key: cord-0807673-l4q2p28w authors: Bhavasar, R. P.; Ajith, N. A.; Dhawal, A.; Vaswani, V. title: Comparative evaluation of oral lesions: Tale - the Covid 19 Tells date: 2022-02-04 journal: nan DOI: 10.1101/2022.02.03.22269712 sha: c5199f774729218264276ece138e89fd9d2d60d2 doc_id: 807673 cord_uid: l4q2p28w Abstract: Introduction & Objectives: The COVID-19 pandemic has been raging across the globe since early January 2020. India has reported over 27 million cases and more than 3, 00,000 deaths. This study was planned to analyze the differences in demographic, clinical features, and oral manifestations of COVID 19 patients hospitalized during the COVID-19 pandemic. Methods: This observational pilot study had a total of 36 participants, 12 each of mild, moderate, and severe RT-PCR positive COVID cases hospitalized during the COVID 19 pandemic. All demographic, clinical features, treatment details, and oral manifestations were noted from the first day of admission to the hospital till treatment completion with a follow-up of a minimum of 7 days. Results: Mean age of the patients was 39.44 years with M: F ratio of 5:4. Most common clinical presentation was fever, shortness of breath, and treatment involved was symptomatic with supplemental oxygen & mechanical ventilation. The most common oral site involved was the tongue & oral lesions observed were herpes labialis, mucositis, burning sensation, dryness of oral cavity, angular cheilitis, aphthous ulcers, geographic tongue, fissuring of the tongue, candidiasis, coated tongue, sublingual varicosity, & scalloped tongue. Interpretation and Conclusion: All demographic, clinical, and oral manifestations were significantly different in mild, moderate, and severe cases of covid hospitalized patients. Though clinical symptoms were improved, oral lesions were worsened. Oral Lesions seen in covid patients were associated with multiple drug therapy for illness along with poor oral hygiene, but further etiology for lesions needs to be evaluated. Sublingual varicosity was observed in our hospitalized covid patients, but a large sample observation is required for confirmation of findings and maybe an early oral feature for covid detection. Prevention is always better than cure, so all patients positive for Covid should have a full mouth examination. Oral health should be a priority during the overall management of COVID patients and dentists should be a part of the Covid management team. Key Words: Oral Lesions, COVID 19, Sublingual varicosity, Candidiasis, Tongue. As we all are aware, the COVID-19 pandemic has been raging across the globe since early January 2020. The All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in Ethical clearance for conducting study was obtained from the Institutional Ethics Committee (SVIEC). All Participants were informed about study through Participant's information sheet. Once Participants were informed regarding study, they were recruited in the study only after taking their consent for study. Following consent, covid RT PCT positive patients were examined for oral lesions during their hospitalization for standard care for covid. Intra-oral examination included oral health status assessment using disposable mouth mirror and probe. Hard tissue as well as soft tissue observation was performed. If any lesion observed in the oral cavity, it was entered in proformas and photographs for the same were taken following their photographic consent. Covid sterilisation & disinfection protocol was strictly followed during patient interaction and data collection for study, as per Covid -19 Guides, & Confidentiality of study subjects was maintained. Following observations of the study, Descriptive statistics was performed, and data was subjected to statistical analysis by using (IBM) SPSS Version 20.0 Software. All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in Tongue was the most common site of involvement for oral lesions in moderate and severe groups whereas labial mucosa was commonly involved in mild covid group of patients. Commonest feature observed was dryness of oral cavity followed by mucositis, edema of lips, burning sensation, herpes lesions followed by angular chelitis, candidiasis and coated tongue. All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in Oral health status in moderate & severe patients was poor whereas in mild cases, it was good. Age distribution in mild, moderate and severe cases was varied but overall Mean Age of 39.44 ± 9.13 years in our study is younger than that reported by Tomo Oral lesions seen in our study were in congruent with numerous oral lesions reported in patients with COVID-19 including a wide and varied range 5 The most common specific oral symptom in all covid patients, found in our study in patients with COVID-19 was dryness of oral cavity, followed by mucositis, oedema, cracking of lips, loss of taste, burning sensation. Dry mouth or xerostomia is a sign of dehydration which could occur secondary to underlying illness such as COVID-19 but viral induced infection and inflammation of salivary glands is a known cause of xerostomia as found