Obliteration of oral and maxillofacial region by SARS-CoV-2 infection

dgkh000558 10.3205/dgkh000558 urn:nbn:de:0183-dgkh0005585 Short Review Obliteration of oral and maxillofacial region by SARS-CoV-2 infection Schädigung im Mund-Kiefer-Gesichtsbereich durch Infektion mit SARS-CoV-2 Shunmugavelu Shunmugavelu Karthik K

Department of Dentistry, Oral and Maxillofacial Pathology, PSP medical college hospital and research institute Tambaram Kanchipuram, main road Oragadam Panruti Kanchipuram district, Tamil Nadu 631604, India. Phone: +919789885622/9840023697Department of Dentistry, Oral and Maxillofacial Pathology, PSP medical college hospital and research institute Tambaram Kanchipuram, India

drkarthiks1981@gmail.com author Saravanan Saravanan Jayakanthan J

Sree Balaji Medical College and Hospital, Chrompet, Chennai, Tamil Nadu, India

author German Medical Science GMS Publishing House

Düsseldorf

610 COVID-19 oral facial dental pathology COVID-19 oral fazial dental Pathologie 20250616 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). 2196-5226 20 GMS Hygiene and Infection Control GMS Hyg Infect Control 29 COVID-19 ist charakterisiert durch Fieber, Husten, Dyspnoe und Pneumonie. In manchen Fällen manifestiert sich die Infektion orofazial, worüber anscheinend weniger häufig berichtet wird, hauptsächlich aufgrund der fehlenden oralen Untersuchung von Patienten mit Verdacht auf und/oder bestätigter COVID-19 Erkrankung. Beschrieben werden COVID-19-bedingte orale Läsionen, die die erste und/oder einzige Manifestation der Krankheit sein können. COVID-19 present as fever, cough, dyspnea, and pneumonia. The infection causes orofacial manifestations in several cases but seems to be underreported, mainly due to the lack of oral examination of patients with suspected and/or confirmed COVID-19. Described are COVID-19- related oral lesions that can be the first and/or the unique manifestation of the disease. IntroductionThe contribution of the oral cavity to COVID-19 pathogenesis and transmission has been little explored. It is unknown whether SARS-CoV-2 can infect and replicate in the oral mucosa or glands , . This is critical because if the glands or mucosa are sites of early infection, they may play an important and underappreciated role in tra</PlainText></TextGroup><TextGroup><PlainText>n</PlainText></TextGroup>smitting virus “intermucosally” to the lungs or gastrointestinal tract. Alternatively, saliva may also play a central role in transmitting the virus extraorally in asymptomatic, pre-symptomatic, or symptomatic individuals <TextLink reference="3"></TextLink>, <TextLink reference="4"></TextLink>.</Pgraph><Pgraph>The human oral cavity is a diverse collection of tissue niches with potentially unique vulnerabilities to viral infection. These sites include oral mucosae (hard palat<TextGroup><PlainText>e, b</PlainText></TextGroup>uccal mucosa, dorsal and ventral tongue) as well as the terminally differentiated secretory epithelia of the minor saliva glands (distributed in the buccal and labial mucosa, hard and soft palate, ventral and dorsal tongue) and major saliva glands (parotid, submandibular, and sublingual) <TextLink reference="5"></TextLink>, <TextLink reference="6"></TextLink>. Nearby are diverse oropharyngeal niches (palatine and lingual tonsils, soft palate). Saliva, a mixture of fluids, electrolytes, proteins, and cells (immune and sloughed mucosal epithelial cells) is made primarily by the saliva glands and empties into the oral cavity where it mixes with other fluids (crevicular fluid) and cells.</Pgraph><Pgraph>SARS-CoV-2 uses host entry factors, such as ACE2 and TMPRSS family members (TMPRSS2 and TMPRSS4). ACE2 and TMPRSS2 expression has been reported in oral tissues. Expression matrices, including a low-frequency ACE2/TMPRSS2 co-expressing cells in basal 1, ducts, mucous acini and myoepithelial clusters <TextLink reference="7"></TextLink>, <TextLink reference="8"></TextLink>.