COVID-19 and Its Repercussions on Oral Health: A Review

An Investigation of temporomandibular pain, headache, and fatigue in relation with long-term mask use during the COVID-19 pandemic period

OBJECTIVE

To investigate the effects of long-term mask use on temporomandibular pain, headache, and fatigue during the COVID-19 pandemic period via a survey.

METHODS

The survey was sent online, and symptoms associated with mask use, perception of mask discomfort, temporomandibular dysfunction, fatigue, headache, and trigger points of temporomandibular joint were evaluated.

RESULTS

For the study, 909 people were screened. Head, neck, face, throat, ear, and jaw pain, cheek tension, teeth clamping, acne, mask trace, palpitation, and voice and sleep disorders were different between groups (p < 0.05). The individuals' temporomandibular dysfunction and fatigue were different between groups (p < 0.05).

CONCLUSION

Long-term mask use can cause many symptoms, such as headache, jaw pain, and fatigue. Furthermore, increased mask-wearing time can trigger all these symptoms. The authors recommend relaxing breaks and exercises for neck, jaw, and face muscles along with the use of appropriate masks to minimize negative symptoms.

Manifestation of Necrotic Palatal Ulceration in COVID-19 Infection: a Case Report

Background

The global pandemic caused by the COVID-19 virus is a serious disease that has significantly affected the lives of millions of people.

Objective

The objective of this case study is to describe the development of a necrotic ulcer on the palate in a COVID-19 patient.

Case presentation

This is the clinical case of a 35-year-old male patient with a 20-year history of two pack-a-day smoking who contracted COVID-19. He was admitted to the Department of Oral and Maxillofacial Surgery at the "Mother Teresa" University Hospital Center in Tirana, Albania, presenting with oral pain, facial swelling, and necrosis in the palatal region and the lower lip.

Conclusion

This case report from Albania is significant as it presents an ulcer with necrotic tissue located in the hard palate region of a patient infected with SARS-CoV-2.

The influence of COVID-19 on temporo-mandibular disorders

Temporomandibular disorders are multi-factorial conditions affected by psychological, biomechanical, and neuromuscular factors. Stress and anxiety experienced during the pandemic are capable of influencing and aggravating temporomandibular disorders and orofacial pain. The study aimed to analyze whether the coronavirus infection can directly affect these diseases. All participants were asked to complete the Pain Screener and Patients Health Questionnaire and were assigned to Group I: healthy participants and Group 2: participants with existing complaints. In group II participants filled the questionnaires twice the Temporomandibular Disorders Symptom Questionnaire and Graded Chronic Pain Scale. The first time to self-report the severity of chronic pain before COVID-19 (T1 timeline) and the second time- to self-report the level of pain after COVID-19 infection (T2 timeline). Totally 150 participants were included in the study. In group II the difference between T1 and T2 timeline was significant for the level of average pain (p = 0.022) and highest facial pain (p = 0.043); Difference in level of interference of daily activities (p > 0.05), recreational activities (p > 0.05) and ability to work (p > 0.05) was statistically not significant. Graded chronic pain status was the same "Grade I" for T1 and T2 timeline. There was no statistically significant difference in stress level between group I and II.

Public Attitudes, Inequities, and Polarization in the Launch of the 988 Lifeline

CONTEXT

To address the considerable burden of mental health need in the United States, Congress passed the National Suicide Hotline Designation Act in 2020. The act rebranded the national suicide prevention lifeline as 988, a three-digit number akin to 911 for individuals to call in the case of a mental health emergency. Surprisingly little is known about American attitudes toward this new lifeline.

METHODS

The authors use a demographically representative survey of 5,482 US adults conducted June 24-28, 2022, to examine the influence of mental health status, partisan identification, and demographic characteristics on public awareness of the new 988 lifeline, public support for the lifeline, and intention to use it.

FINDINGS

The authors find that while only a quarter of Americans are aware of the lifeline, support for the 988 lifeline is widespread, with more than 75% of Americans indicating they would be likely to use the new number if needed. The authors identify key disparities in awareness, support, and intended use, with Republicans, individuals with low socioeconomic status, and Blacks less supportive of the 988 lifeline and in some cases less likely to use it.

CONCLUSIONS

The results point to the need for additional interventions that increase public awareness of 988 and reduce disparities in program knowledge, support, and intention to use.

Assessing the Relationship Between COVID-19 and Dental Decay Risk in Youth: A Retrospective Analysis

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted public health globally, with particular attention on the effects on children, adolescents, and young adults. This study aimed to investigate the potential relationship between COVID-19 and caries risk in this age group.