by Saniasiaya, J 9 who All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted February 4, 2022. ; https://doi.org/10.1101/2022.02.03.22269712 doi: medRxiv preprint reported possible reason for xerostomia occurrence could be the neuroinvasive and neurotropism potential of SARS-Cov-2. High grade fever of covid patients itself can lead to dehydration state of body, & salivary gland inflammation leading to gustatory impairment and thick ropy, viscous saliva is prone for growth of bacteria, fungi which in turn leads to halitosis, another common feature seen in our covid patients. Xerostomia can also be due to ventilation and oxygenated air for artificial oxygen requirement of covid patients if given with inadequate humidification itself becomes another reason for dryness, also patients were prohibited from water intake when on ventilation as requirement of covid treatment. Our finding was in accordance to Study by Biadsee et al 10 perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in Moderate and severe covid cases in our study had poor oral health as compared to mild cases. Lesions are more related to stress, the drugs or immunosuppression driven by the drugs rather than to COVID-19. Covid -19 has been described as vascular disease as SARS-CoV-2 leads to multisystem dysfunction with SARS-CoV-2-mediated endothelial injury, which is an important effector of the virus. 20 It has also been related to thrombotic alterations produced by the virus itself. 21 Sublingual veins, though normal, its inflammation and increased prominence during covid needs to be observed and verified. Examining the lateral borders and sublingual veins of the tongue is easily done, and could be a valuable oral feature for the dental profession to take active part in preventive healthcare during covid. Thus, oral lesions can be an inaugural sign of Covid-19 or a warning sign of peripheral thrombosis. Conclusion: Significant differences were found on intergroup comparison of oral lesions in mild, moderate & severe covid groups. Identification of Oral lesions can significantly impact overall covid prognosis due to multiple secondary infections & influence treatment outcome. Oral Lesions seen in covid patients were associated with All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted February 4, 2022. ; https://doi.org/10.1101/2022.02.03.22269712 doi: medRxiv preprint multiple drug therapy for illness along with poor oral hygiene, but further etiology for lesions needs to be evaluated. Sublingual varicosity was observed in our hospitalised covid patients, and may be an early oral feature of covid detection, as it has vascular pathogenesis. Prevention is always better than cure, so all patients positive for Covid should have a full mouth examination. Oral lesions could be the first COVID-19 signs to arise and hence dental practitioners are first to identify or suspect SARS-CoV-2positive patients if any. Dental Faculty should be a part of Covid pandemic Care. Limitation of our study was less number of patients with short follow up, also photograph of lesions was taken with transparent plastic cover on mobile for protection due to nature of the disease. Further studies should be planned with well distributed larger sample size and longer follow up to find out exact reasons of oral lesions for better treatment outcome. Oral manifestations associated with COVID-19 First confirmed case of COVID-19 infection in India: A case report Ministry of Health and Family Welfare | Home Oral mucositis in a SARS-CoV-2-infected patient: Secondary or truly associated condition? Oral Dis Oral manifestations in patients with COVID-19: a living systematic review Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study SARS CoV-2 related microvascular damage and symptoms during and after COVID-19: Consequences of capillary transit-time changes, tissue hypoxia and inflammation All rights reserved. No reuse allowed without permission. perpetuity High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa Xerostomia and COVID-19: Unleashing Pandora's Box Olfactory and oral manifestations of COVID-19: sex-related symptoms-a potential pathway to early diagnosis. Otolaryngol Head Neck Surg Characteristics of Oral Manifestations in Symptomatic Non-Hospitalized COVID-19 Patients: A Cross-Sectional Study on a Sample of the Saudi Population Inflammation of papillae of Wharton's duct in COVID-19 patients: a debatable entity Oral vesicles and acral erythema: report of a cutaneous manifestation of COVID-19 Aphthous-like stomatitis of COVID-19 patients: case report and review of evidence Oral mucosal lesions in a COVID-19 patient: new signs or secondary manifestations? Oral manifestations of Covid-19-A literature review Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis Oral mucosal lesions and oral symptoms of the SARS-CoV-2 infection Is there a connection between sublingual varices and hypertension COVID-19 -A vascular disease Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19 All rights reserved. No reuse allowed without permission. perpetuity preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted