Oral manifestations of COVID-19 in unvaccinated patients: a cross-sectional study

Abstract

Background: Early studies have highlighted the possible development of dysgeusia and anosmia in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and these manifestations should be considered a potential indication of coronavirus disease 19 (COVID-19). As potential contributors to these symptoms, dentists should perform careful oral and oropharyngeal examinations and document suspicious oral lesions in patients with COVID-19, especially in those who complain of loss of taste and smell. The study's objective was to assess the prevalence of oral manifestations among ambulatory unvaccinated symptomatic patients with suspected COVID-19 during the acute phase of the disease.

Methods: This cross-sectional study evaluated oral manifestations in adults (aged ≥ 18 years) with suspected and confirmed SARS-CoV-2 infection. Chi-square and Fisher's exact tests were used to compare data between the groups (rRT-PCR-positive and rRT-PCR-negative patients).

Results: One hundred thirty-six participants were included. Most were female (n = 79; 58.1%), with a mean age of 39.53 (± 14.17) years. Of these, 54 (39.7%) had a positive rRT-PCR test, and 82 (60.3%) had negative rRT-PCR results. Oral manifestations were observed in 40 participants (74.1%) in the rRT-PCR-positive group and 67 participants (81.7%) in the rRT-PCR-negative group. The most common oral manifestations were xerostomia (n = 85; 62.5%) and dysgeusia/ageusia (n = 57; 41.9%). Different rates of gingivitis (n = 12; 22.2% vs. n = 5; 6.1%; p = 0.005) and halitosis (n = 7; 13.0% vs. n = 1; 1.2%; p = 0.007) were observed between the rRT-PCR-positive and -negative groups, respectively. Mouth ulcers, glossitis, tongue coating, and petechiae were reported in both groups without significant differences.

Conclusions: A high prevalence of oral manifestations was observed in symptomatic patients with suspected or confirmed COVID-19.

Clinical relevance: This study highlights the importance of routine oral examinations by dentists as part of the multidisciplinary care of COVID-19 patients.

Keywords: COVID-19; Oral cavity; Oral manifestations; SARS-CoV-2; Saliva; Xerostomia.

Fig. 1

Flow diagram of the study

Fig. 2

Clinical presentations and diagnoses. (A) A male participant presented with a painful lesion on the inside of the bottom lip, exhibiting a clinical appearance of a white bump surrounded by a red, inflamed border. The center of the lesion appeared grayish-white. Clinical diagnosis: Mouth ulcer. (B) A male participant had a tongue surface coated with a thick whitish film and a fuzzy texture. Clinical diagnosis: Tongue coating. (C) A female participant presented a tongue with deep grooves on the surface running perpendicular to its length. Clinical diagnosis: Glossitis with indentations. (D) A female participant exhibited small pinpoint reddish-purple spots on the soft palate and buccal mucosa. Clinical diagnosis: Oral petechial lesions. Note: The clinical descriptions and diagnoses mentioned above were based on careful examination and evaluation by a qualified dentist