Oral Manifestations of COVID 19

 INTRODUCTION

•  The Coronavirus disease 2019(COVID-19) caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).
• The Virus was first identified in December 2019 in Wuhan, China.
• Pandemic:11th March 2020
• India's first case:30th January 2020

Modes of Spread

Respiratory droplets while sneezing, coughing, speaking.

Morphology

Structure of Coronavirus

Family: Coronaviridae
Genome:ssRNA
Size:120nm
Shape: Crown like or Coronal

General pathogenesis

Oral Pathogenesis

Symptoms

Most common symptoms:

• fever
• dry cough
• tiredness

Less common symptoms:

• aches and pains
• sore throat
• diarrhea
• conjunctivitis
• headache
• loss of taste or smell
• a rash on the skin, or discolouration of fingers or toes

Serious symptoms:

• difficulty breathing or shortness of breath
• chest pain or pressure
• loss of speech or movement

Oral Manifestations of COVID 19

Dysgeusia(loss of taste) is the first recognized oral symptom of novel coronavirus disease (COVID-19).

• Virus distrust cranial nerve 1,7,9,10

1. Dry mouth/Xerostromia: The most common reason for mouth breathing by an individual is due to mask use. Mouth breathing can desiccate oral tissue, especially without frequent hydration. Studies suggest that another biological mechanism involves viral entry into the salivary glands, which are known to be abundant in the ACE2 receptor.
2. Mouth Ulcers: Painful mouth ulcers can be in the tongue, lips,

   

   Mouth ulcers in covid19

    and palate. Coronavirus is known to cause vascularity anomalies due to viral damage of blood vessels. The virus gains entry into the endothelial cells that line blood vessels via the ACE2 receptor and damages them, leading to tissue necrosis, including oral ulcerations. The tissue damage can be further exacerbated by increased inflammation.
   
3. Covid tongue: COVID Tongue, is a symptom that is not very common but is being reported by COVID positive patient. Doctors are trying to identify the reason behind the new symptoms, it can be due to a newer version of mutated covid19virus. Covid tongue mainly starts with irritation, itching, a vague sensation of pain, and extreme dryness of the mouth with the rare occurrence of mouth ulcers. According to the American Academy of Oral Medicine (AAOM), the COVID tongue is an inflammatory disorder that usually appears on the top and sides of the tongue. In the Covid tongue, your mouth fails to produce saliva and you experience dryness, white patches, and bumps on your tongue. Saliva functions as a protection against bad bacteria and in its absence your body will be exposed to them.

   

   Covid Tongue

   • Atrophy of tongue

   • Ulcers on tongue
   • Fissures on tongue
   • Bumps on tongue

4. Gingival inflammation: It can be Due to generalised increase in cytokines and interleukins due to coronavirus19.The inflammatory products can enter the bloodstream through infected gum pockets around the teeth, When inflammatory products from gum disease enter the bloodstream, those products can go to other body organs and potentially cause tissue damage.
5. Herpatiform/zosteriform lesions: Multiple painful, round yellowish-Grey ulcers with an erythematous rim on both keratinised and non keratinised mucosa. Stress and immunosuppression associated with covid 19 is a suggestive cause of the appearance of secondary hepatic gingivostomatitis.
6. Ulcers and erosion: Painful lesions with irregular borders on the tongue, hard palate, and labial mucosa. Different factors such as drug eruption, vasculitis, or thrombotic vasculopathy secondary to covid19 were suggestive as the cause of the development of ulcerative and erosive lesions.
7. White/Red plaques: Reported on the dorsum of the tongue. gingiva and palate of conformed and suspected covid 19 patients. Candidiasis due to long-term antibiotic therapy, poor oral hygiene can be the reason for white and red patches.

8. 

   Petechiae

   Kawasaki-like disease:  Oral lesions including cheilitis, glossitis, Erythematous and swollen tongue(red strawberry tongue)
9. Petechiae: In few cases, petechiae was reported on the lower lip, palate, and oropharynx mucosa. Thrombocytopenia from covid19 infection and prescribed drugs were the suggestive causes of the lesions.
   
10. Erythemamultiforme like lesions: Lesions appears like blisters, desquamative gingivitis, erythematous macules, erosions, painful cheilitis with hemorrhagic crust on the lips.

Management of oral lesions

Conclusion

• Oral Symptoms can also be considered initial symptoms of covid-19.
• Oral manifestation of covid 19 has been widely recognised, however, the pathognomic lesions of covid 19 are still uncertain
• Oral manifestations that may appear in covid19 patients can be important for early detection and prevention of transmission, because oral manifestations in covid 19 could mimic other viral manifestations, including herpes zoster.
• studies are recommended to determine the relationship between covid 19 and manifestations in the oral mucosa.