ORAL MANIFESTATIONS OF COVID- A MUST KNOW!

7 min


INTRODUCTION:

The most searched word in the year 2020 is ‘coronavirus’. All of us are aware of covid and we are facing a very tough situation in this pandemic. In January 2020 WHO qualified COVID 19 as a worldwide pandemic. All of us are aware of the signs and symptoms of covid, but we are not aware of the oral manifestations of covid. Further, the purpose of this article is to highlight the oral manifestations of covid among the people.

ORIGIN OF COVID:

The novel coronavirus was first identified in Wuhan China in Dec 2019. It is an enveloped RNA virus ( ribonucleic acid virus).

TYPES OF COVID STRAINS:

The three types of strains of covid are SARS-CoV( Severe acute respiratory syndrome coronavirus), MERS-CoV(Middle East respiratory syndrome coronavirus), and SARS-CoV-2. Another new strain called nCoV (novel coronavirus) has not been identified in humans. The strain SARS-CoV 2 is the seventh coronavirus to infect humans and is the cause of covid.

PATHOGENESIS OF COVID-19:

Firstly, organs like lungs, intestine, kidney, and blood vessels have ACE-2 receptors. These are target binding organs, coronavirus easily binds to the ACE-2 receptor that is present on these organs. This is the reason why diabetic, hypertension, older age people and cardiac patients are at risk, they are consuming ACE-2 inhibitors medications. For cancer patients, it will suppress the immune level and worsens the case. 

SYMPTOMS OF COVID:

The symptoms appear after 24-72hrs after exposure to the disease:

  • Fever
  • Cold
  • Diarrhoea 
  • Vomiting
  • Headache
  • Shortness of breath (difficulty in breathing)
  • Difficulty in eating
  • Severe body pain

In recent cases, the new variant of covid is asymptomatic. 

CHECK YOUR OXYGEN LEVEL REGULARLY:

It is mandatory for every one of us to use a pulse oximeter and check oxygen saturation level (SPO2 level) every 6 hrs. The normal level is 95 and above. If below the normal level, it’s a risk indication. For this new variant of covid, the main indication is a lower oxygen saturation level. Also, it is asymptomatic (without any symptoms). So, everyone should have a pulse oximeter in their home and check regularly.

TIPS TO INCREASE YOUR OXYGEN LEVEL:

OXYGEN PACKED FOODS:

Consume foods that contain oxygen in high amount. These include:

  • Coconut pieces (Consuming coconut bits every day increases our oxygen level. To clarify, coconuts are oxygen-rich foods)
  • Nuts ( Cashews, Badams, walnut, and accrues)
  • Berries
  • Apple, green apple
  • Bananas, carrots, celery
  • Watermelon, mango 
  • Kiwi
  • Orange, Lemon
  • Avacado
  • Garlic 

PRONING TO IMPROVE OXYGENATION:

If your oxygen level (SPO2) is below 95 try proning. It increase our oxygen level. This technique plays an important role.

Proning is a medically approved technique to help oxygen deprivation.

POSITION 1: LAYING ON YOUR BELLY

Firstly, keep three pillows on a flat surface. Secondly, keep your head below body level. Place the 1st pillow below the neck. The second pillow below your pelvis area ( belly should be free enough to let one hand pass from below). The third pillow below your foot. The duration of this technique is 30 minutes. Further, this technique is easy and we can do this in our home. Also, this technique increases our oxygen level in the blood.

POSITION 2: LAYING ON RIGHT SIDE

Keep three pillows on a flat surface. Firstly, place a pillow below your head. Place the 2nd below the waist. Place the third pillow between your legs. Importantly, the duration of this procedure is 30 minutes. 

POSITION 3: SLANTING POSITION

 The next position is sitting up, rest in a slanted position ( slanting over the three pillows) this improves our oxygen levels in the blood. Above all, the duration of this position is 30 minutes.

Keep switching between these three positions every 30 minutes. Make yourself as comfortable as possible. Besides, keep the room well ventilated and try breathing fresh air.

ORAL MANIFESTATIONS OF COVID:

DYSGEUSIA (PARAGUESIA):

Dysgeusia is the first oral manifestation. It means distortion of taste or loss of taste. On the other hand, ageusia is common (complete loss of taste and smell). Most people are unaware of this. Further, this is the primary symptom of the disease and people should take care of this and report to the physician immediately. 

COVID TONGUE:

The WHO( world health organization) has released a new variant called ‘covid tongue’. It is a non-classic symptom that occurs in most of the covid patients. White rash in the tongue, skin, soles and feet are common characters. Everyone should be aware of this new variant, especially dentists should be aware of this before starting screening of the patients. Further, research is going about covid tongue and they have found that it is a primary symptom of covid, that occurs in asymptomatic cases.

HERPETIFORM LESIONS:

To put in simpler terms herpetic form lesions are viral lesions that occur on the onset of viral infection. Since covid is a viral infection, we might expect these kinds of lesions. The herpes virus causes this. In addition, the stress and immune-compromised state in covid patients leads to these kinds of lesions on the oral cavity.

