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

Sarasati, Andari; Agustina, Dewi; Surboyo, Meircurius Dwi Condro

doi:10.2147/idr.s411615

Cited by 4 publications

(4 citation statements)

References 139 publications

(756 reference statements)

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“…ACE-2 is suspected to serve as the initial receptor for developing oral lesions in SARS-CoV-2-infected patients. With ACE2 expression, oral tissues could facilitate direct SARS-CoV-2 invasion, contributing to its pathogenesis and potentially enhancing human-to-human transmission rates [6,16]. Limongelli et al [18].…”

Section: Discussionmentioning

confidence: 99%

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Oral manifestations of COVID-19 in unvaccinated patients: a cross-sectional study

Fernandes,

Ogrzewalska,

Martins

et al. 2023

BMC Oral Health

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Background Early studies have highlighted the possible development of dysgeusia and anosmia in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and these manifestations should be considered a potential indication of coronavirus disease 19 (COVID-19). As potential contributors to these symptoms, dentists should perform careful oral and oropharyngeal examinations and document suspicious oral lesions in patients with COVID-19, especially in those who complain of loss of taste and smell. The study’s objective was to assess the prevalence of oral manifestations among ambulatory unvaccinated symptomatic patients with suspected COVID-19 during the acute phase of the disease. Methods This cross-sectional study evaluated oral manifestations in adults (aged ≥ 18 years) with suspected and confirmed SARS-CoV-2 infection. Chi-square and Fisher’s exact tests were used to compare data between the groups (rRT-PCR-positive and rRT-PCR-negative patients). Results One hundred thirty-six participants were included. Most were female (n = 79; 58.1%), with a mean age of 39.53 (± 14.17) years. Of these, 54 (39.7%) had a positive rRT-PCR test, and 82 (60.3%) had negative rRT-PCR results. Oral manifestations were observed in 40 participants (74.1%) in the rRT-PCR-positive group and 67 participants (81.7%) in the rRT-PCR-negative group. The most common oral manifestations were xerostomia (n = 85; 62.5%) and dysgeusia/ageusia (n = 57; 41.9%). Different rates of gingivitis (n = 12; 22.2% vs. n = 5; 6.1%; p = 0.005) and halitosis (n = 7; 13.0% vs. n = 1; 1.2%; p = 0.007) were observed between the rRT-PCR-positive and -negative groups, respectively. Mouth ulcers, glossitis, tongue coating, and petechiae were reported in both groups without significant differences. Conclusions A high prevalence of oral manifestations was observed in symptomatic patients with suspected or confirmed COVID-19. Clinical Relevance This study highlights the importance of routine oral examinations by dentists as part of the multidisciplinary care of COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

“…The term “oral manifestations” has not yet been conclusively associated with pathognomonic features of COVID-19. Sarasati et al [ 16 ]. found inconsistencies and the absence of pathognomonic features in previous studies on oral lesions in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Oral manifestations of COVID-19 in unvaccinated patients: a cross-sectional study

Fernandes,

Ogrzewalska,

Martins

et al. 2023

BMC Oral Health

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“…Estimates of the prevalence of COVID-19 associated oral lesions vary widely due to differences in study methodologies and patient populations. However, studies suggest that oral lesions may affect a significant proportion of COVID-19 patients, with some reports indicating a prevalence of up to 30% [ 24 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Awareness of undergraduate dental students, interns, and freshly graduated dentists about oral manifestation associated with COVID-19

Alrajhi,

Shalabi,

Alrajhi

et al. 2023

BMC Oral Health

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Objective There is growing evidence supporting the presence of oral manifestations associated with COVID-19. The study investigates the knowledge of dental undergraduates and recently graduated dentists concerning oral presentations related to COVID-19. Methods A cross-sectional descriptive study in Saudi Arabia comprised 305 individuals, including undergraduate dental students, interns, and freshly graduated dentists. Data were collected using a questionnaire disseminated to approximately 500 subjects via WhatsApp groups and other applications. The questionnaire was tested in a pilot study for validity, edited, and validated by 2 supervisors at the College of Dentistry, Qassim University, Buraydah, Saudi Arabia. The questionnaire consisted of questions regarding sociodemographic attributes, the level of expertise of dental practitioners, and their knowledge and perspectives regarding COVID-19 and the implementation of oral lesions interrelated to it. The data was subjected to analysis through the utilization of descriptive statistics and chi-square tests, employing the statistical software SPSS (version 24). Results About 43.9% of subjects stated that COVID-19 causes oral symptoms. Respondents most frequently reported COVID-19-related dry mouth. Oral ulcers, Candida infection, Hyperpigmentation, tongue coating, atrophy, Petechiae, Herpes, white lesions, Gingivitis, and Periodontitis are further symptoms. COVID-19’s oral manifestation was unknown to 41.0% of subjects, and 37.7% of respondents lacked knowledge regarding the most impacted locations of oral manifestations. Oral signs and COVID-19 symptoms are debated and significantly associated with higher educational levels. Conclusion The dental students and freshly graduated dentists in this study have proper knowledge of COVID-19 and its symptoms. Also, most dental students and newly graduated dentists recognize the potential correlation between COVID-19 and oral manifestations with an average to excellent knowledge of the types and sites commonly affected. The level of awareness was associated with higher educational levels.

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“…A wide range of clinical oral lesions was attributed to SARS-CoV-2 infection and it has been covered in a vast body of literature, which is beyond the aim of the present study [37,38]. However, when data was compilated, selected and systematically analyzed it became obvious that lesions lacked pathognomonic features and were inconsistent so that the current published literature does not allow establishment of a direct link between the oral lesions and causation by SARS-CoV-2 infection, but seems that these were rather related to oral manifestations secondary to existing comorbidities, secondary infections, or the treatment given to combat COVID-19 disease [39][40][41][42][43][44]. Furthermore, the interesting finding of ACE2 isoforms that do not bind SARS-CoV-2 [45][46][47][48], means that identification of ACE2 in host cells does not automatically mean universal viral attachment and infection potential, and should be further analyzed on a personalized level for individual susceptibility for infection.…”

Section: Plos Onementioning

confidence: 90%

Pathological changes in oral epithelium and the expression of SARS-CoV-2 entry receptors, ACE2 and furin

Grinstein-Koren,

Lusthaus,

Tabibian-Keissar

et al. 2024

PLoS ONE

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Background Expression of angiotensin-converting enzyme (ACE)-2 and co-factors like furin, play key-roles in entry of SARS-CoV-2 into host cells. Furin is also involved in oral carcinogenesis. We investigated their expression in oral pre-malignant/malignant epithelial pathologies to evaluate whether ACE2 and furin expression might increase susceptibility of patients with these lesions for SARS-CoV-2 infection. Methods Study included normal oral mucosa (N = 14), epithelial hyperplasia-mild dysplasia (N = 27), moderate-to-severe dysplasia (N = 24), squamous cell carcinoma (SCC, N = 34) and oral lichen planus (N = 51). Evaluation of ACE2/furin membranous/membranous-cytoplasmic immunohistochemical expression was divided by epithelial thirds (basal/middle/upper), on a 5-tier scale (0, 1—weak, 1.5 –weak-to-moderate, 2—moderate, 3—strong). Total score per case was the sum of all epithelial thirds, and the mean staining score per group was calculated. Real time-polymerase chain reaction was performed for ACE2-RNA. Statistical differences were analyzed by One-way ANOVA, significance at p<0.05. Results All oral mucosa samples were negative for ACE2 immuno-expression and its transcripts. Overall, furin expression was weakly present with total mean expression being higher in moderate-to-severe dysplasia and hyperplasia-mild dysplasia than in normal epithelium (p = 0.01, each) and SCC (p = 0.008, p = 0.009, respectively). Conclusions Oral mucosa, normal or with epithelial pathologies lacked ACE2 expression. Furin was weak and mainly expressed in dysplastic lesions. Thus, patients with epithelial pathologies do not seem to be at higher risk for SARS-CoV-2 infection. Overall, results show that oral mucosae do not seem to be a major site of SARS-CoV-2 entry and these were discussed vis-à-vis a comprehensive analysis of the literature.

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

Cited by 4 publications

References 139 publications

Oral manifestations of COVID-19 in unvaccinated patients: a cross-sectional study

Oral manifestations of COVID-19 in unvaccinated patients: a cross-sectional study

Awareness of undergraduate dental students, interns, and freshly graduated dentists about oral manifestation associated with COVID-19

Pathological changes in oral epithelium and the expression of SARS-CoV-2 entry receptors, ACE2 and furin

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