Oral cavity manifestations in COVID-19 patients: A cross-sectional study

doi:10.21203/rs.3.rs-2967810/v1

Download PDF

Research Article

Oral cavity manifestations in COVID-19 patients: A cross-sectional study

https://doi.org/10.21203/rs.3.rs-2967810/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 27 Sep, 2023

Read the published version in BMC Oral Health →

You are reading this latest preprint version

Objective

To determine the prevalence of oral manifestations in symptomatic patients in the ambulatory setting with suspected COVID-19.

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 (RT-PCR-positive and RT-PCR-negative patients).

Results

One hundred and thirty-sixparticipants were included. Mostwere female (n = 79; 58.1%), mean age of 39.53 (± 14.17) years. Of these, 54 (39.7%) had a positive RT-PCR test, and 82 (60.3%) had negative RT-PCR results. Oral manifestations were observed in 40 participants (74.1%)in the RT-PCR-positive group and in 67 participants (81.7%) in the RT-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%) and halitosis (n = 7; 13.0% vs n = 1; 1.2%) were observed between the RT-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.

SARS-CoV-2

COVID-19

saliva

oral manifestations

oral cavity

xerostomia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious zoonotic virus that originated in Wuhan, China in December 2019[1]. Coronaviruses are a family of viruses that cause respiratory infections, including the new coronavirus (SARS-CoV-2).The resulting coronavirus disease 19 (COVID-19) was declared a global health emergency on January 30, 2020, and a pandemic on March 11, 2020, by the World Health Organization (WHO)[2, 3]. As a result, there is growing concern in multiple specialties, including dentistry, due to its high virulence and transmission routes through salivary aerosols. Research addressing crucial unknowns regarding the clinical severity, extent of transmission, and treatment options has been ongoing worldwide since the inception of the disease. The primary response strategy includes limiting human-to-human transmission [4].

As the oral cavity is one of the first interfaces between the environment and the body, there is a high potential that this route of colonization and viral infection was critical for the emergence of COVID-19[5]. Approximately 99% of saliva is water; the rest comprises components responsible for digestion, taste, buffering, remineralization balance, and anti-microbial activity. The remaining components include a mixture of desquamated oral epithelial cells, salivary secretions from major and minor glands, crevicular fluid, and microorganisms including bacteria, fungi, and viruses. The oral cavity is an entrance and outlet of the body, and saliva plays a role in the early diagnosis and close contact transmission of infectious diseases[6].

Accurate diagnosis is essential to control the outbreak and to propose measures related to the prevention and prognosis of infection. Saliva is a reliable, noninvasive specimen for diagnosing patients with suspected COVID-19 [7]. Furthermore, oral fluid can be self-collected by subjects and can be easily managed, dramatically reducing the risk of viral transmission for healthcare workers [8].

Early studies have highlighted the possible development of dysgeusia and anosmia in SARS-CoV-2 infection[9, 10], and these manifestations should be considered a potential indication of 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.

A cross-sectional study conducted in Spain with 666 hospitalized COVID-19 patients reported oral findings in 78 cases (25.7%), including transient lingual papillitis (11.5%), glossitis with lateral indentations (6.6%), aphthous stomatitis (6.9%), glossitis with patchy depapillation (3.9%), and mucositis (3.9%)[11].

A review of oral manifestations in COVID-19 patients reported the presence of several oral lesions, including ulcers, erosions, bullae, vesicles, pustules, fissured or depapillated tongue, macules, papules, plaques, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding [12]. In addition, a recent systematic review found a higher prevalence of oral manifestations of SARS-CoV-2, especially xerostomia, ulcerations, and taste alterations in patient with active disease [13].

This study aimed to determine the prevalence of oral manifestations in a cohort of ambulatory symptomatic patients with suspected COVID-19 during the acute phase of the disease.

This observational cross-sectional study was conducted at the outpatient service for acute febrile illnesses at the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil. Males and females (pregnant or non-pregnant) aged ≥ 18 years with signs and symptoms of SARS-CoV-2infection or who were in contact with people with confirmed COVID-19 were screened and enrolled in the study after signing informed consent. The study excluded individuals who refused nasopharynx/oropharynx and salivary sample collection.

The patients were interviewed by a dentist using an electronic case report form (eCRF) based on the Research Electronic Data Capture (REDCap) platform[14, 15]hosted at the Evandro Chagas National Institute of Infectious Diseases. An enrollment questionnaire collected detailed baseline sociodemographic features, comorbidities, clinical signs, and symptoms. A thorough oral examination was performed using a mouth mirror by the same dentist wearing complete personal protective equipment. Before oral examination the patients performed for 15 seconds a mouthwash containing chlorhexidine (Periogard© from Colgate).Data were recorded on an oral clinical examination form.

