Oral Blisters Research Articles

Exploring the relationship between cycle threshold values and oral manifestations in COVID-19: a comprehensive overview.

This cross-sectional study aimed to compare oral manifestations between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients and to examine associations between oral symptoms, Ct values of E and N SARS-CoV-2 viral genes, and the implications of low Ct values indicating a high viral load, which is a predictive factor for the outcome of COVID-19. A total of 353 participating patients were aged ≥18 years with clinical manifestations of COVID-19 infection and tested for SARS-CoV-2 carriage at the medical center, by reverse transcriptase polymerase chain reaction (RT-PCR). All patients filled out an anonymous digital questionnaire regarding oral and general symptoms and overall medical health. Results: A significant association was found between SARS-CoV-2 carriage and dry mouth, unpleasant taste and changes in taste (p < 0.001); for example, 37.4% of the 147 SARS-CoV-2- positive participants had a dry mouth, compared to 18.9% of the 206 SARS-CoV-2- negative participants. Oral blisters were experienced by patients with an E gene Ct value of 10-20 (50%) or 21-30 (50%) (p = 0.041). Bad breath, dry mouth, unpleasant taste and changes in taste were mostly present in participants whose Ct values of both E and N genes were between 21 and 30. Conclusions: This study found significant associations between low Ct values of E and N SARS-CoV-2 viral genes and high viral load, indicating that Ct values can serve as predictive factors for COVID-19 outcomes. The findings suggest that while oral symptoms are present, the Ct values and associated high viral loads are more critical indicators of disease severity and prognosis.

Proposal of a modified technique of Nikolsky's sign in oral autoimmune vesiculobullous diseases.

Nikolsky's sign, originally described for skin lesions, presents challenges when applied to the oral mucosa. To address this, a modified Nikolsky's sign has been proposed specifically for the oral mucosa. In this variant, a gentle breath of air from the air syringe embedded in the dental unit is used to inflate a pre-existing collapsed blister (non-induced technique). Alternatively, in the induced technique, a healthy peri-lesion mucosal site is gently scratched with a blunt dental tool, and after a few minutes, air is blown on the same area to inflate any newly formed blister. The sign is considered positive if a blister is raised from the blown surface. The described modified Nikolsky's sign improves the visualization of oral vesicles and blisters in a cost-effective, easy, and minimally invasive manner. Its elicitation can aid in referring patients to specialized tertiary care units.

Questionnaire Survey of Information Printed on the Blister Pack of Medicine in Japan

Introduction: In Japan, dispensing medicines in blister packs is more common than dispensing them in boxes containing the blister packs. Handling errors by health care professionals and medication errors by patients can occur depending on the level of understanding of the package information. Methods: A survey was conducted to determine whether the expiration dates and medicinal effects of 220 randomly selected blister packs were recorded. In the survey, respondents were asked to indicate the percentage of blister-packed medicines that they expected would have expiration dates and medicinal effects written on them. Respondents were then asked to rate the expiration dates and medicinal effects written on the blister pack medicines on a scale of 10, from unnecessary to very necessary. Results: Of the 220 randomly selected blister packs, expiration dates were listed on 10.5%, and medicinal effects were listed on 31.4%. In the questionnaire survey, pharmacists accurately described the percentages of expiration dates and medicinal effects, whereas the prescribing doctors and nurses did not. Medical professionals wanted the expiration dates written on blister packs. Regarding the description of medicinal effects, there were differences in requests among the prescribing doctors, nurses, and pharmacists. Conclusion: We focused on the level of understanding of information printed on oral drug blister packs. There are differences among medical professionals, such as prescribing doctors, nurses, and pharmacists, in their views on the expiration dates and descriptions of the medicinal effects of blister packs. Medical professionals had differing opinions on the items listed on the blister packs, such as the expiration date and medicinal effects. This can potentially cause medical malpractice and reduce medication adherence.

Frequency of Oral Lesions, Olfactory, and Gustatory Disorders and Xerostomia in Patients with COVID-19.

