Oral findings in SARS-CoV-2 infection- A comprehensive review

The COVID-19 has presented as a worldwide threat to global health. It is highly necessary to study signs and symptoms associated with this infection. This review highlights the role of dental practitioners to diagnose the early signs of oral lesions in COVID-19 infection. They can play an important role in managing pain, giving support to patient and improving the quality of life, by becoming a part of multi-disciplinary team to fight against this global pandemic.

A Real-World Evidence-Based Management of HIV by Differential Duration HAART Treatment and its Association with Incidence of Oral Lesions

Background: The efficacy of highly active antiretroviral therapy (HAART) therapy can be estimated by immunological response and the incidence of opportunistic infections. Objective: To evaluate the effectiveness of different durations of HAART in terms of immunological response markers (CD4 count and CD4/CD8 ratio) along with disease progression markers (incidence of oral lesions) in Chinese patients with HIV. Methods: This single-center, retrospective, real-world study included patients with HIV, grouped into treatment group and treatment-naïve group of which the former was further divided into (6, 12, and 18 months) based on the treatment duration. The CD4 and CD8 cell counts were analyzed by the FACSCalibur flow cytometry. Kruskal-Wallis test was applied to determine the outcome of different duration of HAART. Oral examination was carried out according to the WHO type IV examination Results: In 246 patients with HIV, CD4 counts increased significantly post-HAART compared with pre-HAART in all three treatment groups (P<.001), while CD8 count decreased significantly (P<.05) in all three treated group. A significant association of HAART with CD4/CD8 ratio was observed (P<.001). A significant increase in CD4 count was observed between 12-month and 18-month treatment group (P<.05). The occurrence of oral lesions reduced significantly in the treatment group. Conclusion: We observed a better response of HAART regimen with 18 months of duration than 12-months and 6-months therapies and reduction in oral lesions.

Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

An intact and fully functional immune system plays a crucial role in the prevention of several infectious diseases. Interleukin (IL)17 is significantly involved in oral mucosa immunity against several antigens and microorganisms, including Candida albicans (CA). Herein, we present three cases of oral candidiasis (OC) related to the use of an IL17A inhibitor for psoriasis. Three psoriatic individuals presented for evaluation of widespread symptomatic oral lesions temporally correlated with the onset of IL17A inhibitors (secukinumab in two patients and brodalumab in one patient). Clinical examination revealed either partially removable white plaques in an erythematous background (case #1) or diffuse erythematous lesions (cases #2 and 3) involving several areas of the oral mucosa. Cytology smear, accompanied by histopathologic examination in case #1, confirmed the clinical impression of OC in all three cases. All patients received antifungal therapy with satisfactory clinical response. No discontinuation of the antipsoriatic regimen was recommended, but all patients were advised to remain under monitoring for possible OC relapses. During the last few years, new systemic biologic agents targeting IL17 have been used for the management of variable immune-mediated diseases. Few clinical trials and scarce case reports have shown that these medications place individuals at high risk of developing candidiasis. We propose that patients treated with these medications should be at close monitoring for the development of OC and, if it occurs, receive appropriate management.

Immune mediated Lesions of the oral cavity: A scrupulously researched review

Oral mucosa may be the first site to manifest protean signs and symptoms in immune mediated diseases. Therefore, it is of paramount importance to have a thorough and vast knowledge about various diseases. It is the role of Oral and Maxillofacial Diagnostician to diagnose the lesions according to their salient features.In this review article, we aim to describe the immune mediated oral lesions, their clinical features, investigations and management.

Atypical Oral Presentation of SARS-CoV-2 Infection: Case Report

Hypogeusia, dysgeusia and ageusia are commonly prevalent and considered as the first recognized oral symptom of SARS-CoV-2 infection. Various other oral manifestations have also been reported in patients positive for SARS-CoV-2 infection. This article presents clinical presentation of oral lesions in two patients who were subsequently confirmed with SARS-CoV-2 infection.

Oral lesions in older patients: a descriptive analysis of a brazilian population

The objective of this retrospective, observational study was to describe the oral lesions diagnosed in older patients through histopathological reports from the oral pathology service of a private university in Rio de Janeiro over a 19 year period (1999-2017) and to call attention to the oral health of the elderly. Information was collected and analyzed from 713 medical records of patients aged ≥ 60 years old. The data collected included the patient's age, gender and the type and location of the injury. The mean age of the patients was 68.1 years old, with a higher prevalence of lesions in the 60 to 74 age group. The results showed that three of the four most common oral lesions were more frequent in women and only one (oral squamous cell carcinoma) was more common in men. The 4 most common injuries were: fibrous inflammatory hyperplasia (187; 26.2%), oral squamous cell carcinoma (78; 10.9%), leukoplakia (40; 5.6%) and oral lichen planus (36; 5.0%). These lesions were distributed mainly in the alveolar edge (71; 20.8%) followed by tongue (57; 16.7%), bottom of the vestibule (55; 16.1%), and buccal mucosa (44; 12.9%). The results obtained should be used to alert health professionals, especially dentists, so that early diagnoses of such lesions can be made and thus contribute to improving the quality of care for the elderly.

Oral Reactive Lesions Associated to Incomplete Removal of Natal Teeth: Case Report

Natal teeth are infrequent at birth. Dental extraction is the most recommended treatment to avoid complications. Reactive soft tissue lesions associated to natal tooth or its incomplete removal are rare. A five-month-old female presented natal teeth #71 and #81 which were removed the day after the birth. The baby evolved with two nodules in the region of #71 and #81, pedunculated, 10 and 9 mm, respectively, covered by a pink mucosa, firm in consistency. Periapical radiography showed two radiopaque areas, suggestive of root fragments. After 30 days the nodule located in the region of #81 became purple in color and ulcerated. Both lesions were removed with high intensity diode laser. Histopathological analysis was compatible with inflammatory fibrous hyperplasia (#71) and pyogenic granuloma (#81). Early diagnosis of oral lesions in newborns by means of histopathological examination and a minimum invasive treatment, such as laser surgery, should be of primary concern.