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Oral Manifestations of Covid -19

Dysgeusia (loss of taste) is the first recognized oral symptom of Covid -19. However, there are far more Oral manifestations of Covid -19.  Most of these are noticed in “Long Haulers”, survivors of covid 19 who had the disease from weeks to months. They have experienced oral problems such as “teeth falling out, sensitive gums, teeth turning grey, and teeth cracking.”

Some of the most common oral manifestations are:

A. GINGIVITIS (BLEEDING GUMS)

SARS COV -2 Virus has resulted in increased inflammation due to elevated levels of cytokines and interleukins, which is believed to cause bleeding of gums and swelling. Periodontal disease (Pyorrhea) can increase levels of circulating cytokines, particularly interleukin-6 (IL-6), which has been implicated as one of the major interleukins leading to the cytokine storm.

“In fact periodontal disease (Pyorrhea) is currently being studied as a contributing disease to increase the severity of Covid -19”

B. XEROSTOMIA (DRY MOUTH)

Most of the covid patients are experiencing dry mouth.  According to the ADA American Dental Association, SARS COV -2 virus can affect the quality and quantity of the salivary gland.

Salivary gland is abundant in ACE2 receptor.  And the ACE2 receptor has been well-documented to be the target receptor of the SARS-CoV-2 virus and the portal of entry into the human cell.

C. COVID TONGUE

According to the American Academy of Oral Medicina (AAOM), COVID tongue is an inflammatory disorder that usually appears on the top and sides of the tongue. Affected tongues typically have a bald, red area of varying sizes that is surrounded by an irregular white border. Because the affected areas on the tongue can change in shape and size, like the continental drift, the disease is commonly referred to as “geographic tongue”.

D. ORAL ULCERATION

SARS COV- 2 virus can lead to the damage of blood vessels.  The virus enters the endothelial cells that line the blood vessels via the ACE2 receptors and damages them.  Oral ulceration and tissue necrosis happens as a result of vessel damage.

E. CRACKED TEETH

Worldwide, dentist reported more cases of cracked teeth in 2020.  An article was published in 2020 in the New York Times highlighting the same.

The article specifically examined three COVID-19 pandemic-related factors that could cause an increase in tooth facture from bruxism. First, psychological stress from the pandemic could have a major role in stress-related tooth fracture. Second, poor orthopedic posture from makeshift at-home workstations could lead to bruxism. Finally, sleep deprivation and/or obstructive sleep apnea could result in bruxism and cracked teeth.

F. LOSS OF TASTE AND SMELL

A sudden onset in loss of taste (ageusia) and smell (anosmia) are two symptoms that can be the earliest indicator of covid -19. The mechanism behind this loss is suspected to be viral disruption of cranial nerves 1, 7, 9, and 10.In addition, because the tongue has an abundance of ACE2 receptors, direct viral entry into tongue cells is possible.

According to another study, Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki-like, EM-like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa-like, angular cheilitis, atypical Sweet syndrome, and Melkerson-Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID-19 disease had more widespread and sever oral lesions.

Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper-inflammatory response secondary to COVID-19 are the most important predisposing factors for onset of oral lesions in COVID-19 patients.

Covid -19 has grappled us all. Only if we are mindful of all the small signs and symptoms and we take utmost precautions, we will be able to overcome the havoc of the pandemic. We are available for Online consultation and in case of any emergency appointment. Call 011- 41606066. to book an appointment.

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