COVID-19, a respiratory illness with a global impact on millions, has recently been linked to manifestations affecting various bodily systems, including the oral cavity. Studies highlight oral issues, like ulcers, blisters, and white patches, alongside olfactory and gustatory dysfunction, influencing an individual's quality of life. In this context, our study aimed to assess the frequency of oral lesions, olfactory and gustatory disorders, and xerostomia resulting from COVID-19. An observational study was conducted with 414 patients to evaluate the frequency of oral symptoms resulting from COVID-19. Patients were diagnosed with mild symptoms and evaluated through clinical examination of the oral cavity and a questionnaire to assess functional alterations. The findings showed that 139 out of 414 patients presented clinical manifestations, with oral lesions being the most prevalent (19.1%), followed by gustatory disorders (18.1%), xerostomia (14.2%), and olfactory dysfunction (14%). The most prevalent oral lesions were ulcerations (n = 51), candidiasis (n = 8), and erythema or red plaques (n = 7). Unfortunately, 50 (12.1%) patients died during this study. Therefore, oral lesions, olfactory and gustatory dysfunctions, and xerostomia are common symptoms associated with COVID-19.

Transcriptome analysis of long non-coding RNA and mRNA Profiles in VSV-infected BHK-21 Cells

BackgroundVesicular stomatitis virus (VSV) is a typical non-segmented negative-sense RNA virus of the genus Vesiculovirus in the family Rhabdoviridae. VSV can infect a wide range of animals, including humans, with oral blister epithelial lesions. VSV is an excellent model virus with a wide range of applications as a molecular tool, a vaccine vector, and an oncolytic vector. To further understand the interaction between VSV and host cells and to provide a theoretical basis for the application prospects of VSV, we analyzed the expression of host differentially expressed genes (DEGs) during VSV infection using RNA-Seq.ResultsOur analyses found a total of 1015 differentially expressed mRNAs and 161 differentially expressed LncRNAs in BHK-21 cells infected with VSV for 24 h compared with controls. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment showed that the differentially expressed lncRNAs and their target genes were mainly concentrated in pathways related to apoptosis, cancer, disease, and immune system activation, including the TNF, P53, MAPK, and NF-kappaB signaling pathways. The differentially expressed lncRNA can modulate immune processes by regulating genes involved in these signaling transmissions. Ten randomly selected DEGs, namely, Il12rb2, F2, Masp2, Mcl1, FGF18, Ripk1, Fas, BMF, POLK, and JAG1, were validated using RT-qPCR. As predicted through RNA-Seq analysis, these DEGs underwent either up- or downregulation, suggesting that they may play key regulatory roles in the pathways mentioned previously.ConclusionsOur study showed that VSV infection alters the host metabolic network and activates immune-related pathways, such as MAPK and TNF. The above findings provide unique insights for further study of the mechanism of VSV–host interactions and, more importantly, provide a theoretical basis for VSV as an excellent vaccine carrier.

Plasma Exosomal microRNA Profile Reveals miRNA 148a-3p Downregulation in the Mucosal-Dominant Variant of Pemphigus Vulgaris.

The mucosal-dominant variant of pemphigus vulgaris (MPV) is an autoimmune disease characterized by oral mucosal blistering and circulating pathogenic IgG antibodies against desmoglein 3 (Dsg3), resulting in life-threatening bullae and erosion formation. Recently, microRNAs (miRNAs) have emerged as promising players in the diagnosis and prognosis of several pathological states. For the first time, we have identified a different expression profile of miRNAs isolated from plasma-derived exosomes (P-EVs) of MPV patients positive for antibodies against Dsg3 (Dsg3-positive) compared to healthy controls. Moreover, a dysregulated miRNA profile was confirmed in MPV tissue biopsies. In particular, a strong downregulation of the miR-148a-3p expression level in P-EVs of MPV patients compared to healthy controls was demonstrated. Bioinformatics prediction analysis identifies metalloproteinase-7 (MMP7) as a potential miR-148a-3p target. An in vitro acantholysis model revealed that the miR-148a-3p expression level was dramatically downregulated after treatment with Dsg3 autoantibodies, with a concomitant increase in MMP7 expression. The increased expression of MMP7 leads to the disruption of intercellular and/or extracellular matrix adhesion in an in vitro cellular model of MPV, with subsequent cell dissociation. Overexpression of miR-148a-3p prevented cell dissociation and regressed MMP7 upregulation. Our findings suggest a pivotal role of P-EV cargo in regulating molecular mechanisms involved in MPV pathogenesis and indicate them as potential MPV therapeutic targets.

