Oral manifestations and dental practice recommendations during COVID-19 pandemic

Abstract

Oral health is a pivotal sign of overall health, well-being, and quality of life. With the emergence of COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), insights into the relationship between SARS-CoV-2 and oral diseases are urgently needed to elucidate the oral manifestations of SARS-CoV-2. The current review aims at analyzing various reports available on oral symptoms along with possible causation, their relationship to the time of occurrence of clinical symptoms, and to shape guidelines for dental practices that could help in combating this global pandemic. The common symptoms that patients report to the dental office even at the presymptomatic stage are ageusia (loss of taste), non-specific anosmia (loss of smell-not associated with rhinitis), and hyposalivation. Few studies also report unexplained ulcers in the oral cavity, desquamative gingivitis, herpetiform ulcers on attached gingiva, blisters/irregular ulcers on the tongue's dorsal surface enlargement of submandibular glands, and cervical lymph node enlargement. Dental surgeons should abide by the prevalent precautionary guidelines. They are at very high risk due to their close contact with patients and exposure to saliva and blood during treatment.

Keywords: Ageusia; COVID-19; SARS-CoV-2; anosmia; dental practice; oral manifestations; oral ulcers.

Figure 1

Detail structure of coronavirus (a). Transmission of SARS-CoV-2 through respiratory droplets / aerosols (b). The entry of SARS-CoV-2 into the host target cells is initiated by binding Spike glycoproteins with angiotensin-converting enzyme-2 (ACE2) and also utilize serine protease for spike protein priming (c and d). Interaction of RBD with ACE2 (d). Oral Manifestations of SARS-CoV-2 (all or none can occur separately or concurrently) (e). The illustration is made Biorender.com

Figure 2

Algorithm for dental patient management during COVID-19 pandemic