Eliete Neves da Silva Guerra, professora titular do Departamento de Odontologia da Faculdade de Saúde da Universidade de Brasília (UnB) -  (crédito: Arquivo pessoal )

Dry mouth, inflammation and tongue injuries are among the consequences of covid-19

posted on 08/14/2022 06:00


Eliete Neves da Silva Guerra, professor at the Department of Dentistry, Faculty of Health, University of Brasília (UnB) – (credit: Personal archive)

Fatigue, muscle pain and memory problems are well-documented symptoms of post-covid. Now, research begins to point out that the syndrome, which affects more than 50% of patients, according to the World Health Organization (WHO), also has manifestations in the oral cavity. Dry mouth, inflammation and lesions on the tongue and mucosa, among others, were some signs detected in the post-infection phase and that may increase the list of sequelae associated with Sars-CoV-2.

To better understand the scenario, a multicenter group led by researchers from the University of Brasília (UnB) is evaluating about 300 articles, selected from more than 1,700 publications, that present evidence of post-covid dental symptoms. This is the same team of scientists that previously published two reviews of articles on orofacial manifestations during infection, such as taste changes and herpes-like lesions and canker sores.

“Now, our focus is the long-term covid, in a post-vaccine scenario. They are completely different realities”, defines Eliete Neves da Silva Guerra, a professor in the Department of Dentistry at the Faculty of Health of the University of Brasília (UnB) and one of the project leaders. The results of the study will be published later this year in the Journal of Dental Research.

The researcher says that she expected reports of xerostomia (dry mouth) and gustatory dysfunctions, but was surprised to also find occurrences of Bell’s palsy — sudden muscle weakness on one side of the face — and oral lichen planus, an inflammation inside the face. of the mouth that causes white and red patches that can be painful. In the second case, it is possible to attribute the symptom to changes in the immune system in the post-covid, when the body continues to produce defense cells against the virus even when it is no longer present, explains Eliete Neves da Silva Guerra. This triggers the autoimmune reaction, characterized by the inflammatory process.

Bell’s palsy, on the other hand, can be a consequence of viral tropism, that is, the propensity of the pathogen to infect some cell types – in this case, cells of the central nervous system. One of the studies evaluated by the team was published in the journal Jama, of the North American Medical Association, and also found cases of the type after vaccination for covid-19, but in a lower percentage, explains dental surgeon Juliana Amorim dos Santos, a doctoral student. from the Faculty of Health Sciences at UnB. “The incidence in people who had the covid was six times higher, compared to those who took the vaccine”, says the researcher.

health covid-19
health covid-19
(photo: BRAZILIENSE CORREIO)

Necrosis

According to the dentist, cases of post-covid osteonecrosis of the jaw have also been identified. A study of Egyptian institutions recently published in The British Medical Journal Infection Diseases, included in the UnB meta-analysis, reported 14 such complications. In this injury, which is often painful, the jaw bone is exposed, requiring immediate surgery. The possible association with Sars-CoV-2 is not explained by the virus or the disease itself, but by the treatment of covid. “The patients in these cases used corticosteroids and a monoclonal antibody that can explain the necrosis”, says Juliana Amorim dos Santos.

In Poland, researchers at the Medical University of Warsaw found other symptoms in the oral cavity, with different durations and severity, in patients cured of the infection. In an article published in the European Journal of Dentistry, the authors report that, of the 1,256 people included in the study — all of them previously infected with the coronavirus — 32% had discoloration, ulcerations and bleeding in the oral mucosa, 29.69% had mycosis on the tongue. , 25.79% developed canker sore-like lesions on the hard palate and 12.5% ​​had a type of lip inflammation.

During the consultation, 60% of the patients reported salivary disturbances at the beginning of the infection, and for 6.7% of them, the condition lasted up to four months after the other symptoms disappeared. “Older people with comorbidities, people who had more severe covid, and patients who were hospitalized had more extensive and severe lesions in the oral cavity that persisted long after infection,” the article’s authors wrote.

  • dental surgeon Juliana Amorim dos Santos, doctoral student at the Faculty of Health Sciences at UnB.
    Personal archive

  • Eliete Neves da Silva Guerra, professor at the Department of Dentistry, Faculty of Health, University of Brasília (UnB)
    Personal archive

Voltage

“Stress is also an important factor to consider when we think about the late oral effects of covid-19”, highlights periodontics specialist Elisa Grillo Araújo, researcher at the University Hospital of the University of Brasília (HUB) and technical manager of the Perio’ clinic. life “Dealing with the sequelae of the disease and the uncertainties involved, economic losses and pressure at work can increase the occurrence of bruxism and/or teeth clenching, causing fracture and tooth loss, a condition whose frequency has increased a lot during the pandemic. Therefore, the patient’s mental state should also be considered”, he recommends.

The dentist says that, in addition to stress, adverse effects of medications and the state of inflammation resulting from the infection, other pathophysiological mechanisms can help to elucidate post-covid complications and oral sequelae. “In addition to direct cell damage, another suggested pathway leading to long-term complications of COVID-19 infection is the state of immune dysregulation. Compromised immunity can lead to opportunistic infections, reactivation of latent viruses such as herpes, or even exacerbate preexisting oral conditions”, he says.

Therefore, Elisa Grillo Araújo reinforces the need for patient follow-up. “Often, oral lesions are underestimated given the situation, with attention focused on other more serious symptoms. But failure to monitor these oral lesions can have undesired consequences that compromise the general condition of the patient.”

three questions for

Celso Augusto Lemos Júnior, professor at the Faculty of Dentistry of the University of São Paulo (USP) and member of the board of the Brazilian Society for Dental Research (SBPqO)

  (credit: Personal Archive)


credit: personal archive

Oral manifestations during SARS-Cov infection have been well documented. Is it possible that, after healing, patients may develop oral symptoms associated with the virus?

Yes, it is possible, and every day more research papers are published on this subject. Oral manifestations of covid-19 were observed during the acute period of the disease, related to the infection itself or to the therapeutic measures adopted, such as taste alteration, non-specific oral ulcerations, gum peeling, petechiae on the oral mucosa and opportunistic infections, such as candidiasis. Nowadays, the concern of health professionals has turned to the consequences of post-covid-19 symptoms. Studies have shown a higher prevalence of certain symptoms, such as xerostomia (feeling dry in the mouth), sialoadenitis (inflammation of the salivary glands), lesions on the surface of the tongue, chronic pain and periodontal disease, in addition to opportunistic fungal infections. There is still a considerable degree of uncertainty whether these symptoms are necessarily associated with the consequence of covid or even the treatments used in survivors. Therefore, we will still need some time for studies and research that can more accurately characterize what the oral manifestations would be in post-covid.

Can the infection chronically change the region’s microbiota?

There are no published data to date that can prove a relevant change in the oral microbiota. It can be assumed that, if these changes exist, they should occur in patients who have had a severe manifestation of covid, including factors such as long hospital stays and long-term use of multiple drugs.

From a clinical point of view, how should patients who have had covid be monitored?

Routine dental care appears to be sufficient so far, according to published data. However, the necessary hygiene care must be carefully maintained and adjusted to each patient. If the patient complains of symptoms that he did not have before covid, the dental surgeon should be sought so that the possible relationship can be investigated in detail. For example, in cases of xerostomia (complaint of dry mouth), altered sensitivity of the oral mucosa and gingivitis that do not yield to normal brushing and flossing care.

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