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2021, Number 2

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Rev Odont Mex 2021; 25 (2)

COVID-19 and oral ulcers: a common sign?

Rocafuerte-Acurio, Marco Antonio1

Language: English/Spanish [Versi?n en espa?ol]
References: 7
Page: 113-114
PDF size: 85.93 Kb.




Several studies suggest that the most common signs and symptoms of SARS-CoV-2 infection are headache, sore throat, hyposmia, hypogeusia, diarrhea, dyspnea and, in severe cases, pneumonia.1 However, one of the scarcely documented aspects is the semiology at the oral cavity level. This could be due to some dentists in the world are feared to attend infected with SARS-CoV-2 patients because of the high risk of contagion that involves intimate contact with saliva and the major salivary glands, in which large amounts of ACE-2 receptors that make it easy to virus its entry into the cell in addition to being a preferred site to fix SARS-CoV-2 spike protein coronavirus.2

Chaux-Bodard and colleagues3 reported for the first time a sign of COVID-19, which was an irregular ulcer on the tongue that developed into an acral erythema that preceded the respiratory symptoms of COVID-19. This caused due importance to be given to these oral manifestations as initial signs. Favia and colleagues4 found a higher prevalence of painful ulcers in the oral cavity (65-52.8%) in patients infected by SARS-CoV-2 -comparing them with other type of lesions- and they presented as both single (40%) and multiple lesions (60%).

The ulcers appearance could be due to an inflammatory reaction, the deterioration of the immune system, stress, bacteria, fungal coinfections, etc.5,6 Other authors suggest that this may be due to the COVID-19 infection itself, because a vascular and arterial thrombosis would occur in small and medium vessels, producing a superficial necrosis of the tissues.7 Furthermore, SARS-CoV-2 would induce an immune response similar to that observed in other viral infections. In addition, COVID-19 can cause an over activation of the inflammatory immune response, leading to elevated cytokine production and immune system fatigue.

The case of a 42-year-old man diagnosed with COVID-19 is presented. The symptoms he referred were fever, sore throat and general malaise. His physician requested a consultation with the dental area since the patient reported having pain and burning in the palate. The patient sent a self-taken photo showing multiple small ulcers located in the mid-palate (Figure 1) which remitted after ten days. As the only treatment, the patient was recommended to use an antiseptic rinse based on 0.12% chlorhexidine for seven days.

This paper aims to raise awareness in dentists as a careful intraoral examination of the oral mucosa is mandatory before starting dental treatment, especially when it is suspected that patients are infected with SARS-CoV-2. Likewise, it is imperative to rule out SARS-CoV-2 infection in patients with oral ulcers of unknown etiology. Extensive research is needed to understand the connection between oral mucosal injuries and COVID-19.


REFERENCES

  1. Babu A, Malathi L, Kasthuri L. Ulcerative lesions of the oral cavity – an overview. Biomed Pharmacol J. 2017; 10 (1): 401-405.

  2. Carreras-Presas C, Amaro Sánchez J, López-Sánchez A, Jané-Salas E, Somacarrera Pérez M. Oral vesiculobullous lesions associated with SARS-CoV-2 infection. Oral Dis. 2021; 27 (3): 710-712.

  3. Chaux-Bodard AG, Deneuve S, Desoutter A. Oral manifestation of Covid-19 as an inaugural symptom? J Oral Med Oral Surg. 2020; 26 (2): 18.

  4. Favia G, Tempesta A, Barile G, Brienza N, Capodiferro S, Vestito MC et al. Covid-19 symptomatic patients with oral lesions: clinical and histopathological study on 123 cases of the University Hospital Policlinic of Bari with a purpose of a new classification. J Clin Med. 2021; 10 (4): 757.

  5. Cornejo Ovalle M, Espinoza I. COVID-19 y manifestaciones orales. Int J Odontostomat. 2020; 14 (4): 538-539.

  6. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020; 12 (1): 8.

  7. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020; 323 (11): 1061-1069.



AFFILIATIONS

1 Especialista Universitario en Medicina Oral. Facultad de Odontología de la Universidad Complutense de Madrid. Madrid, España.



CORRESPONDENCE

Marco Antonio Rocafuerte-Acurio. E-mail: drmarcorocafuerte@gmail.com


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