Laboratory Analysis and Confirmation

Nasopharynx/oropharynx swabs and saliva samples were tested using RT-PCR for SARS-CoV-2detection. Nurses collected nasopharyngeal and oropharyngeal swabs. The same dentist collected saliva by asking the participants to accumulate saliva (at least 1–2 mL) in the mouth for one minute and then spit it into a sterile container without coughing or clearing their throats. Briefly, samples were screened for SARS-CoV-2 by rRT-PCRto amplify the E gene and RdRp region of the Orf1ab gene of SARS-CoV-2 using the SARS-CoV-2 E/RP molecular kit (Bio-Manguinhos, Rio de Janeiro, Brazil). A cycle threshold (Ct) less than 40 was classified as positive.Participants with a detectable rRT-PCR test in nasopharyngeal/oropharyngeal swabs and/or saliva were assigned to the positive rRT-PCR group. Conversely, the negative rRT-PCR group included participants with undetectable rRT-PCR results in nasopharyngeal/oropharyngeal swabs and saliva specimens.

Statistical analyses

The sample size calculation was performed in the epiDisplay package of the R 4.1.1 software in order to compare the proportions between the two groups, with a significance level of 5%anda power of 90% and at least 55 people in each group to state the difference between these proportions, which reached a sample size of 110 participants.

Sociodemographic and clinical variables were determined using frequencies and proportions for categorical variables, and means with standard deviations for continuous variables. The Chi-square test or Fisher's exact test for categorical variables was conducted to assess differences in oral manifestations between the rRT-PCR-positive and rRT-PCR-negative groups, as appropriate. Statistical analyses were performed using the IBM SPSS Statistics 22.0.The recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were applied for reporting.

Between October 2020 and September 2021, 191 individuals were assessed for eligibility and 136 participants were enrolled in the study (Fig. 1). Of these, 54 (39.7%) had a positive rRT-PCR test result, and 82 (60.3%) had negative rRT-PCR results. Samples were collected at a mean of 4.56 (± 2.90) days after the onset of symptoms.

Sociodemographic and clinical characteristics

Table 1 summarizes the sociodemographic and clinical characteristic profiles of all participants according to the rRT-PCR results. Most of the participants were female (n = 79; 58.1%).The mean age of all study participants was 39.53 (± 14.17) years; most were white (n = 60;44.1%) and had a university/post-graduation level of education (n = 70; 51.5%). Several comorbidities were reported in both the groups.

Table 1

Baseline characteristics of 136 study participants.
Characteristics	Positive rRT-PCR N (%)	Negative rRT-PCR N (%)
	(n = 54)	(n = 82)
Mean age (± SD)	41.87 (± 14.04)	37.99 (± 14.13)
Gender
Male	27 (50)	30 (36.6)
Female	27 (50)	52 (63.4)
Race/ethnicity, n (%)
White	25 (46.3)	35 (42.7)
Black	8 (14.8)	17 (20.7)
Mixed	21 (38.9)	25 (30.5)
Indigenous	-	1 (1.2)
Yellow	-	4 (4.9)
Highest formal educational attendance, n (%)
University/post-graduation	24 (44.4)	46 (56.1)
High school/technical college	24 (44.4)	21 (25.6)
Lower Secondary	3 (5.6)	2 (2.4)
Primary	1 (1.9)	2 (2.4)
Less than primary	2 (3.7)	10 (12.2)
Missing	-	1 (1.2)
Self-reported history of preexisting diseases, n (%)
Obesity	7 (12.9)	11 (13.4)
Cancer	3 (5.6)	2 (2.4)
Diabetes mellitus	3 (5.6)	5 (6.1)
HIV infection	8 (14.8)	11 (13.4)
Cardiovascular disease	5 (9.2)	6 (7.3)
Asthma requiring medication	2 (3.7)	7 (8.5)
Lung disease (other than asthma)	4 (7.4)	6 (7.3)
Chronic liver disease	2 (3.7)	-
Chronic hematologic disease	2 (3.7)	3 (3.6)
Chronic kidney disease	3 (5.6)	4 (4.9)
Chronic neurological disease	2 (3.7)	8 (9.8)
Received transplant	1 (1.8)	2 (2.4)
Hypertension	13 (24.1)	12 (14.6)
Chronic rhinitis	10 (18.5)	14 (17.1)
Thyroid disease	8 (14.8)	6 (7.3)
Current smoker	6 (11.1)	10 (12.2)

SD: Standard deviation.

Oral signs and symptoms

Oral manifestations at enrollment included xerostomia (dry mouth), taste alterations (dysgeusia/ageusia), gingivitis, glossitis, halitosis, mouth ulcers, petechiae, and tongue coating (Table 2).

Table 2

Oral manifestations of 136 study participants.
Oral Manifestations	Symptomatic positive RT-PCR N (%)	Symptomatic negative RT-PCR N (%)	P value
Xerostomia	29 (53.7)	56 (68.3)	0.086
Dysgeusia/ageusia	24 (44.4)	33 (40.2)	0.627
Gingivitis	12 (22.2)	5 (6.1)	0.005
Halitosis	7 (13.0)	1 (1.2)	0.007*
Mouth ulcers (self-reported)	5 (10.0)	12 (14.6)	0.441
Mouth ulcers (clinical exam)	0 (0.0)	3 (3.7)	0.276*
Glossitis	5 (9.3)	8 (9.8)	0.923
Tongue coating	4 (7.4)	2 (2.4)	0.214*
Petechiae	4 (7.4)	3 (3.7)	0.435*
* Fisher exact test

Xerostomia (53.7%) was the most frequent oral manifestation in the symptomatic positive RT-PCR group, followed by dysgeusia/ageusia (44.4%), gingivitis (22.2%), halitosis (13.0%), self-reported mouthulcers (10%), and glossitis (9.3%). In the symptomatic negative RT-PCR group, xerostomia (68.3%) was the primary oral manifestation, followed by dysgeusia/ageusia(40.2%), self-reported mouth ulcers (14.6%), glossitis (9.8%), and gingivitis (6.1%). Mouth ulcers were self-reported in 12 participants (14.6%) but were observed in only three participants (3.7%) in the negative group when the oral examination was performed (Fig. 2A). Tongue coating (Fig. 2B), glossitis with indentations (teeth marks on the sides) (Fig. 2C), and oral petechial lesions (Fig. 2D) were observed in both groups.

In this study, xerostomia and dysgeusia/ageusia were the most frequent oral manifestations in symptomatic participants regardless of the molecular confirmation of COVID-19. These results weresimilar to another study conducted with 128 non-hospitalized patients with COVID-19 confirmed by rRT-PCR, where 56% of patients reported xerostomia as the most frequent oral manifestation, followed by gustatory dysfunction (32.8%)[16].

Gingivitis and halitosis were more frequent in the rRT-PCR-positive group than in the RT-PCR-negative group. Both oral findings could be associated with a lack of oral hygiene, stress, or immunosuppression, which might be some of the most important predisposing factors for the onset of oral lesions in COVID-19 [12]. Gingivitis is a mild periodontal disease characterized by inflammation of the gums and is mainly caused by poor oral hygiene[17]. Periodontal disease is caused by poor oral hygiene, which results in bacteria in dental plaque. The presence of these bacteria causes a local inflammatory reaction and the emergence of neutrophils and other inflammation-promoting cells that receive the mediation of proinflammatory cytokines [18]. Furthermore, evidence suggests that the worsening of SARS-CoV-2 infection in the lung region may be caused by the aspiration of periodontal pathogens, increasing the secretion of inflammatory cytokines such as IL-6 [19]. Our results are similar to those of Anand et al., where periodontitis was more frequent among COVID-19 patients[20].

In the symptomatic RT-PCR-negative group, mouth ulcers were self-reported in 12 participants (14.6%) but observed in only three participants (3.7%) during the oral examination. In contrast, only five participants (10.0%) reported mouth ulcers in the RT-PCR-positive group, with none presenting with such lesions during the clinical oral examination. According to a Spanish study [11], vesicular eruptions (1.6%) were observed in a minority of patients and appeared within the first few days of illness onset. This finding may suggest that vesicular eruptions in the Spanish study and mouth ulcers in our study could be more frequent in the early prodromal phase of the disease.

Glossitis was observed in both groups in our study, with similar relative frequencies. A Spanish study of 666 hospitalized COVID-19 patients presented several oral cavity findings, including transient lingual papillitis (11.5%), aphthous stomatitis (6.9%), and glossitis with lateral indentations (6.6%) [11].They suggested that these alterations could also be due to certain procedures in hospitalized patients, including ventilation masks. Papillitis was not observed in the present study, however, isolated glossitis and glossitis with lateral indentations were associated with tongue coating.

Glossitis with lateral indentations (teeth marks on the sides) was described as tongue depapillation with bilateral atrophy of the tongue's surface located in the lateral sides, recently coined as “COVID tongue”. Both oral manifestations are related to a particular state of immunosuppression, and stress may play an essential role in the appearance of these oral conditions[12, 21].

Tongue coating (yellow color) was found in four participants (7.4%) in the RT-PCR-positive group and only two participants (2.4%) in the symptomatic negative group, with no statistically significant difference between the groups. In addition, tongue coating and glossitis with indentations appeared together in some patients and were observed in both groups. According to a retrospective cross-sectional study of tongue features in 1043 patients with COVID-19[22], with disease progression, the proportion of critically ill patients with yellow tongue coating increased to 62.5%. The authors agreed that fever and infection might cause it to turn yellow. Furthermore, the degree of yellow coating was positively correlated with the degree of lung infection and disease severity. In addition, tongue color change could be attributed to difficulties in complying with meticulous oral hygiene measures, as the severity of the disease increases and deteriorates[23].

Petechiae were found in the RT-PCR-positive group (n = 4; 7.4%) and the symptomatic negative group (n = 3; 3.7%). These findings are consistent with those of previous studies that reported petechiae on the palate, lower lip, and oropharyngeal mucosa during COVID-19 [24, 25]. These authors suggested that the oral lesions were associated with COVID-19. In our study, petechiae were found in the soft palate of seven patients. However, the direct effect of SARS-COV-2 on these lesions remains uncertain because other conditions may be related to these findings besides viral infection, such as adverse drug reactions [24].

The findings of oral manifestations in both groups were relatively similar, although it was not possible to detect SARS-CoV-2 using rRT-PCR in all participants. Recent studies suggest that RT-PCR for SARS-CoV-2 detection should be performed between the third and seventh days of symptom onset to reduce false negative results [26]. Although the participants in our study performed the RT-PCR test an average of 4.68 days after the onset of signs and symptoms, the range was from one to 16 days, leading to potential false negative results. Another explanation for false-negative results is the sensitivity (86%) and specificity (96%) of the PCR test used for diagnosis. Therefore, a second sample collection is recommended when the first evaluation is negative, to improve the probability of confirming the diagnosis using this molecular technique[27].

Our study has limitations that cannot be generalized to all COVID-19 patients. First, we evaluated only patients with mild-to-moderate disease and not hospitalized patients with more severe forms of COVID-19. Second, we did not analyze the use of medications to treat pre-existing diseases, which may have influenced tongue findings and xerostomia. Third, as previously discussed here, a second sample was not systematically collected from all symptomatic patients with negative RT-PCR results.

COVID-19 has a high infectivity rate, mainly because of its spread through respiratory droplets. In addition to studying the role of saliva in the transmission of the virus and as an alternative fluid for diagnosis, one must carefully ensure the identification of saliva quality and presence of xerostomia. A thorough oral clinical examination can indicate the presence of oral manifestations related to COVID-19, and thus establish immediate measures to reduce the transmission and pathogenicity of SARS-CoV-2.

In conclusion, a high prevalence of oral manifestations was observed in symptomatic patients with suspected or confirmedCOVID-19, highlighting the importance of routine oral examinations by dentists as part of the multidisciplinary care of COVID-19 patients.

Ethics approval and Consent to Participate

An electronic informed consent was obtained from all study participants. No illiterate participant was included in the present study. Even in the “Less than primary” category, the participants could read and write and understood what was written in the electronic informed consent.

The Institutional Ethics and Research Committee of the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro (CAAE) reviewed and approved the study (37811220.0.0000.5262) and was conducted according to the Declaration of Helsinki principles.

Availability of Data and Materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Consent for Publication

Not applicable.

Funding

The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article: Guilherme Calvet was supported by the Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro(FAPERJ) Young Scientist Fellowship no. E26/201.379/2021. Marilda Siqueira was supported by CGLab/MoH (General Laboratories Coordination of Brazilian Ministry of Health), CVSLR/FIOCRUZ (Coordination of Health Surveillance and Reference Laboratories of Oswaldo Cruz Foundation), The National Council forScientific and Technological Development (CNPq) COVID-19 MCTI 402457/2020-0, INOVA VPPCB-005-FIO-20-2-69, and FAPERJ no.E26/210.196/2020.

Competing Interests

The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.