METHODS

A retrospective chart review was conducted on 120 patients between the ages of six and 25 years who received dental treatment at a university-affiliated dental clinic between January 2020 and December 2021. Demographic and medical data were collected, and dental examinations were performed to record the number of decayed, missing, and filled teeth (DMFT) and decayed, missing, and filled surfaces (DMFS). Data were analyzed using descriptive statistics, chi-square test or Fisher's exact test, student's t-test or Mann-Whitney U test, and multivariate regression analysis.

RESULTS

Of the 120 patients, 40 were COVID-19-positive, and 32 of those patients were at high caries risk. Of the 80 patients who were COVID-19 negative, 48 were at high caries risk. There was a statistically significant association between COVID-19 exposure and caries risk. Participants who tested positive for COVID-19 had 1.8 times higher odds of dental caries than those who tested negative. However, no significant association was found between caries risk and age, gender, or previous dental history.

CONCLUSION

The findings suggest that COVID-19 may be a risk factor for caries in children, adolescents, and young adults. Dental professionals should consider COVID-19 exposure as a potential risk factor when assessing caries risk in this age group. Further research is needed to better understand the mechanism underlying this association.

Relationship between oral lesions and severe SARS-CoV-2 infection in intensive care unit patients

OBJECTIVE

Oral lesions received increased attention as likely new signs or secondary manifestations of COVID-19. Therefore, we clinically examined oral cavity of patients with COVID-19 and investigated oral lesions and patient comorbidities as possible risk factors of COVID-19 disease outcome.

METHODS

From January to March 2022, a prospective study was conducted by recruiting all COVID-19 patients admitted to the Intensive Care Unit and Respiratory Intensive Care Unit of Maxi-Emergencies Hospital in Bari, Italy.

RESULTS

From the enrolled 103 COVID-19 patients, 46.6% were females and 53.4% were males. Findings show that risk of presenting with severe COVID-19 disease was higher in patients who developed oral lesions related to COVID-19 than those with no oral lesions (RR = 7.998, p = .002). Next, patients with concomitant autoimmune diseases were at higher risk of a negative COVID-19 disease outcome than those without comorbidities (OR = 8.838, p = .026).

CONCLUSIONS

COVID-19-related lesions of oral mucosa should not be ignored as they can be early and easily detectable signs of severe COVID-19 disease condition, thus, serving as a prevention measure for any potential unfortunate event. Findings of this study, without implying causation, offer a direction for future investigations that aim to confirm the presence of specific oral lesions in COVID-19 patients as signs of severe disease progression.

Noninvasive Diagnostic Technique for Nonalcoholic Fatty Liver Disease Based on Features of Tongue Images

OBJECTIVE

To investigate a new noninvasive diagnostic model for nonalcoholic fatty liver disease (NAFLD) based on features of tongue images.

METHODS

Healthy controls and volunteers confirmed to have NAFLD by liver ultrasound were recruited from China-Japan Friendship Hospital between September 2018 and May 2019, then the anthropometric indexes and sampled tongue images were measured. The tongue images were labeled by features, based on a brief protocol, without knowing any other clinical data, after a series of corrections and data cleaning. The algorithm was trained on images using labels and several anthropometric indexes for inputs, utilizing machine learning technology. Finally, a logistic regression algorithm and a decision tree model were constructed as 2 diagnostic models for NAFLD.

RESULTS

A total of 720 subjects were enrolled in this study, including 432 patients with NAFLD and 288 healthy volunteers. Of them, 482 were randomly allocated into the training set and 238 into the validation set. The diagnostic model based on logistic regression exhibited excellent performance: in validation set, it achieved an accuracy of 86.98%, sensitivity of 91.43%, and specificity of 80.61%; with an area under the curve (AUC) of 0.93 [95% confidence interval (CI) 0.68-0.98]. The decision tree model achieved an accuracy of 81.09%, sensitivity of 91.43%, and specificity of 66.33%; with an AUC of 0.89 (95% CI 0.66-0.92) in validation set.

CONCLUSIONS

The features of tongue images were associated with NAFLD. Both the 2 diagnostic models, which would be convenient, noninvasive, lightweight, rapid, and inexpensive technical references for early screening, can accurately distinguish NAFLD and are worth further study.

Periodontal and Peri-Implant Diagnosis: Current Evidence and Future Directions

Dentistry and periodontology in particular are constantly evolving in terms of both diagnostic and therapeutic tools [...].