Dental management of patients with recessive dystrophic epidermolysis bullosa:

Introduction:&#x0D; Epidermolysis bullosa (EB) is a group of rare inherited disorders uniquely characterised by skin, and in some instances, mucosal blistering. In the most severe form of the disease, recessive dystrophic EB (RDEB), the blister-inducing split occurs below the lamina densa. Extensive scarring of the oral mucosa results in limited mouth opening, making speech and mastication difficult. At the same time, oral mucosal blisters often lead to patients restricting their diets to soft, and generally cariogenic, foods, and battling with oral hygiene practices. This results in poor plaque control, a high caries burden and complex dental management.&#x0D; Aims and objectives:&#x0D; This paper presents a report on two siblings suffering from generalised RDEB affecting the oral cavity and their extensive dental treatment needs.&#x0D; Design/Methods:&#x0D; The siblings were referred to the University of Pretoria Oral Health Centre, complaining of painful teeth and oral mucosal discomfort. Their clinical features, dental condition and subsequent management are presented.&#x0D; Results:&#x0D; Restricted mouth opening, limited personal plaque control, and diets limited to soft, carbohydrate-rich foods because of oral mucosal discomfort, resulted in extensive dental decay that required multiple extractions.&#x0D; Conclusions:&#x0D; The dental and anaesthetic management of patients with RDEB is complex, and due to the friable tissues, requires the most atraumatic care possible. Ideally, patients with this condition need to have early dental intervention where preventive programmes can be implemented to reduce the need for later extensive and complicated dental interventions. Maintenance of the patient’s oral health is essential to ensure adequate nutrition, yet, reducing the consumption of soft cariogenic diets which increased their caries risk.

The Importance of Patient-Focused Drug Development in Pemphigus and Pemphigoid

The Importance of Patient-Focused Drug Development in Pemphigus and Pemphigoid

A Narrative Review of the Oral Manifestations Encountered in COVID-19 Patients

This article aims to review the literature regarding oral manifestations found in patients with covid-19 to aid dental professionals in diagnosing the condition if it presents in their dental offices. A search was made in the international literature and all the articles, found in the English language, on the stated objectives, were included. Articles published between January 2020 to December 2022 were included. A review was done of the available literature. The review was conducted on a total of 30 articles. The oral manifestations reported were dysgeusia, anosmia, dry mouth, herpetiform-like ulcers, erythematous lesion, ulceration of the palate, and oral blisters and aphthous-like ulcers.

ODP107 Oral Ulcerations, A Rare Side Effect of Intravenous Zoledronic Acid

Abstract Introduction Zoledronic acid is an intravenous bisphosphonate known for its anti-resorptive effects and osteoporotic fracture risk reduction. A common adverse reaction with this medication is mild to moderate flu-like symptoms, which are transient and attributed to an acute phase reaction post treatment. A less common side effect, of oral ulcers is associated with oral bisphosphonates, attributed to incorrect oral intake but the real mechanism is still not well understood. We present a patient that developed oral ulcers after use of both oral and intravenous bisphosphonates, leading to suspicion of other underlying mechanisms other than incorrect oral intake of bisphosphonates. Case Report We present a 73 year old male with history of mild primary hyperparathyroidism and osteoporosis. Patient opted for medical management of his mild primary hyperparathyroidism in addition to having non-localizing studies. Treatment for osteoporosis was recommended due to femoral neck T score -2.4, FRAX score of 3.3% risk for hip fractures and history of low impact right foot fracture. The primary care team started treatment with alendronate 70 mg once a week, but patient developed oral blisters within a week of starting the treatment. Stopping alendronate led to resolution of the oral symptoms without any additional supportive treatment. Patient was later started on intravenous zoledronic acid, attributing the previous history of oral ulcers to a local effect of the oral bisphosphonates. Two days after the zoledronic acid infusion patient developed fatigue, fever, and oral ulcers. The oral ulcers were described as painful, located at the base and lateral aspects of the tongue. The ulcers later progressed to the buccal mucosa. No gingival ulcers were reported. Development of the oral blisters led to significant discomfort in eating and talking. Patient was treated with liquid nystatin 10,000 units/mL and lidocaine 2% viscous liquid. Patient had resolution of the painful ulcers approximately 2 weeks after the initial appearance. No recurrence of the oral ulcers has been reported, 4 months post treatment with zoledronic acid. Discussion Intuitively oral bisphosphonate induced mucosal injury is thought to be related to direct contact of the tablet with the oral mucosa or inappropriate ingestion of the medication and is not thought to be a systemic reaction. Our patient developed oral ulcers from both oral and intravenous bisphosphonates suggesting a possible systemic mechanism involved. Understanding potential side effects such as mucosal injury from intravenous bisphosphonates will be helpful for patient education and timely care. Presentation: No date and time listed

ANGINA BULLOSA HEMORRHAGICA: A RARE OR UNDIAGNOSED CONDITION?

Angina Bullosa Hemorrhagica (ABH) is a recurrent disorder characterized by the appearance of oral mucosal blisters filled with blood, mainly in the soft palate and tongue of middle-aged or older adults. We report a case of a 68-year-old White female patient with no relevant medical history complaining of a blood blister on the lateral surface of the tongue lasting 2 days. No possible triggering factors were identified. Based on clinical features and exclusion of hematologic disorders, the diagnosis was ABH. The treatment was an incision of the blister and prescription of analgesic drugs. At 15 days of follow-up, the oral mucosa was normal. ABH can easily be confused with autoimmune or hematologic disorders. Therefore, recognition of the lesion is essential to dentists to avoid misdiagnosis. The clinical management of ABH is often focused only on the relief of symptoms.

Oral Alterations in Heritable Epidermolysis Bullosa: A Clinical Study and Literature Review.

Epidermolysis bullosa (EB) is a group of skin disorders with skin fragility characterized by blistering from minimal mechanical trauma with rupture at the dermoepidermal junction. There are four major classical heritable EB types, due to mutations in as many as 20 distinct genes: EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), and Kindler EB (KEB). This study is aimed at reporting case series on patients (N = 8; males, n = 5 and females, n = 3, age range 12-68 years) affected by EB and performs a review of the literature on this topic. This group of disorders can affect oral soft and hard tissues in various ways, resulting in various effects including enamel hypoplasia, dental caries, microstomia, ankyloglossia, oral blistering, and ulcerations early-onset periodontal disease. From the sample results, it can be concluded that the clinical manifestation of EB patients is highly variable and very different in prognosis. Oral health deeply influences the quality of life of EB patients. Dental management is essential to prevent the aggravation of soft tissue damage and tooth loss and to improve the quality of life through prosthetic and restorative therapies. Dentists should consider the oral alterations of EB subtypes to perform a personalized approach to the patients' needs in a preventive and therapeutic point of view.

A RAPIDLY PROGRESSIVE AND RARE ILLNESS: AUTOANTIBODIES AGAINST MELANOMA DIFFERENTIATION-ASSOCIATED PROTEIN 5 (ANTI-MDA5): AMYOPATHIC DERMATOMYOSITIS WITH PROGRESSIVE INTERSTITIAL LUNG DISEASE THAT DEVELOPED AFTER COVID-19 VACCINE

TOPIC: Critical Care TYPE: Global Case Reports INTRODUCTION: Anti-MDA5 dermatomyositis is a subtype of dermatomyositis characterized by a high risk of rapidly progressive interstitial lung disease. It is characterized by fever, progressive shortness of breath, joint swelling and skin ulcerations. (1) There is invariable hyper-ferritinemia and radiographically there is a pattern of diffuse bilateral ground glass opacities. Complications with spontaneous pneumothorax and pneumomediastinum are not uncommon. Diagnosis is confirmed by biopsy as well as serum antibodies against MDA5. A known trigger is viral infection. (2) CASE PRESENTATION: We present the case of a 58-year-old man who was admitted to the Intensive Care Unit on account of respiratory failure and shock. He had a progressive Illness that started 4 days after receiving a novel mRNA COVID-19 Vaccine. He developed bilateral extremities edema, oral sores, worsening fatigue and dyspnea on exertion. He failed outpatient treatment for empiric pneumonia as well as prednisone for vaccine reaction. He presented to the hospital with fever, progressive dyspnea and fatigue. On physical exam he had oral blisters, digital tip ischemia and ulceration. His vital signs were pertinent for a SpO2 of 90% on ventilator support. A chest CT revealed diffuse and sub-pleural ground-glass opacities.There was an extensive negative infectious work up from serum, urine and BAL samples. These included negative SARS COV2 Antigen and SARS-Cov2 IgG. His inflammatory markers were pertinent for a positive ANA with titer of 1:320, Ferritin of 2,143 mcg/L, LDH of 1,105 U/L and CRP of 2.7mg/dL. Based on this information the differential for amyopathic dermatomyositis with progressive interstitial lung disease was considered. A skin biopsy of his index finger confirmed the diagnosis. His therapeutic interventions through his hospitalization included a trial of stress dose steroids, cyclophosphamide, IVIG, colchicine and tacrolimus. His ICU course was complicated by pneumomediastinum, pneumothorax and pericardial effusion. These were managed by placing a chest tube thoracotomy and pericardial drain respectively. His plan of care was changed to comfort measures after he had a drastic and prolonged desaturation episode without recovery. DISCUSSION: For conditions that lead to cytokine storm with subsequent development of ARDS or multi-organ dysfunction;there is a progressive clinical deterioration and high risk of death. We had insufficient evidence to definitively demonstrate a direct correlation between the vaccination and the patient's illness. CONCLUSIONS: In conditions that lead to Cytokine storm with multi-organ dysfunction targeting timely control of this inflammatory cascade via immunomodulation, cytokine antagonist and reduction of inflammatory cell infiltration in particular early in the process could lead to a reduction in mortality. REFERENCE #1: Fiorentino D, Chung L, Zwerner J, Rosen A, Casciola-Rosen L. The mucocutaneous and systemic phenotype of dermatomyositis patients with antibodies to MDA5 (CADM-140): a retrospective study. J Am Acad Dermatol. 2011;65(1):25-34. doi:10.1016/j.jaad.2010.09.016 REFERENCE #2: Sakamoto N., Ishimoto H., Nakashima S. Clinical features of anti-MDA5 antibody-positive rapidly progressive interstitial lung disease without signs of dermatomyositis. Intern Med. 2019;58(6):837–841. doi: 10.2169/internalmedicine. 1516-18. REFERENCE #3: Margherita Giannini,1 Mickael Ohana,2 Benoit Nespola,3 Giovanni Zanframundo,4,5 Bernard Geny,1,6 and Alain Meyer1,6,7 Similarities between COVID-19 and anti-MDA5 syndrome: what can we learn for better care? Eur Respir J. 2020 Sep;56(3): 2001618. Published online 2020 Sep DISCLOSURES: No relevant relationships by Ashlie Arthur, source=Web Response No relevant relationships by Leonel Carrasco, source=Web Response no disclosure on file for Chad Case;No relevant relationships by Juan Gaitan Rueda, source=Web Response

English

Supernumeraries erupting in ectopic regions are one of the commonly found anomalies of orofacial region.1 The mesiodens, being located between the maxillary central incisors is the most common supernumerary tooth.2,3 But impacted mesiodens erupting into nasal cavity is a rare finding. We are detailing an instance of an inverted impacted mesiodens in the nasopalatine canal of an adult patient with encroachment on the nasal floor diagnosed as an incidental finding in panoramic radiograph. Intranasal tooth in adults is reported rare in the literature. Although surgical removal is advised generally on diagnosis of impacted mesiodens, we stress the importance of periodic monitoring of such cases which adds significantly to the patient wellbeing, function and aesthetics. There are few published case reports and most of the cases reported in the literature are in children which prompt for immediate removal upon its recognition. A supernumerary tooth that erupts ectopically into the nasal cavity is referred to as an intranasal tooth. Its occurrence rate is low with only 0.1 to 1 % people being affected from the community.4 The aetiology of intranasal tooth stays undefined. Supernumerary teeth may develop from the region of the nasal cavity as a result of a damage caused by an injury, rhinogenic maxillary sinusitis, a dental disease, oral blisters, obstructed path of dental eruption, and disruption of developmental tissue in the palatine gap.4 The potential complications that can arise due to nasal eruption of tooth are perforation of nasal septum, naso-oral fistula and aspergillosis4. The probable dental complications include midline diastema (17.6 %), late eruption of the permanent incisors (38.8 %), axial rotation of the permanent incisors (16.4 %), root resorption of the neighbouring teeth (4.7 %),5 cyst formation, 6 and infection.1 A team approach with inclusion of disciplines in medicine and dentistry is necessary for planning and execution of an appropriate treatment method in order to prevent complications related to inadvertent surgical entry into vital structures.

Pathogenicity Analysis of Weaned Piglets Challenged With Novel Emerging Senecavirus A in Fujian, China.

In order to evaluate the pathogenicity of Senecavirus A (SVA) to weaned piglets preliminarily, 28-day-old weaned piglets were challenged with SVA by intramuscular injection. The clinical manifestations, antibody levels, and tissue viral load of infected piglets were detected. The results indicated that the piglets challenged with SVA CH/FuJ/2017 showed drowsiness, lameness, oral blisters, diarrhea, and other clinical signs. Lesions on the hooves were observed. Red spots or plaques were initially observed on the hoof and then developed into blisters that cracked and gradually formed scab. The symptoms and signs were relieved after 8 days post-infection (dpi). The sentinel piglet, feeding together with the challenged piglets, showed similar clinical signs with the challenged piglets after 3 dpi. Monitoring of antibody levels showed that anti-SVA antibody could be detected at 5 dpi by competition enzyme-linked immunosorbent assay (cELISA) method, and neutralizing antibody could be detected after 7 dpi. Analysis of viral tissue distribution and viral load indicated that SVA could replicate in the liver, spleen, lung, kidney, and lymph node. In all, Senecavirus disease was successfully replicated by SVA CH/FuJ/2017 isolate, which verified the clinical manifestations of SVA infection in weaned piglets, and provided a foundation for further SVA pathogenesis and vaccine development.

Covid-19 and oral diseases: Crosstalk, synergy or association?

SummaryThe coronavirus disease 2019 (Covid‐19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) that clinically affects multiple organs of the human body. Cells in the oral cavity express viral entry receptor angiotensin‐converting enzyme 2 that allows viral replication and may cause tissue inflammation and destruction. Recent studies have reported that Covid‐19 patients present oral manifestations with multiple clinical aspects. In this review, we aim to summarise main signs and symptoms of Covid‐19 in the oral cavity, its possible association with oral diseases, and the plausible underlying mechanisms of hyperinflammation reflecting crosstalk between Covid‐19 and oral diseases. Ulcers, blisters, necrotising gingivitis, opportunistic coinfections, salivary gland alterations, white and erythematous plaques and gustatory dysfunction were the most reported clinical oral manifestations in patients with Covid‐19. In general, the lesions appear concomitant with the loss of smell and taste. Multiple reports show evidences of necrotic/ulcerative gingiva, oral blisters and hypergrowth of opportunistic oral pathogens. SARS‐CoV‐2 exhibits tropism for endothelial cells and Covid‐19‐mediated endotheliitis can not only promote inflammation in oral tissues but can also facilitate virus spread. In addition, elevated levels of proinflammatory mediators in patients with Covid‐19 and oral infectious disease can impair tissue homeostasis and cause delayed disease resolution. This suggests potential crosstalk of immune‐mediated pathways underlying pathogenesis. Interestingly, few reports suggest recurrent herpetic lesions and higher bacterial growth in Covid‐19 subjects, indicating SARS‐CoV‐2 and oral virus/bacteria interaction. Larger cohort studies comparing SARS‐CoV‐2 negative and positive subjects will reveal oral manifestation of the virus on oral health and its role in exacerbating oral infection.