Authors' Contribution

Tatiana Fernandes contributed to data acquisition and interpretation, statistical analyses, and drafted and critically revised the manuscript;

Maria Ogrzewalska contributed to data acquisition, performed laboratory exams, and critically revised the manuscript;

Ezequias Martins contributed to the data acquisition, and critically revised the manuscript;

Marilda Siqueira contributed to the conception, design, acquisition of funds, and critically revised the manuscript;

Patrícia Brasil contributed to the conception, design, and critically revised the manuscript;

Guilherme Calvet contributed to the conception, design, acquisition of funds, performed statistical analyses, and drafted and critically revised the manuscript.

All authors gave their final approval and agreed to be accountable for all aspects of this work.

Acknowledgment

We thank our patients for their willingness to participate in the study.

World Health Organization (2020) Novel coronavirus (2019-nCoV): situation report – 01 [Internet]. Geneva: World Health Organization. [accessed 2020 Jan 20]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4.
World Health Organization (2020) WHO Emergencies Coronavirus Emergency Committee Second Meeting, January 30 2020. [accessed 2020 Jan 30]. Available from: https://www.who.int/docs/default-source/coronaviruse/transcripts/ihr-emergency-committee-for-pneumonia-due-to-the-novel-coronavirus-2019-ncov-press-briefing-transcript-30012020.pdf?sfvrsn=c9463ac1_2.
World Health Organization (2020) Virtual press conference on COVID-19 – March 11 2020. [accessed 2020 Mar 11]. Available from: https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-and-final-11mar2020.pdf?sfvrsn=cb432bb3_2.
Sharma S, Kumar V, Chawla A and Logani A (2020) Rapid detection of SARS-CoV-2 in saliva: can an endodontist take the lead in point-of-care COVID-19 testing? Int Endod J 53:1017-1019. doi: 10.1111/iej.13317
Herrera D, Serrano J, Roldan S and Sanz M (2020) Is the oral cavity relevant in SARS-CoV-2 pandemic? Clin Oral Investig 24:2925-2930. doi: 10.1007/s00784-020-03413-2
Xu R, Cui B, Duan X, Zhang P, Zhou X and Yuan Q (2020) Saliva: potential diagnostic value and transmission of 2019-nCoV. Int J Oral Sci 12:11. doi: 10.1038/s41368-020-0080-z
McPhillips L and MacSharry J (2022) Saliva as an alternative specimen to nasopharyngeal swabs for COVID-19 diagnosis: Review. Access Microbiol 4:acmi000366. doi: 10.1099/acmi.0.000366
Azzi L, Maurino V, Baj A, Dani M, d'Aiuto A, Fasano M, Lualdi M, Sessa F and Alberio T (2021) Diagnostic Salivary Tests for SARS-CoV-2. J Dent Res 100:115-123. doi: 10.1177/0022034520969670
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X and Zhang L (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395:507-513. doi: 10.1016/S0140-6736(20)30211-7
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J and Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497-506. doi: 10.1016/S0140-6736(20)30183-5
Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Martin Rios MD, Herranz Manas C, Artigas Almazan J, Garcia Casasola G, Perez Castro E, Gallego Arenas A, Mayor Ibarguren A, Feito Rodriguez M, Lozano Masdemont B, Beato M, Ruiz Bravo E, Oliver P, Montero Vega MD and Herranz Pinto P (2021) Prevalence of mucocutaneous manifestations in 666 patients with COVID-19 in a field hospital in Spain: oral and palmoplantar findings. Br J Dermatol 184:184-185. doi: 10.1111/bjd.19564
Iranmanesh B, Khalili M, Amiri R, Zartab H and Aflatoonian M (2021) Oral manifestations of COVID-19 disease: A review article. Dermatol Ther 34:e14578. doi: 10.1111/dth.14578
Nijakowski K, Wyzga S, Singh N, Podgorski F and Surdacka A (2022) Oral Manifestations in SARS-CoV-2 Positive Patients: A Systematic Review. J Clin Med 11. doi: 10.3390/jcm11082202
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N and Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377-81. doi: 10.1016/j.jbi.2008.08.010
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN and Consortium RE (2019) The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 95:103208. doi: 10.1016/j.jbi.2019.103208