The herpetic form lesions are:

HERPES LABIALIS:

Herpes labialis is a herpes simplex virus infection that is characterized by vesicles on the lip, and adjacent facial skin, which rapidly break down to produce shallow ulcer-like lesions. 

ACUTE HERPETIC GINGIVOSTOMATITIS:

The intraoral lesions of the gingiva are referred to as acute herpetic gingivostomatitis. These lesions may involve the palate, pharynx, and tonsils. Herpetic stomatitis occurs more commonly in children. In addition, it is characterized by pinhead-sized vesicles, which collapse to form small ulcer-like lesions. Further, these lesions can be treated by administration of oral acyclovir.

HERPES ZOSTER:

It is more commonly encountered in immune-compromised patients, cancer patients. This is a recurrent viral infection seen in HIV-infected patients. It is characterized by a unilateral cluster of vesicles and ulcers, it might occur on the skin also. Also, the treatment of these lesions is the administration of oral acyclovir.

ULCER LESIONS:

Ulcer or erosive lesions occur due to a break in the lining of the epithelium. The common cause of ulcers is stress. Herpes simplex virus also causes ulcers. These are painful lesions that occur on the labial and buccal mucosa, hard palate, and irregular borders of the tongue. It appears 3 -4 days after exposure. These ulcerative lesions occur as a result of the secondary effect of covid and due to various drug side effects. Further, there is a recent study that corona patients develop a strange type of mouth ulcer.

LEUKOPLAKIA (GREENSPAN LESION):      

It is a white non-scrapable white patch that occurs bilaterally on the buccal mucosa, lateral border of the tongue. Covid confirmed patients show leukoplakia. This usually occurs in immune-compromised patients. Immune suppression is common in covid patients. They have more tendency to develop leukoplakia. Further, in patients with long-term antibiotic therapy, poor oral hygiene can cause leukoplakia. The treatment is antiviral drugs like acyclovir and anti-fungal drugs. Also, it is usually an asymptomatic lesion.

ERYTHROPLAKIA:

It is similar to leukoplakia. Long-standing leukoplakia leads to erythroplakia. It occurs as a red patch in the buccal mucosa, tongue, palate, etc. Further, patients severely affected with covid might develop erythroplakia. In the same vein, treatment is similar to leukoplakia.

CANDIDIASIS (ORAL THRUSH):

It occurs as a white patch in the tongue, buccal mucosa. Candidiasis is the most common type of fungal infection in the oral cavity. It occurs in immune-suppressed patients, patients with poor oral hygiene especially older patients using dentures. Patients affected with covid have a high chance to develop candidiasis, especially older patients. Consequently, treatment includes topical nystatin and mouth wash.

ERYTHEMA MULTIFORME (TARGET LESION):

It presents as oral ulceration on the lips. This also involves the skin. Secondly, this is a contagious mucocutaneous disorder. Cutaneous target lesions are typical characteristics. Seen on the extremities hence the name target lesion. The cause is unknown it mainly occurs due to allergic drug reactions. Blisters, ulcerative lesions are also seen. In addition, erythematous purple blisters without spontaneous bleeding on the tongue and palate are seen in confirmed covid cases.

KAWASAKI DISEASE:

This is characterized by oral lesions which include cheilitis, glossitis, and erythematous tongue. This appeared in covid patients. Likewise, they have found this variant in a recent study. Moreover, the onset of these symptoms is delayed in patients due to severe respiratory distress.

MELKERSSON ROSENTHAL SYNDROME:

It is a neurological disorder that is characterized by facial paralysis, swelling in the face and lips, furrows or grooves present in the tongue. Recently they found that 50 years old women diagnosed with this syndrome tested positive for covid.

ATYPICAL SWEET SYNDROME (ACUTE FEBRILE NEUTROPHILIC DERMATOSIS):

Fever, rashes, and blisters or lesions mark this syndrome. It is a rare dermatological syndrome. Recently they discovered that 61 years old woman with fever, myalgia tested positive for covid and was admitted to the hospital. Further, she developed this syndrome after 1 week.

NECROTIZING ULCERATIVE PERIODONTITIS:

Firstly, it is a severe type of periodontal disease. Destruction, necrosis of the periodontal tissues are common characteristics. Further, recent covid cases report this condition.

CONCLUSION:

To conclude, everyone should be aware of these oral manifestations, especially dentists who are at high risk of performing dental procedures. The oral cavity acts as the direct transmission of infection. Moreover, high safety and care are mandatory. Increase immunity and stay away from infections. Consume healthy foods packed with oxygen. To sum up, staying healthy plays a very important part in this pandemic.


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Dr Shalini S.G
I am a dental surgeon. I love travelling and listening to music and a passionate person in research and doing lots of presentation. My area of interest is pathology, diagnosis and forensics.

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