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Oral Manifestations of Covid-19

By May 21, 2021News

It has been reported that patients with COVID-19 infection who have had the disease for a long time—termed “long haulers”—described  problems in their mouths including teeth loosening or falling out, sensitive gums, teeth turning a darker or grey colour, and teeth developing cracks. Although many health professionals may question whether there is a direct link between SARS-CoV-2 (Covid-19) and oral disease, some early reports suggest that the mouth is likely to be a vulnerable area to the virus due to the huge numbers of the ACE2 (angiotensin converting enzyme) receptor in oral tissue cells. There are many studies currently being conducted around the world and the results will be released over the next few months or so.

A cell receptor called the ACE2 receptor is known to be the target receptor of the SARS-CoV-2 virus and the entry point into the human cell. A recent study found that, compared with other oral tissues, cells of the tonsils, salivary glands and tongue, carry the most RNA linked to certain proteins that the SARS-CoV-2 virus needs to infiltrate cells and create an infection. These include the ACE2 receptor and an enzyme called transmembrane protease, serine 2 (TMPRSS), which allows the virus to combine its membrane with that of the host cell and enter the cell.

This is why the pre-procedure mouthwash which we use at in Coburg Dental Group as a family dentist near Reservoir, before each dental treatment visit, is so important. It decreases the viral load and the load of most oral bacteria to lessen the likelihood of viral spread through droplets and aerosols.

So, the most common oral manifestations associated with COVID-19 are as follows:-

Xerostomia (dry mouth)

COVID-19 infection and the pandemic in general, has been suggested to cause dry mouth for a variety of reasons. The most common is mouth breathing due to long periods of mask wearing or upper respiratory tract infections. Mouth breathing can dry out oral soft tissues especially without frequent hydration so as always, it’s important to keep up your fluid intake . Studies suggest that another biologic mechanism involves viral entry into the salivary glands which in turn, reduces salivary production and flow so that you have a dry mouth.  This is because the salivary glands have an abundance of the ACE2 receptor which the SARS-CoV-2 virus can hook on to.

Additional research is needed to identify causal effect, but in the meantime, clinicians have noted that xerostomia has been linked to an increase in both caries, gum disease and thrush infections.

Gingival inflammation

Bleeding and inflammation in oral tissue and in particular the gums, have been suggested to be a result of a generalized increase in inflammation and seen as elevated levels of cytokines and interleukins which are initiated by the SARS CoV-2 virus. COVID-19 disease severity has been linked to an immune dysregulation, leading to a cytokine storm. Periodontal disease caused by oral neglect can increase levels of circulating cytokines, particularly interleukin-6 (IL-6), which has been implicated as one of the major interleukins leading to the cytokine storm.

Periodontal disease is currently being studied as a possible contributing disease toward COVID-19 severity.

Oral ulcerations and gingival tissue breakdown

COVID-19 has been associated with viral damage of blood vessels. It is thought that this involves a process whereby the Covid-19 virus gains entry into the cells that line blood vessels via the ACE2 receptor and damages these cells, leading to areas of depleted oxygen. Tissue necrosis, including oral ulcerations, can be the result of this vessel damage. Ulceration and tissue damage can be further exacerbated by increased inflammation.

Numerous case reports have now confirmed that COVID-19–positive patients can have oral ulcerations that were suspected to be caused by the SARS-CoV-2 virus. These ulcerations can be treated with laser ablation which is available at Coburg Dental Group.

Tooth grinding and cracked teeth

In September 2020, the New York Times published an article which discussed the observation that dentists were seeing a significant increase in patients with fractured or cracked teeth during the coronavirus pandemic. We saw the same at Coburg Dental Group. The article described an increase in bruxism (teeth grinding and clenching) as the mostly likely culprit.

The article specifically examined three COVID-19 pandemic-related factors that could cause an increase in tooth fracture from bruxism. First, psychological stress from the pandemic could have a major role in stress-related tooth grinding and clenching. Second, poor neck and back posture from makeshift at-home workstations could lead to bruxism. Finally, sleep deprivation and/or obstructive sleep apnoea could result in bruxism and cracked teeth Hence, we often use the term “sleep bruxism”.

A study has also suggested a significant increase in orofacial pain which is usually associated with tooth grinding and clenching. This was a significant finding in a study of over 1800 participants.

The incidence of jaw clenching and bruxism increased from 35% pre-COVID pandemic to 47% at the height of the lockdown. There were similar increases with tooth grinding. A 15% increase in severity of symptoms was also reported.

Loss of taste and smell

A sudden onset in loss of smell (known as anosmia) and taste (known as ageusia) are two symptoms that can be the earliest indicators of COVID-19 infection. Depending on the study, between 50 and 80% of patients who test positive for COVID-19 can have subjective complaints of taste and smell loss, particularly in cases of asymptomatic or mild disease.

The mechanism behind this loss is suspected to be viral disruption of some of the cranial nerves, and associated cells.  In addition, because the tongue has an abundance of ACE2 receptors, direct viral entry into tongue cells is possible but not yet proven conclusively.

In addition, a study conducted by Tel Aviv University during the first COVID-19 lockdown, found women suffered from these symptoms more than men and in terms of age groups, 35 to 55-year-olds struggled the most.

To have these issues assessed and treated, call us at Coburg Dental Group on 9386 1805 to make an appointment.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

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