipient preventing mRNA rapid degradation, was proven to cross‐react with polyethylene glycol, which is involved in delayed (>24 h) mucocutaneous lesions following mRNA‐based COVID‐19 vaccines (Hatami et al, 2021 ). Accordingly, Manfredi et al reported diffuse erythematous and ulcerative lesions in a subject vaccinated with mRNA BNT162b2 Comirnaty (Pfizer‐BioNTech) containing PS80 (Di Spirito, Amato, et al, 2022 ; Di Spirito, Pelella, et al, 2022 ).…”

“…A further pathogenic hypothesis may be linked to the reactivation of herpes simplex virus type 1 and varicella‐zoster virus (Di Spirito, Amato, et al, 2022 ; Di Spirito, Pelella, et al, 2022 ; Shafie'ei et al, 2022 ), observed in oral mucosal and cutaneous adverse reactions. Both viruses are also involved in the genesis of erythema multiforme and Bell's palsy (Cirillo & Doan, 2022 ), the last seeming increasingly documented following mRNA and inactivated COVID‐19 vaccines compared with the background rate.…”

“…In conclusion, the proposed pathogenic mechanisms should be furtherly elucidated, given the rapidly evolving findings concerning oral lesions following COVID‐19 vaccines, and considering the continuously emerging SARS‐CoV‐2 variants (Di Spirito, Pelella, et al, 2022 ) and the newly developed vaccines (Di Spirito, Amato, et al, 2022 ).…”