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The grim milestone of three million deaths due to the global pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reached a few weeks ago. COVID-19 is a multi-system all-pervasive disease with protean manifestations, and its major signs and symptoms, such as the incessant dry cough, fever, and pneumonia, are well known. Yet, its mucocutaneous manifestations, particularly those of the oral cavity, appear to be little recognized. This may be due either to the rarity of oral manifestations of COVID-19, or poor detection of such symptoms by attending physicians who may do only a cursory examination of the oral mucosa because of the overwhelming gravity of the other major systemic presentations. Nevertheless, there are now a considerable number of reports, including systematic reviews, on oral manifestations of COVID-19 in the literature. These, apart from the now well-known dysgeusia of COVID-19, range from ulcers, erosions, bullae, vesicles, mucosal pustules, macules, papules and pigmentations, as well as haemorrhagic manifestations including petechiae, crusts and spontaneous bleeding. Unfortunately, the majority of these reports are anecdotal in nature and remain to be substantiated. Here, we provide a brief overview of the reported oral manifestations of COVID-19, and their management protocols.
CPD/Clinical Relevance: To raise awareness of the currently reported major and minor oral manifestations of COVID-19 and their management protocols.
Article
The first reports on mucocutaneous manifestations of COVID-19 were by dermatologists,1,2 who correctly surmised that the skin lesions noted in these patients were very similar to cutaneous manifestations of common viral diseases. They also noted that the cutaneous lesions, in particular, could be due to the drug reactions in these early cohorts of COVID-19 patients and not necessarily due to the viral infection per se.3 Some of the lesions described in the earliest reports were present on the skin as well as on oral mucosal surfaces.
Apart from these nondescript findings, one of the earliest, virtually pathognomonic oral manifestations was the loss of taste or dysgeusia/ageusia, and anosmia in a majority of patients. These essentially manifested in the pre-symptomatic or the early symptomatic phase of the disease leading to a rash of reports from many regions of the World where the pandemic was taking root. In the following account, we briefly discuss dysgeusia and anosmia, followed by salivary gland affections and, finally, the reported oral mucosal lesions.
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