Biadsee A, Biadsee A, Kassem F, Dagan O, Masarwa S and Ormianer Z (2020) Olfactory and Oral Manifestations of COVID-19: Sex-Related Symptoms-A Potential Pathway to Early Diagnosis. Otolaryngol Head Neck Surg 163:722-728. doi: 10.1177/0194599820934380
Christofoli BR, Rios FS, Costa RSA, Wagner TP, Goergen J, Izquierdo C, Jardim JJ, Maltz M and Haas AN (2021) Changes in gingivitis and protective factors among adults: A 4-year prospective population-based study. Community Dent Oral Epidemiol 49:437-444. doi: 10.1111/cdoe.12619
Pan W, Wang Q and Chen Q (2019) The cytokine network involved in the host immune response to periodontitis. Int J Oral Sci 11:30. doi: 10.1038/s41368-019-0064-z
Hayata M, Watanabe N, Tamura M, Kamio N, Tanaka H, Nodomi K, Miya C, Nakayama E, Ueda K, Ogata Y and Imai K (2019) The Periodontopathic Bacterium Fusobacterium nucleatum Induced Proinflammatory Cytokine Production by Human Respiratory Epithelial Cell Lines and in the Lower Respiratory Organs in Mice. Cell Physiol Biochem 53:49-61. doi: 10.33594/000000120
Anand PS, Jadhav P, Kamath KP, Kumar SR, Vijayalaxmi S and Anil S (2022) A case-control study on the association between periodontitis and coronavirus disease (COVID-19). J Periodontol 93:584-590. doi: 10.1002/JPER.21-0272
Diaz Rodriguez M, Jimenez Romera A and Villarroel M (2022) Oral manifestations associated with COVID-19. Oral Dis 28 Suppl 1:960-962. doi: 10.1111/odi.13555
Pang W, Zhang D, Zhang J, Li N, Zheng W, Wang H, Liu C, Yang F and Pang B (2020) Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study. Integr Med Res 9:100493. doi: 10.1016/j.imr.2020.100493
Eita AAB (2021) Parosmia, Dysgeusia, and Tongue Features Changes in a Patient with Post-Acute COVID-19 Syndrome. Case Rep Dent 2021:3788727. doi: 10.1155/2021/3788727
Jimenez-Cauhe J, Ortega-Quijano D, de Perosanz-Lobo D, Burgos-Blasco P, Vano-Galvan S, Fernandez-Guarino M and Fernandez-Nieto D (2020) Enanthem in Patients With COVID-19 and Skin Rash. JAMA Dermatol 156:1134-1136. doi: 10.1001/jamadermatol.2020.2550
Gutierrez-Camacho JR, Avila-Carrasco L, Martinez-Vazquez MC, Garza-Veloz I, Zorrilla-Alfaro SM, Gutierrez-Camacho V and Martinez-Fierro ML (2022) Oral Lesions Associated with COVID-19 and the Participation of the Buccal Cavity as a Key Player for Establishment of Immunity against SARS-CoV-2. Int J Environ Res Public Health 19. doi: 10.3390/ijerph191811383
Lima FET, Albuquerque NLS, Florencio SSG, Fontenele MGM, Queiroz APO, Lima GA, Figueiredo LM, Amorim SMC and Barbosa LP (2020) Time interval between onset of symptoms and COVID-19 testing in Brazilian state capitals, August 2020. Epidemiol Serv Saude 30:e2020788. doi: 10.1590/S1679-4974202100010002
Floriano I, Silvinato A, Bernardo WM, Reis JC and Soledade G (2020) Accuracy of the Polymerase Chain Reaction (PCR) test in the diagnosis of acute respiratory syndrome due to coronavirus: a systematic review and meta-analysis. Rev Assoc Med Bras (1992) 66:880-888. doi: 10.1590/1806-9282.66.7.880

No competing interests reported.

Download PDF

Journal Publication

published 27 Sep, 2023

Read the published version in BMC Oral Health →

Editorial decision: Major revision
22 Jul, 2023
Reviews received at journal
22 Jul, 2023
Reviewers agreed at journal
09 Jul, 2023
Reviews received at journal
16 Jun, 2023
Reviewers agreed at journal
03 Jun, 2023
Reviewers agreed at journal
31 May, 2023
Reviewers invited by journal
31 May, 2023
Editor assigned by journal
31 May, 2023
Editor invited by journal
31 May, 2023
Submission checks completed at journal
31 May, 2023
First submitted to journal
22 May, 2023

You are reading this latest preprint version

Oral cavity manifestations in COVID-19 patients: A cross-sectional study

Status:

Journal Publication

Version 1

Abstract

Figures

Introduction

Material and methods

Laboratory Analysis and Confirmation

Statistical analyses

Results

Sociodemographic and clinical characteristics

Oral signs and symptoms

Discussion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1