Oral Manifestations in Patients with COVID-19: A 6-Month Update

Abstract

This is the first update of the previously published living systematic review that summarized evidence on the prevalence of oral signs and symptoms in patients with COVID-19. Hitherto, 183 studies were included, reporting data from 64,876 patients with COVID-19 worldwide. The overall prevalence of taste disorders was 38% (95% CI = 22% to 56%, I2 = 98%). Hypogeusia, dysgeusia, and ageusia were also evaluated by a meta-analysis, and the pooled prevalence was 34% for hypogeusia, 33% for dysgeusia, and 26% for ageusia. Taste disorders were associated with a positive COVID-19 test (odds ratio [OR] = 7.54, 95% CI = 5.24 to 10.86, I2 = 93%, P < 0.00001), showing high certainty of evidence. However, the association between taste disorders and mild/moderate severity of COVID-19 (OR = 1.63, 95% CI = 1.33 to 1.99, I2 = 69%, P < 0.0001) and female patients with COVID-19 (OR = 1.77, 95% CI = 1.26 to 2.48, I2 = 79%, P = 0.001) presented low certainty of evidence. Xerostomia was a new feature of this update, and the pooled data demonstrated a prevalence of 43% (95% CI = 36% to 50%, I2 = 71%) in patients with COVID-19. Regarding oral mucosal lesions, the most common clinical pattern was aphthous like, followed by herpes-like lesions, candidiasis, glossitis/depapillation/geographic tongue, parotitis, and angular cheilitis. Oral lesions were more frequent in the tongue, lips, and palate, presenting miscellaneous clinical aspects that are more likely to represent coinfections. Therefore, the reanalysis of current evidence suggests the triad xerostomia, taste dysfunction, and oral mucosal lesions as common manifestations in patients with COVID-19. However, these outcomes are under discussion, and more studies will be necessary to confirm their association with direct SARS-CoV-2 infection in the oral cavity.

Side Effects of mRNA-Based COVID-19 Vaccine: Nationwide Phase IV Study among Healthcare Workers in Slovakia

“…The oral cavity represents a vital locus for exhibiting extrapulmonary symptoms of SARS-CoV-2 [49][50][51]. The oral manifestations of COVID-19 patients varied significantly, and they included dysgeusia, xerostomia, aphthous stomatitis, herpetic ulcers, oral mucositis, salivary gland involvement, and fungal co-infections such as oral candidiasis and mucormycosis [49,[52][53][54][55][56][57][58][59][60].…”

“…The oral cavity represents a vital locus for exhibiting extrapulmonary symptoms of SARS-CoV-2 [49][50][51]. The oral manifestations of COVID-19 patients varied significantly, and they included dysgeusia, xerostomia, aphthous stomatitis, herpetic ulcers, oral mucositis, salivary gland involvement, and fungal co-infections such as oral candidiasis and mucormycosis [49,[52][53][54][55][56][57][58][59][60]. However, the pathophysiology of these symptoms is not fully understood, and a number of hypotheses have been proposed to explain them, including inflammatory response; the direct infiltration of SARS-CoV-2 to the lining epithelium of the oral cavity, which was found to be rich with angiotensin-converting enzyme 2 (ACE2) receptors; and secondary infection [49,50].…”

Predictors of Willingness to Receive COVID-19 Vaccine: Cross-Sectional Study of Palestinian Dental Students

“…In addition to the increased occupational risks of the dental practice, COVID-19 brought a new challenge for oral health professionals through its oral symptoms that still have no clear pathophysiology or prevalence. COVID-19-associated oral manifestations were increasingly reported in the last months, e.g., loss of taste (dysgeusia), perioral and intraoral ulcers, oral candidiasis, oral mucositis, and parotid gland inflammation; therefore, they are widely viewed as a demanding knowledge gap that requires rigorous investigation by dental researchers and practitioners [30][31][32][33][34][35][36].…”

Universal Predictors of Dental Students’ Attitudes towards COVID-19 Vaccination: Machine Learning-Based Approach

“…The discontinuation of clinical training, the abrupt shift to online education, and the increased risk of contracting COVID-19 infection through aerosol-generating procedures were found to be affecting the dental students' attitudes and behaviors amid the pandemic, which may promote their willingness to get vaccinated in order to overcome the pandemic restrictions [25][26][27][28][29]. Moreover, COVID-19 as a syndromic disease imposes further challenges to the dental practice through its puzzling oral manifestations, e.g., loss of taste (dysgeusia), oral ulcers, oral candidiasis, etc., that can complicate the timely and proper diagnosis of oral lesions [30][31][32][33][34][35][36][37]. Contrarily, dental students' knowledge about the COVID-19 pandemic was barely adequate in some countries, especially the low-income ones, which might endanger their willingness to get vaccinated [38].…”