COVID-19 on Oral Health: A New Bilateral Connection for the Pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and transmission are generally known to be produced by respiratory droplets and aerosols from the oral cavity (O.C.) of infected subjects, as stated by the World Health Organization. Saliva also retains the viral particles and aids in the spread of COVID-19. Angiotensin-converting enzyme Type 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) are two of the numerous factors that promote SARS-CoV-2 infection, expressed by O.C. structures, various mucosa types, and the epithelia of salivary glands. A systemic SARS-CoV-2 infection might result from viral replication in O.C. cells. On the other hand, cellular damage of different subtypes in the O.C. might be associated with various clinical signs and symptoms. Factors interfering with SARS-CoV-2 infection potential might represent fertile ground for possible local pharmacotherapeutic interventions, which may confine SARS-CoV-2 virus entry and transmission in the O.C., finally representing a way to reduce COVID-19 incidence and severity.

A reflection on COVID-19 and oral mucosal lesion: a systematic review

Introduction

The aim of this systematic review is to provide a clinical update of the current knowledge on COVID-19 and oral mucosal lesions, to analyze the types and prevalence of oral mucosal lesions in patients with COVID-19, and to clarify the potential association between COVID-19 and oral mucosal lesions.

Methods

The literature search was conducted using PubMed, Web of Science, Scopus and the Cochrane Library, as well as literatures via manual searches of the reference lists of included studies. Studies published in English that mentioned oral mucosal lesions in patients with COVID-19 were included, resulting in a total of 31 studies.

Results

Most of the included studies were considered to have a moderate to high risk of bias according to the Joanna Briggs Institute bias assessment tools. Based on COVID-19 severity, the characteristics and patterns of oral mucosal lesions in COVID-19 patients were described, analyzed and synthesized. Overall, ulcers without specific diagnosis had the highest prevalence in COVID-19 patients, followed by traumatic ulcers, candidiasis, petechiae and aphthous-like lesions. Homogeneity of data cannot be achieved in statical analysis, indicating randomness of outcome (ulcers without specific diagnosis, 95% CI: 28%-96%, I2 = 98.7%).

Discussion

Given the limited evidence from currently available studies, the association between COVID-19 and oral mucosal lesions remains difficult to clarify. Healthcare professionals should be aware of the possible association between COVID-19 and oral mucosal lesions, and we hereby discuss our findings.

Therapeutic Effect and Safety Evaluation of Naringin on Klebsiella pneumoniae in Mice

Critically ill patients with Corona Virus Disease 2019 (COVID-19) often develop secondary bacterial infections that pose a significant threat to patient life safety, making the development of drugs to prevent bacterial infections in the lungs critical to clinical care. Naringin (NAR) is one of the significant natural flavonoids rich in Pummelo Peel (Hua Ju Hong), with anti-inflammatory, antimicrobial, and antioxidant activities, and is commonly used in treating respiratory tract infectious diseases. In this study, the in vitro and in vivo findings revealed that, after Klebsiella pneumoniae (Kpn) infection, NAR inhibited overactivation of the nuclear factor kappa-B(NF-κB) signaling pathway in alveolar macrophages of mice, reduced neutrophil (NEs) recruitment, and lowered the induced production of proinflammatory markers, such as Interleukin-6(IL-6) and tumor necrosis factor α(TNF-α). Thus, it suppressed excessive immune responses in the lungs, as well as attenuated the induced pulmonary fibrosis and inflammatory infiltrates. These results suggest that NAR has a preventive effect against Kpn in mice. In addition, the study evaluated NAR's potential toxicity, demonstrating that NAR is safe at effective doses. These results suggested that NAR effectively reduces excessive inflammatory damage in the lungs induced by Kpn and enhances the body's ability to clear bacteria. Therefore, NAR may be an effective and safe healthcare drug for preventing and caring for bacterial pneumonia.

Ludwig's Angina: Higher Incidence and Worse Outcomes Associated With the Onset of the Coronavirus Disease 2019 Pandemic

