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. 2021 Aug 25:8:726753.
doi: 10.3389/fmed.2021.726753. eCollection 2021.

Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis

Javier Aragoneses  1 , Ana Suárez  2 , Juan Algar  3 , Cinthia Rodríguez  4 , Nansi López-Valverde  5 , Juan Manuel Aragoneses  6
Affiliations

Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis

Javier Aragoneses et al. Front Med (Lausanne). .

Abstract

There is increasing evidence for oral lesions and manifestations of COVID-19. The aim of this meta-analysis was to investigate the types of oral manifestations of COVID-19 and their prevalence. PubMed/Medline, Scopus, Web of Science, and Google Scholar databases were used to search for publications on oral manifestations in patients with PCR-confirmed COVID-19. A total of 310 records were selected, and 74 were included. Oral lesions in COVID-19 were classified according to their etiologies, including iatrogenic lesions caused by intubation and opportunistic infections. Of the included studies, 35 reported oral lesions probably caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection. Meta-analysis of prevalence data on oral manifestations and aphthous lesions indicated high heterogeneity, while meta-analysis of xerostomia prevalence data revealed a pooled prevalence, with considerable heterogeneity. In conclusion, the meta-analysis yielded high heterogeneity between studies: oral lesions yielded a prevalence of 0.33 (95% CI 0.11-0.60), xerostomia lesions a prevalence of 0.44 (95% CI 0.36-0.52) and aphthous lesions 0.10 (95% CI 0.01-0.24). In addition, a gap in the evidence regarding the prevalence of oral lesions in COVID-19 was identified and the need for further observational studies focusing on this issue and on the causal relationships between oral lesions and COVID-19 was highlighted.

Keywords: COVID-19; SARS-CoV-2; meta-analysis; oral diseases; oral manifestations; oral pathology; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Forest plot showing the pooled prevalence of oral lesions in general in COVID-19.
Figure 3
Figure 3
Forest plot showing the pooled prevalence of xerostomia in COVID-19.
Figure 4
Figure 4
Forest plot showing the pooled prevalence of aphthous oral lesions in COVID-19, with studies at high risk of bias included.
Figure 5
Figure 5
Forest plot showing the pooled prevalence of aphthous oral lesions in COVID-19 with studies at high risk of bias excluded.
Figure 6
Figure 6
Funnel plot of studies on the prevalence of oral lesions in general.
Figure 7
Figure 7
Funnel plot of studies on the prevalence of xerostomia.
Figure 8
Figure 8
Funnel plot of studies on the prevalence of aphthous lesions.
See this image and copyright information in PMC

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