key: cord-1051668-vegmosf3
authors: Riad, Abanoub; Klugar, Miloslav; Krsek, Martin
title: COVID‐19 Related Oral Manifestations, Early Disease Features?
date: 2020-06-30
journal: Oral Dis
DOI: 10.1111/odi.13516
sha: e30bf71f47a884d67f4fd6df1156a5ee895d89fb
doc_id: 1051668
cord_uid: vegmosf3

The outbreak of novel communicable diseases urges epidemiologic and clinical researchers to establish highly sensitive case definitions to track all true positive cases; therefore, there is emerging evidence on the oral lesions that may be indicative of the coronavirus disease (COVID-19).

Prevention and Control (ECDC), 2014) While specific respiratory symptoms of COVID-19 are lacking; dental facilities are preparing for reopening amid a pandemic with anticipated outbreaks. Therefore, we aim to scrutinize the epidemiologic significance of the potential COVID-19 oral manifestations.

Heretofore eight cases were reported to have had oral lesions adjacent to SARS-COV-2 infection (Table   1 ). (Ansari et al., 2020; Chaux-Bodard et al., 2020; Martín Carreras-Presas et al., 2020; Patel & Woolley, 2020; Sakaida et al., 2020) All reports were published as correspondence articles (short communication or letter to the editor), thus imposing editorial limitations per se that minimize reporting comprehensibility.

Manifestations were equally distributed among females and males. The mean age was 55.3 ± 11.3 years old, with seven cases (88%) were above 45 years old. While five cases (62%) were laboratory-confirmed, three cases (38%) were suspected based on clinical manifestations.

The masticatory mucosa was affected in 75% of the cases (2 tongue dorsum, 3 hard palate, 1 gingival mucosa), whereas 25% of manifestations were in the lining mucosa (1 labial mucosa, 1 buccal mucosa). Three cases (38%) experienced erythematous lesions, four cases (50%) had ulcers, and one case (12%) had blisters.

As for the etiology, the authors suggested various underlying causes and pathophysiologic courses. Oral manifestations were suggested by Sakaida et al. to be a possible drug reaction that may develop during the latency period. (Sakaida et al., 2020) Viral exanthem was also suggested, and it may impose additional challenges to differential diagnosis in dental practice because of the wide array of viral agents that cause oral exanthems. (Ansari et al., 2020; Martín Carreras-Presas et al., 2020; Rocha et al., 2020) The psychosocial burden of the pandemic outbreak and the physical distancing policies should not be overlooked while evaluating oral ulcers. (Ansari et al., 2020) Oral symptoms may occur due to co-infection with SARS-COV-2 and another bacterial infection enhancing the COVID-19 severity. (Patel & Woolley, 2020) 

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The onset of the oral manifestations varied considerably among the cases due to lack of reference time points.

The days of lab-testing, drug administration, admission to the hospital, discharge from the hospital, and respiratory and systemic manifestations were used as reference time points to describe the onset of oral symptoms. It is worthy to note that no case was reported yet to have oral symptoms prior to respiratory symptoms; this may be attributed to the methodological flaws.

To conclude, dentists may have a life-saving role in intervening with the pandemic severity among children by early detection of the mucosal symptoms of PIMS-TS. The epidemiologic significance of the oral manifestations remains unclear, thus necessitating larger observational studies to reveal the prevalence and the onset of these symptoms while maintaining the methodological quality by following the CARE and STROBE guidelines. (Gagnier et al., 2013; Von Elm et al., 2009) 

Oral cavity lesions as a manifestation of the novel virus (COVID-19): a letter-to-editor

Oral manifestation of Covid-19 as an inaugural symptom? Journal of Oral Medicine and Oral Surgery

Sensitivity and Specificity of a case definition

The CARE guidelines: Consensus-based clinical case reporting guideline development

Oral vesiculobullous lesions associated with SARS-CoV-2 infection

Necrotizing periodontal disease: oral manifestation of COVID-19. Oral Diseases, odi.13462

Viral enanthema in oral mucosa: a possible diagnostic challenge in the COVID-19 pandemic

Unique skin manifestations of COVID-19: Is drug eruption specific to COVID-19?

Kawasaki-like disease: emerging complication during the COVID-19 pandemic

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines

None to declare.

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for reporting observational studies. UroToday International Journal, 2(2).