An Oral Blood-filled Blister: A Quiz.

An Oral Blood-filled Blister: A Quiz.

How to deal with coronavirus disease 2019: A comprehensive narrative review about oral involvement of the disease.

ObjectivesThe aim of this narrative review was to collect all findings from literature about oral signs and symptoms of COVID‐19, in order to draw a picture of oral involvement of this challenging viral infection, to help oral professionals in a better triage and early diagnosis.Material and methodsThe search for international literature was made including articles written in English and reporting about oral manifestations in patients with a diagnosis of COVID‐19. The publication time was limited to 2019 and 2020, up to May 20, 2020. A narrative review was performed.ResultsTwenty‐three articles were included in this review. Three different oral manifestations were found: taste alteration, oral blister and ulcers, and oral lesions associated with Kawasaki‐like diseases (erythema, bleeding of lips, “strawberry tongue”). The higher expression of Angiotensin‐converting enzyme 2 in the oral cavity and in endothelial cells might be responsible for oral manifestation and the major report of signs and symptoms in the occidental countries.ConclusionsDetecting oral signs and symptoms of COVID‐19 could be useful to perform a better preliminary triage in dental setting, and in recognizing possible early manifestations of the disease. However, considering the outbreak of COVID‐19 and the consequent difficulty of undergoing oral examinations, the oral manifestations might be misdiagnosed; then, we would encourage oral professionals to perform other studies about this topic.

Oral ulceration and blistering in patients with COVID-19.

Design Case series.Introduction The most common signs and symptoms of SARS-CoV-2 infection include headache, sore throat, hyposmia, hypogeusia, diarrhoea, dyspnoea and pneumonia. Dermatological manifestations have also been reported but few authors have documented oral signs and symptoms. Methods Three cases are reported where oral ulceration or blistering is found in patients with confirmed or suspected COVID-19.Results One patient had serologically confirmed COVID-19, whilst the remaining two cases were only suspected. Two patients reported pain from the palate, whilst the third reported in the tongue. The first two patients had lesions affecting keratinised tissue consistent with herpes simplex lesions but with no history of herpetic infection. The third patient had lesions compatible with erythema multiforme.Conclusions The authors suggest a link between COVID-19 and oral ulceration and blistering, but acknowledge these signs may often go undetected due to a lack of intraoral examination during hospital admission.

Salivary Glands, Saliva and Oral Findings in COVID-19 Infection

The world is under the threat of the novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite several efforts to contain the disease spread, it still constitutes a public health emergency of international concern. Several published reports in the scientific literature called attention of the oral cavity as the potential route of infection, the implications for dental practice and the use of saliva in the diagnose of the COVID-19. The aim of this article is to provide an overview of the literature on the salivary glands and saliva in the context of SARS-CoV-2 infection. A brief discussion of taste disturbances and oral findings in COVID-19 patients is also presented. The literature shows that SARS-CoV-2 could infect the salivary glands. It is not possible, however, to make speculations regarding them as reservoirs for the SARS-CoV-2. In addition, patients with COVID-19 presented several oral repercussions, including hyposalivation and taste disturbances. A few reports showed oral ulcers and blisters associated with SARS-CoV-2 infection. However, it remains not fully understood and might lead to erroneous assumptions. Overall, further studies are necessary to understand the real role of salivary glands and saliva in the context of SARS-CoV-2 infection.