Oral manifestations in a patient with a history of asymptomatic COVID-19: Case report

Abstract

The pandemic situation has led to public health measures that have forced patients with and without the SARS-CoV-2 virus to remain isolated and take steps to prevent the spread. Many of these patients have been unable to attend the control of medical-dental services, which in many cases complicates their situation. This study reports on the oral manifestations of an asymptomatic COVID-19 patient treated interdisciplinary by teleconsultation due to the sudden appearance of lesions in the oral mucosa. Lesions are diagnosed, therapeutic measures are taken, and improvement is shown. This case shows that the problems that arise in the oral mucosa in patients with suspected or confirmed SARS-CoV-2 infection can be monitored through interdisciplinary teleconsultation during the pandemic with the support of information technology currently available worldwide. It also decreases the risk of transmission of SARS-Cov-2 between patients and health professionals.

Keywords: COVID-19; Candidiasis; Case report; Hyperpigmentation; Melanin; Oral mucosa; SARS-CoV-2.

Figure 1

A, B, C, and D were photos taken at the first dental teleconsultation of a 40-year-old woman. E, F and G are the photos from the second teleconsultation twenty days later. In (A) multiple petechiae are observed in the mucosa of the lower lip in an area of 3 × 1 cm. Image (D) shows scattered petechiae on the upper part of the face. In (F) remission of the lesions of the lip present in (A) due to the possible suspension of ibuprofen is observed. Image (B) shows a tongue with whitish areas of a more intense color in the posterior area of the tongue and slightly diffuse in the anterior part suggesting a diagnosis of mild C. albicans. Image (G) shows a significant decrease in the lesion on the tongue after two weeks of treatment with nystatin and oral hygiene. Image (C) shows an aphthous ulcerative lesion at the level of the attached gum of the first lower left premolar. In the upper part of the lesion, melanin pigmentations are observed that compromise the attached and papillary gingiva of the canine and the first premolar. The attached and papillary gum between the two premolars does not have this pigmentation. Dark brown pigmentation due to possible melanin hyperpigmentation is visible in the attached gingiva of the anterior teeth (E) (F). In (H) a photo of the patient is presented 6 months before the dental teleconsultation showing that she had no pigmentation.