</Pgraph></TextBlock> <TextBlock name="Oral manifestations of COVID-19" linked="yes"> <MainHeadline>Oral manifestations of COVID-19</MainHeadline><SubHeadline>Ulcer and erosions</SubHeadline><Pgraph>One of the most common oral complications associated with COVID-19 confirmed or suspected individuals are ulcerative lesions of the oral cavity. The site, pattern and presentation vary. Tongue (dorsum and lateral boarder) is the most common reported site followed by hard palate and buccal mucosa. Irregular and painful ulcers either appear alone (single ulcers) or in the form of multiple tiny ulcers. Clusters of ulcers either resemble herpetiform ulcers or multiple apthoid ulcers with diffuse erythematous base. These multiple aphthoid ulcers later on coalesce to form large ulcers with yellowish fibrin covering them, resembling erythema multiform-like disease. Ulcers, erosions and blood crust on labial mucosa along with palatal and gingival petechiae are also reported <TextLink reference="9"></TextLink>, <TextLink reference="10"></TextLink>.</Pgraph><SubHeadline>Vesiculobullous lesions</SubHeadline><Pgraph>These lesions mostly appear in association with cutaneous manifestations and show a range of presentation such as blisters, petechiae, erythematous lesions and erythema multiform-like lesions. Tongue and palate (soft and hard) are the most common reported location of these lesions. Erythema multiform-like lesions are most commonly reported lesions accompanied by skin target lesions <TextLink reference="11"></TextLink>, <TextLink reference="12"></TextLink>.</Pgraph><SubHeadline>Plaques</SubHeadline><Pgraph>Candidal plaque-like lesions are also observed in association with COVID-19 both red; and white plaques. They are located on the dorsum of the tongue and palate. They were also observed along with multiple tiny ulcers, taste changes, tongue and masticatory muscles pain. Immune system suppression because of antibiotic therapy, deteriorating general health and neglected oral hygiene can be possible causes of these plaques <TextLink reference="13"></TextLink>, <TextLink reference="14"></TextLink>.</Pgraph><SubHeadline>Reactivation of HSV</SubHeadline><Pgraph>Hedou et al. <TextLink reference="15"></TextLink> while reporting cutaneous manifestations of COVID-19 in 103 patients found reactivation of herpes simplex in one intubated patient in intensive care. Although cutaneous manifestations disappeared with median time of 48 h (from 24 h to 6 days), no information regarding resolution of Herpes simplex was provided. Studies have also reported multiple tiny yellow ulcers on dorsum of the tongue that resembled to late stage of herpetic recurrent infection along with geographical tongue <TextLink reference="16"></TextLink>, <TextLink reference="17"></TextLink>.</Pgraph><SubHeadline>Angina bullosa</SubHeadline><Pgraph>These blood filled blisters are observed on soft palate, tongue and cheek. They are brown– black single or multiple lesions and may appear after initiation of therapies for COVID-19 <TextLink reference="18"></TextLink>.</Pgraph><SubHeadline>Gingival changes </SubHeadline><Pgraph>Gingival changes such as generalized erythematous and edematous gingivae, gingivo-parodontal bleeding, necrotic interdental papillae and desquamative gingivitis are reported in the literature in critically ill patients with neglected oral hygiene. In a COVID-19 suspected patient symptoms disappeared within 10 days of antibiotics and topical antiseptic mouthwash usage <TextLink reference="19"></TextLink>, <TextLink reference="20"></TextLink>.</Pgraph><SubHeadline>Dry mouth</SubHeadline><Pgraph>Dry mouth is also reported in association with COVID-19 positive patients. In a study, 16 patients reported dry mouth along with other symptoms (PCR positive for COVID-19). This number reduced to 1 when PCR for the disease became negative. In another cross-sectional study, 72 patients with COVID-19 reported dry mouth <TextLink reference="21"></TextLink>.</Pgraph><SubHeadline>Gustatory changes</SubHeadline><Pgraph>Gustatory and olfactory changes can be the only symptom in mild cases of COVID-19 or the initial symptom in patients who ultimately present with more severe respiratory failure. The reported gustatory changes associated with COVID-19 are hypogeusia, dysgeusia and ageusia <TextLink reference="22"></TextLink><TextGroup><PlainText>. I</PlainText></TextGroup>t is reported that angiotensin-converting enzyme 2 (ACE2) cell receptors are expressed in abundance on respiratory epithelium and oral mucosa especially tongue. SAR<TextGroup><PlainText>S-CoV-2</PlainText></TextGroup> has a great affinity for these receptors. Direct damage to nasal and oral epithelium and neuroinvasive nature of this virus can result in olfactory and gustatory disorders <TextLink reference="23"></TextLink>. Symptoms such as halitosis, tongue and masticatory muscle pain and swelling, geographical tongue, hyperplasia of papilla associated with taste changes and macroglossia have also been reported along with fatigue and major symptoms of COVID-19 in few case reports <TextLink reference="24"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="27"></TextLink>.</Pgraph></TextBlock> <TextBlock name="Conclusion" linked="yes"> <MainHeadline>Conclusion</MainHeadline><Pgraph>COVID-19 patients may present with ulcerative, erosive, vesicobullous and plaque-like oral lesions. Further research is needed to confirm a link between reported mucosal lesions and COVID-19, as these lesions may be the first sign of the disease or secondary to medications, reduced immunity, vascular compromise, localized or generalized inflammation and neglected oral hygiene. Dental professionals should be aware of oral manifestations, predisposing factors and underlying mechanisms while examining and before initiating any treatment in patients. </Pgraph></TextBlock> <TextBlock name="Notes" linked="yes"> <MainHeadline>Notes</MainHeadline><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph><SubHeadline>Funding </SubHeadline><Pgraph>None.</Pgraph><SubHeadline>Authors’ ORCIDs</SubHeadline><Pgraph><UnorderedList><ListItem level="1">Karthik Shunmugavelu: <Hyperlink href="https://orcid.org/0000-0001-7562-8802">0000-0001-7562-8802</Hyperlink></ListItem><ListItem level="1">Jayakanthan Saravanan: <Hyperlink href="https://orcid.org/0000-0002-4965-8829">0000-0002-4965-8829</Hyperlink></ListItem></UnorderedList></Pgraph></TextBlock> <References linked="yes"> <Reference refNo="1"> <RefAuthor>Huang N</RefAuthor> <RefAuthor>Pérez P</RefAuthor> <RefAuthor>Kato T</RefAuthor> <RefAuthor>Mikami Y</RefAuthor> <RefAuthor>Okuda K</RefAuthor> <RefAuthor>Gilmore RC</RefAuthor> <RefAuthor>Conde CD</RefAuthor> <RefAuthor>Gasmi B</RefAuthor> <RefAuthor>Stein S</RefAuthor> <RefAuthor>Beach M</RefAuthor> <RefAuthor>Pelayo E</RefAuthor> <RefAuthor>Maldonado JO</RefAuthor> <RefAuthor>Lafont BA</RefAuthor> <RefAuthor>Jang SI</RefAuthor> <RefAuthor>Nasir N</RefAuthor> <RefAuthor>Padilla RJ</RefAuthor> <RefAuthor>Murrah VA</RefAuthor> <RefAuthor>Maile R</RefAuthor> <RefAuthor>Lovell W</RefAuthor> <RefAuthor>Wallet SM</RefAuthor> <RefAuthor>Bowman NM</RefAuthor> <RefAuthor>Meinig SL</RefAuthor> <RefAuthor>Wolfgang MC</RefAuthor> <RefAuthor>Choudhury SN</RefAuthor> <RefAuthor>Novotny M</RefAuthor> <RefAuthor>Aevermann BD</RefAuthor> <RefAuthor>Scheuermann RH</RefAuthor> <RefAuthor>Cannon G</RefAuthor> <RefAuthor>Anderson CW</RefAuthor> <RefAuthor>Lee RE</RefAuthor> <RefAuthor>Marchesan JT</RefAuthor> <RefAuthor>Bush M</RefAuthor> <RefAuthor>Freire M</RefAuthor> <RefAuthor>Kimple AJ</RefAuthor> <RefAuthor>Herr DL</RefAuthor> <RefAuthor>Rabin J</RefAuthor> <RefAuthor>Grazioli A</RefAuthor> <RefAuthor>Das S</RefAuthor> <RefAuthor>French BN</RefAuthor> <RefAuthor>Pranzatelli T</RefAuthor> <RefAuthor>Chiorini JA</RefAuthor> <RefAuthor>Kleiner DE</RefAuthor> <RefAuthor>Pittaluga S</RefAuthor> <RefAuthor>Hewitt SM</RefAuthor> <RefAuthor>Burbelo PD</RefAuthor> <RefAuthor>Chertow D</RefAuthor> <RefAuthor> NIH COVID-19 Autopsy Consortium</RefAuthor> <RefAuthor> HCA Oral and Craniofacial Biological NetworkFrank K</RefAuthor> <RefAuthor>Lee J</RefAuthor> <RefAuthor>Boucher RC</RefAuthor> <RefAuthor>Teichmann SA</RefAuthor> <RefAuthor>Warner BM</RefAuthor> <RefAuthor>Byrd KM</RefAuthor> <RefTitle>SARS-CoV-2 infection of the oral cavity and saliva</RefTitle> <RefYear>2021</RefYear> <RefJournal>Nat Med</RefJournal> <RefPage>892-903</RefPage> <RefTotal>Huang N, Pérez P, Kato T, Mikami Y, Okuda K, Gilmore RC, Conde CD, Gasmi B, Stein S, Beach M, Pelayo E, Maldonado JO, Lafont BA, Jang SI, Nasir N, Padilla RJ, Murrah VA, Maile R, Lovell W, Wallet SM, Bowman NM, Meinig SL, Wolfgang MC, Choudhury SN, Novotny M, Aevermann BD, Scheuermann RH, Cannon G, Anderson CW, Lee RE, Marchesan JT, Bush M, Freire M, Kimple AJ, Herr DL, Rabin J, Grazioli A, Das S, French BN, Pranzatelli T, Chiorini JA, Kleiner DE, Pittaluga S, Hewitt SM, Burbelo PD, Chertow D; NIH COVID-19 Autopsy Consortium; HCA Oral and Craniofacial Biological NetworkFrank K, Lee J, Boucher RC, Teichmann SA, Warner BM, Byrd KM. 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