Covid-19 Signs & Symptoms in Oral & Maxillofacial Region

- Dr Mriganka Sekhar Ghose

Abstract

Background: This is a clinical research which specifically focusses on COVID-19 signs & symptoms in the oral & maxillofacial region, which every dentist practicing in this current time must be aware of. Symptoms such as high fever, dry cough and difficulty in breathing are the cardinal symptoms of the New Coronavirus (COVID-19) Disease but it must be acknowledged that COVID-19 does show other signs & symptoms in the oral & maxillofacial region too. Objectives: Various other signs & symptoms of COVID-19 may be present in the oral & maxillofacial region of patients who show the cardinal symptoms of the disease, which need active research. Methods: This clinical research is done in a dental clinic with normal inflow of patients who came for dental treatments but were having COVID-19 signs & symptoms. General methods of examination such as inspection, palpation, percussion & auscultation were performed. Outcome: Some patients who were having the COVID-19 symptoms of dry cough, high fever & difficulty in breathing also exhibited other signs & symptoms in the oral & maxillofacial region which rarely are taken into account by the clinicians involved. These signs & symptoms includes gingivitis, xerostomia, oral ulcerations, loss of taste sensations and bad breath, and must be taken seriously. Keywords: Gingivitis, Loss of taste sensation, COVID-19, bad breath, ulcerations in the oral mucosa ,salivary glands.

Novelty

This research indicates that COVID-19 signs & symptoms , which are specific to the oral & maxillofacial region,may be present and may be treated by the dental surgeon in a symptom based approach.

Study Objective

To find out whether COVID-19 shows signs & symptoms specific to the oral & maxillofacial region.

Methodology

This research was put into paper after taking medical literature into consideration and instances in the clinic where patients came with COVID symptoms & on examining the oral cavity, it was found that all these patients were showing various other signs & symptoms. All patients showing classical COVID symptoms were carefully evaluated for other oral signs and symptoms. This was done under strict disinfection and sterilization protocol as recommended by authoritative bodies. The symptoms were noted and symptomatic relief was given. It must be noted that none of these patients were having carious teeth or third molar impaction problems.

• For patients who showed gingival bleeding, a prescription of 2 tablets of Vitamin C daily along with an anti plaque tooth paste (X tar), a Chlorhexidine mouthwash (Clohex ADS), a Metronidazole ointment (Metrohex) to be applied on the gingiva, and oral Doxycycline 100mg was given.
• For patients with xerostomia, complete abstinence from smoking was advised and a prescription of a nutritional supplement (Becadexamin) and a medicine to stimulate salivation (Wet Mouth) was given. Nicotine replacement therapy was not advised as patient was showing symptoms of COVID-19.
• For patients with oral mucosal ulcerations, a prescription of topical paste such as triamcenolone buccal paste (Caziq), nutritional supplement (A to Z Multivitamin) and oral Rebemipide was given.
• For the patients with gingivitis, the patients were prescribed only medicines & no oral prophylaxis procedure or scaling could be performed, as it was a COVID pandemic period & all precautionary measures were taken to prevent the spread of coronavirus through aerosols or droplets.

Discussion

Pathophysiology Of The Oral & Maxillofacial Signs & Symptoms Of Covid-19

1. Gingivitis:Inflammation and bleeding in the oral tissue, known as gingivitis, is believed to be caused by an overall increase in inflammation due to elevated levels of cytokines and interleukins that are initiated by the SARS COV-2 virus. COVID-19 disease severity has been linked to immune disregulation leading to a cytokine storm. Periodontal disease can exacerbate this condition by increasing circulating cytokine levels, particularly interleukin-6 (IL-6), which is implicated as a major factor in cytokine storms.
2. Xerostomia (Dry Mouth):COVID-19 may cause dry mouth, or xerostomia, due to several factors. Mouth breathing can dry out oral tissues, especially without proper hydration.
3. Oral Ulcerations & Gingival Tissue Breakdown:Oral ulcerations and breakdown of gingival tissue have been associated with COVID-19 due to vascularity anomalies resulting from viral damage to blood vessels. William Li, MD, President and Medical Director of the Angiogenesis Foundation, describes the process by which the virus gains entry into the endothelial cells lining blood vessels via the ACE 2 receptor and damages them, leading to oxygen deprivation and tissue necrosis such as oral ulcerations.
4. Loss Of Taste & Smell:
   Loss of taste and smell may be among the earliest indications of COVID-19. The mechanism behind these symptoms is suspected to be viral disruption of cranial nerves 1, 7, 9, and 10, as well as supporting cells of neural transmission.