Oral lesions and saliva alterations of COVID-19 patients in an intensive care unit: A retrospective study

Abstract

To detect the type and frequency of oral lesions and clinical conditions suggestive of saliva alterations in COVID-19 patients in an intensive care unit (ICU), as well as to describe the patient´s management in each case METHODS: Information about oral conditions and mechanical ventilation was collected from oral medicine records of COVID-19 patients in an ICU (n = 519) RESULTS: From the total collected, 472 patients (90.9%) were examined by the oral medicine staff. In 242/472 patients (51.3%), alterations in the oral cavity were noted. The most frequent changes were mechanical trauma (18.1%, derived mainly from intubation), vascular/coagulation disturbances (24.1%, petechiae, bruises, varicoses, and oral bleeding), and saliva alterations (24.4%, dry mouth, and sialorrhea). Infectious lesions were mentioned in the oral medicine records (16.9%), most associated with a viral infection (15.7%), mainly herpesvirus. Improved oral change protocols included oral hygiene, use of specific medications, and laser therapy CONCLUSION: COVID-19 patients in the ICU often showed dryness in the oral and mucosa oral lesions related to vascular/coagulation disturbances, and mechanical trauma derived from orotracheal tube. An oral medicine staff must be aligned with the ICU multidisciplinary team to manage COVID-19 patients, as well as to establish diagnoses and oral cavity treatments.

Keywords: COVID-19; intensive care unit; oral lesions; oral medicine; salivary flow changes.

FIGURE 1

(A) Age frequency in patients with or without oral changes in a COVID‐19 intensive care unit. (B) Type and frequency of oral changes detected in COVID‐19 patients

FIGURE 2

Clinical aspects of oral lesions in patients in a COVID‐19 intensive care unit. (A) Traumatic ulceration derived from the endotracheal tube friction in the upper lip mucosa. (B) Petechias and bruises in the soft palate. (C) Varicoses in the lateral border of the tongue, suggestive of microthrombi formation. (D) Multiple ulcerations in the hard and soft palate suggestive of viral infection. (E) Ulcerations in skin and lip vermillion and mucosa, suggestive of herpetic lesion. (F) Unspecific erosion with irregular borders in attached gingiva without a clear etiological factor [Colour figure can be viewed at wileyonlinelibrary.com]