Background: Ludwig's angina (LA) is a diffuse cellulitis of the submandibular space and adjacent tissues. During the coronavirus disease 2019 (COVID-19) pandemic, odontogenic treatments were often delayed because of the implementation of safety measures to avoid the spread of the virus. We hypothesized that delayed odontogenic treatments associated with the onset of the COVID-19 pandemic would be associated with an increase in the incidence of LA and worse outcomes related to these infections. Patients and Methods: Patients from June 2018 to June 2022 with computed tomography images suggestive of LA and confirmed by ear, nose, throat (ENT) consult were included. We abstracted demographics, outcomes, clinical management, and microbiology. Patients were stratified into pre-COVID and COVID-onset. Our primary outcome, incidence of LA, was defined as: (new LA cases) ÷ (ED evaluations of oral or dental infections × 1.5 years). Results: In the pre-COVID group, we identified 32 of 1,301 patients with LA for an incidence of 0.02 per year. The COVID-onset group consisted of 41 of 641 patients, with an incidence of 0.04 per year. In the COVID-onset group, progression to necrotizing fasciitis was more likely (0% vs. 15%; p < 0.024), and they returned to the operating room for repeated debridement (3% vs. 22%; p < 0.020). Likewise, hospital length of stay, intensive care unit (ICU) length of stay, and ventilator days were higher (4.3 ± 3.5 vs. 9.5 ± 11.3; 1.1 ± 1.2 vs. 9.5 ± 7.1; 0.3 ± 1 vs. 3.6 ± 7.1; p < 0.001). Conclusions: Although the prognosis for dental infections diagnosed early is generally favorable, we observed a notable increase in the incidence of LA after the onset of the COVID-19 pandemic. Moreover, complications stemming from these infections became more severe in the COVID-onset era. Specifically, the likelihood of necrotizing fasciitis showed a substantial increase, accompanied by an increased risk of respiratory failure and mediastinitis.

Oral manifestations of COVID-19 and its management in pediatric patients: A systematic review and practical guideline

OBJECTIVES

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes coronavirus disease 2019 (COVID-19), a respiratory infection that has spread worldwide and is responsible for a high death toll. Although respiratory symptoms are the most common, there is growing evidence that oral signs of COVID-19 can also be seen in children. The purpose of this systematic review is to provide a comprehensive analysis of the available data on the oral manifestations of COVID-19 in children and to recommend appropriate methods of diagnosis and treatment.

METHODS

A systematic search of the MEDLINE, EMBASE, Scopus, and Web of Science databases was done to discover relevant papers published between their establishment and January 2023. Articles detailing oral symptoms in pediatric patients with confirmed COVID-19 infection were included, and data on clinical characteristics, diagnosis, treatment, and outcomes were extracted and evaluated.

RESULTS

A total of 24 studies involving 2112 pediatric patients with COVID-19 were included in the review. The most common presentations are oral lesions, taste and smell disorders, oral candidiasis, hemorrhagic crust, tongue discoloration, lip and tongue fissuring, gingivitis, and salivary gland inflammation. These manifestations were sometimes associated with multi-system inflammatory syndrome in children (MIS-C) or Kawasaki disease (KD). Management strategies varied depending on the severity of the oral manifestation and ranged from symptomatic relief with topical analgesics to systemic medications.

CONCLUSION

Oral symptoms of COVID-19 are relatively prevalent in juvenile patients and can be accompanied by severe systemic diseases, such as MIS-C or Kawasaki illness. Early detection and adequate care of these oral symptoms are critical for the best patient results. Understanding the underlying pathophysiology and developing targeted treatments requires more investigation.

Oral health, the patients' perspective during the COVID 19 pandemic

Background and aims

On March 16, 2020, the state of emergency was established with drastic measures of isolation and quarantine. Among the measures taken in the context of the state of emergency was the closure of dental offices throughout the country. The aim of our questionnaire-based cross-sectional study was to identify the psycho-affective implications of the Romanian citizens induced by the COVID-19 pandemic period as well as their opinion related to the self-perceived oral health status during this period.

Methods

An original questionnaire was designed consisting of 41 questions, which were distributed to the general population via the Internet. The first part of the questionnaire investigated the respondents' opinion regarding the impact of this COVID-19 pandemic period of isolation on their oral health and the attention paid by the subjects to oral hygiene during restrictions. The second part refers to their addressability to the dental services during this pandemic and the third part interrogates different characteristics, namely the presence of comorbidities, possible anxiety, and stress.

Results

A total of 769 participants answered the questionnaire online.

Conclusion

According to their responses most of the respondents were not afraid of the possibility of contracting Sars-Cov-2 during dental treatments, but were in certain periods deprived of accessing dental services due to lockdown restrictions. They are aware of their oral health problems and pay more attention to oral hygiene so that they do not get worse during restrictions.

Comorbidities, Associated Diseases, and Risk Assessment in COVID-19-A Systematic Review

It is considered that COVID-19's pandemic expansion is responsible for the particular increase in deaths, especially among the population with comorbidities. The health system is often overwhelmed by the large number of cases of patients addressing it, by the regional limitation of funds, and by the gravity of cases at subjects suffering from this pathology. Several associated conditions including diabetes, cardiovascular illnesses, obesity, persistent lung condition, neurodegenerative diseases, etc., increase the mortality risk and hospitalization of subjects suffering from COVID-19. The rapid identification of patients with increased risk of death from the SARS-CoV-2 virus, the stratification in accordance with the risk and the allocation of human, financial, and logistical resources in proportion must be a priority for health systems worldwide.

