Oral manifestations and the role of the oral healthcare workers in COVID‐19

Abstract

Dear Editor, Together with the plethora of the well known clinical signs of COVID-19, including coughing, dyspnea, fever, conjunctivitis, diarrhea and, noteworthy, olfactory, and taste disorders, oral manifestations have also been described by several authors, and someway related to SARS-CoV-2 infection it-self, co-infections, and treatment (Carreras-Presas et al., 2020; Petrescu, 2020; Pitones-Rubio et al., 2020; Rodriguez-Morales et al., 2020; Sampson et al., 2020; Vieira, 2020; Wan et al., 2020). Considering that oral manifestations related to SARS-CoV-2 may be more frequent in severe COVID-19 illness, as hypothesized by Vieira (Vieira, 2020), we evaluated, during the peak of the pandemic in Italy, the oral lesions reported in patients with severe COVID-19 illness. Clinical records from the totally 610 subjects, hospitalized with severe COVID-19 illness, between the 4th of March and the 5th of June 2020, at Cotugno Hospital in Naples and at San Giovanni di Dio e Ruggi d'Aragona University Hospital in Salerno, both in the Campania region in Southern Italy, were retrospectively reviewed to evaluate the oral lesions and the need for oral, dental, and periodontal care reported. Although the patients in both Hospitals were affected by the severe form of the COVID-19 illness (Vieira, 2020), no oral manifestations potentially associated with SARS-CoV-2 infection, therapy, nor co-infection were recorded, possibly supporting the hypothesis that such manifestations may be the first COVID-19 signs (Petrescu et al., 2020), occurring prior to hospitalization. Moreover, no mucosal lesions were registered at all in such patients hospitalized with severe form of COVID-19, likely because of the very small number of subjects, totally 6, receiving an oral and dental examination, as also proposed by Carreras-Presas (Carreras-Presas et al., 2020). A possible reason for the lack of reports of any oral lesions may be the fact that the presence of oral manifestations was so borderline compared to the life-threatening general conditions, and, definitely, not important in the light of life-saving therapeutic measures, that may have not been considered by the physicians mainly responsible of the patient treatment. However, to the current state of knowledge, emerging evidence suggests the importance of oral healthcare in hospitalized patients with COVID-19, possibly addressing diagnostic, therapeutic, and preventive goals, in the comprehensive inter-disciplinary management of COVID-19-positive patients. Indeed, oral and especially periodontal microbiome, scarce oral hygiene, and periodontitis have been proposed as risk factors for developing complications from COVID-19 (Pitones-Rubio et al., 2020; Sampson et al., 2020), along with the widely recognized ones, comprising older age, male gender, obesity, hypertension, diabetes, and heart disease. Therefore, taking into account that periodontitis may worsen patients' clinical conditions (Pitones-Rubio et al., 2020; Sampson et al., 2020), oral hygiene instructions and motivation and active periodontal treatment may be introduced, together with oral antisepsis with hydrogen peroxide, to reduce the oral viral load (Vergara-Buenaventura & Castro-Ruiz, 2020), in the systematic management of subjects suffering from mild-to-moderate form of COVID-19 illness, and, if possible, in severe cases, to avoid illness worsening (Sampson et al., 2020; Vieira, 2020), especially for subjects suffering from heart disease (Sarra et al., 2020). In addition, considering periodontal pocket as possible reservoir of SARS-CoV-2 and other viruses, oral infection control and periodontal treatment may reduce the risk of re-infection in healed subjects (Pitones-Rubio et al., 2020; Sampson et al., 2020). Moreover, if the hypothesis that the oral mucosal lesions are prodromal signs of COVID-19 (Petrescu et al., 2020) will be validated, oral healthcare workers may assume a key role in the early diagnosis of the disease. In this perspective, oral examinations, performed by specifically trained dentists, should be performed in ill as well as in asymptomatic subjects with COVID-19. All the authors declare that no conflict of interest nor financial relationship regarding any of the products involved in this study. Federica Di Spirito: contributed to the conception and design of the study and drafting the article. Sergio Pelella: contributed to the data collection. Salvatore Argentino: contributed to the data collection. Laura Sisalli: contributed to the data collection. Ludovico Sbordone: contributed to the conception and design of the study and critical revision of the article. All the authors gave final approval of the version to be submitted. The peer review history for this article is available at https://publons.com/publon/10.1111/odi.13688.

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