Oral Lesions Associated with COVID-19 and the Participation of the Buccal Cavity as a Key Player for Establishment of Immunity against SARS-CoV-2

BACKGROUND

Some oral lesions have been described in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the possibility has been raised that the buccal lesions observed in patients with the coronavirus disease 2019 (COVID-19) are due to this virus and the patient's systemic condition. The aim of this review was to integrate the knowledge related to the oral lesions associated with COVID-19 and the participation of the buccal cavity in the establishment of immunity against SARS-CoV-2.

METHODS

A literature search on the manifestations of buccal lesions from the beginning of the pandemic until October 2021 was carried out by using the PubMed database. A total of 157 scientific articles were selected from the library, which included case reports and reports of lesions appearing in patients with COVID-19.

RESULTS

Oral lesions included erosions, ulcers, vesicles, pustules, plaques, depapillated tongue, and pigmentations, among others. The oral cavity is a conducive environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, immunodeficiencies, and autoimmunity primarily.

CONCLUSIONS

The oral cavity is an accessible and privileged environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; the direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, in particular those related to immunodeficiencies and autoimmunity.

Oral Hygiene practices and Oral Health Related Quality of Life observed in patients reporting to Dental Institution in North India during COVID-19 Pandemic

OBJECTIVE

The purpose of the study was to ascertain Oral Health Related Quality of Life (OHRQOL) and evaluate oralhygiene practices in patients visiting a dental institution during COVID-19 time.

MATERIALS AND METHODS

Face-to face interviews were conducted using a semi-structured close-ended questionnaire,assessing oral hygiene practices and self-reported oral problems perceived in last 6 months, using both Hindi and English version of Oral Health Impact Profile (OHIP-14) Questionnaire. Frequency distribution of oral hygiene practices were obtained, and Descriptive statistics computed the scores of OHIP-14. Kruskal-wallis test and Independent t-test were used to match the association of OHIP-14 with demographic variables. Multiple linear regression analysis was utilized to compute the association of OHIP-14 with independent variables, age and gender.

RESULTS

Subjective evaluation of OHRQOL (Oral Health Related Quality of Life) using OHIP-14 Porforma resulted in high score for physical pain and psychological discomfort but subjects expressed less discomfort in connection to functional limitation, physical disability, psychological discomfort, social disability and handicap domains of OHIP-14. With progressive increase in age OHRQOL worsened. Females had poor OHRQOL, with significant difference as compared to males. Gender and marital status observed variance in OHIP-14 with statistically significant difference (P <0.000).

CONCLUSION

More than two-third subjects preferred cleaning their teeth using toothbrush and toothpaste. Therefore, COVID-19 consequently impacted OHRQOL of the general population.

Impact of COVID-19 on fertility and assisted reproductive technology (ART): a systematic review

The appearance of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a major obstacle for the performing of current medical activities throughout the world. COVID-19 has affected humanity in many ways, thus causing a great medical, social, economic, and political instability. The aim of this study was to make an analysis of the scientific data obtained by so far to highlight the impact that COVID-19 has had on fertility and assisted reproductive technology (ART). Infection with SARS-CoV-2 alters the normal immune response by local and systemic damage to tissues and organs. After the virus enters the body, the first lesions are produced in the respiratory tract. Extrapulmonary lesions specific to COVID-19 include acute renal lesions/acute kidney damage, hepatocellular lesions, neurological diseases, myocardial dysfunction and arrhythmia, gastrointestinal diseases but also genital impairment. The possible impairment of the male reproductive system is because angiotensin-converting enzyme 2 (ACE2) receptors are in an increased number in the testes, seminiferous duct cells, spermatogonia, Leydig cells and Sertoli cells. Many published studies to date have pointed out that COVID-19 could also affect female fertility and disrupt the functions of the female reproductive system. The theory that this virus can also be transmitted sexually and can cause infertility or testicular damage is supported by the fact that the virus can be isolated in the semen of COVID-19 patients but only during the disease. Choosing the best method of treating infertility during the COVID-19 pandemic is multifactorial, but the risk of infection and compliance with specific ART hygiene protocols must always be considered. Currently, there is no scientific basis regarding the fact that the COVID-19 vaccination would influence fertility.