The Oral Complications of COVID-19

Background: COVID-19 is a novel coronavirus infectious disease associated with the severe acute respiratory syndrome. More and more patients are being cured due to the development of clinical guidelines for COVID-19 pneumonia diagnosis, treatment, and vaccines. However, the long-term impact of COVID-19 on patients after recovery is unclear. Currently available reports have shown that patients recovered from COVID-19 continue to experience health problems in respiratory and other organ systems. Oral problem is one of the important complications which has serious impacts on the rehabilitation and future quality of life, such as ageusia and macroglossia, but the oral complication is often being neglected.Aim of Review: From the perspective of stomatology, we summarized and elaborated in detail the types, pathogenesis of oral complications from COVID-19 patients after rehabilitation, and the reported prevention or treatment recommendations which may improve the COVID-19 patients associated oral diseases.Key Scientific Concepts of Review: 1) To understand the common oral complications and the mechanisms of the development of oral complications after the COVID-19 recovery; 2) To summary the practical strategies to prevent the oral complications and construct the rehabilitation plans for patients with oral complications.

How Oral Specialists Can Help Diagnose and Manage Extra-Digestive Inflammatory Bowel Disease Complications

Identification of extra-digestive manifestations of inflammatory bowel disease (IBD) is essential. The oral cavity is a preferential site in which gingival enlargement may be one of these manifestations. We present, in this article, two original cases and a concept map that highlights the need for a close collaboration between the dental surgeon or oral specialist, the dermatologist, and the gastroenterologist. In the first case, the strictly local management of a systemic IBD oral complication, can relieve and answer the patient’s complaint without modifying or disrupting the systemic treatment already implemented by the gastroenterologists. In the second case, the dental surgeon’s diagnosis of gingival enlargement turns out to be the inaugural manifestation of Crohn’s disease and allows early treatment of the intestinal pathology. These two cases illustrate the close link between the oral cavity and IBD. Knowledge and multidisciplinary management of these manifestations such as proposed in the concept map are essential for clinicians for the early diagnosis and the improvement of the oral and general quality of life of patients suffering from IBD.

Photobiomodulation for Taste Alteration

Photobiomodulation (PBM) therapy employs light at red and near-infrared wavelengths to modulate biological activity. The therapeutic effect of PBM for the treatment or management of several diseases and injuries has gained significant popularity among researchers and clinicians, especially for the management of oral complications of cancer therapy. This entry focuses on the current evidence on the use of PBM for the management of a frequent oral complication due to cancer therapy—taste alteration.

Benefits of the Involvement of Dentists in Managing Oral Complications Among Patients With Oral Cavity and Oropharyngeal Cancer: An Analysis of Claims Data

PURPOSE: Patients with oral cancer and oropharyngeal cancer frequently develop treatment-related oral complications that negatively affect patients' quality-of-life, cost, and health outcomes. We investigated whether the provider specialty affected the costs and treatment duration of managing oral complications. METHODS: Using deidentified claims from a commercial insurer from 2008 to 2019, we compared costs and duration of common oral complication management between patients whose care included a dentist, with those whose care did not include a dentist. Our primary outcomes were treatment cost and duration. Multivariate linear regression models were used to evaluate the relationship between the primary outcomes and involvement of dentists. Separate analyses were conducted for acute and chronic oral complications. RESULTS: Involvement of dentists in oral complications management resulted in lower costs and shorter treatment duration for acute complications on average. For chronic complications, when dentists were involved, the average cost was higher by $1,672 (USD) (95% CI, 1,124 to 2,219), but the average treatment duration was shorter by 74 days (95% CI, 62 to 84). When complications were acute, dentists’ intervention was beneficial for dentofacial functional abnormalities, disorders of teeth and supporting structures, stomatitis and mucositis (ulcerative), and thrush, in terms of both costs and duration. Among chronic complications, dental caries was the only complication type that resulted in lower cost and shorter treatment duration with dentists’ involvement. CONCLUSION: Oral complications of cancer therapy incur a significant financial and clinical burden. Involvement of dentists results in shorter treatment duration, while lowering the financial burden of care for certain complication types.

Aphthous-like stomatitis of COVID-19 patients

The emerging evidence on oral symptoms that occur in conjunction with coronavirus disease (COVID-19) infection has triggered wide debates on the pathophysiology as well as the potential implications of these manifestations. Hereby, we aim to report according to the CARE guidelines the clinical characteristics of a COVID-19 patient with aphthous-like stomatitis from our clinic. We also performed a literature search in PubMed, Scopus, Google Scholar from inception until 6th of September 2020 with a combination of keywords (COVID-19 OR SARS-CoV-2) AND aphthous. On reviewing the emerging evidence of aphthous lesions in COVID-19, we have found that 14 cases were reported heretofore. Aphthous-like stomatitis as a characteristic condition of immuno-affected patients is a predictable and clinically relevant oral complication of COVID-19 patients. Further studies are warranted to establish its epidemiologic significance and to understand its pathophysiology in COVID-19 patients.

Bidirectional Association between Tooth Loss and Hypertension: A Systematic Review and Meta-analysis

Background: To investigate the bidirectional association between tooth loss and hypertensionMethods: PubMed, EMBASE, OVID were searched through May, 2020. Longitudinal and cross-sectional studies reporting the association between tooth loss and hypertension were included. We quantitatively analyzed the basic framework and study characteristics, and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included studies using random-effects meta-analysis.Results: This systematic review included sixteen studies involving about 188,000 participants. Quantitatively summarized results suggested, compared to individuals who have lost fewer than ten teeth, there was no significantly difference in the incidence of hypertension among participants who lost more than ten teeth (OR: 1.09, 95%CI: 0.93,1.28). Besides, there is no significant difference of incident hypertension between individuals who ever lost teeth and never lost teeth (OR:1.03, 95% CI: 0.85,1.25). There was a significant association between hypertension and incidence of tooth loss (OR: 1.33, 95% CI: 1.04,1.70). Subgroup analysis by study design, age, gender ratio and religion showed statistically significant association between hypertension and incidence of tooth loss in specific subgroups.Conclusions: This meta-analysis identified hypertension as a significantly risk factor of tooth loss while tooth loss was not an efficient predictor for incident hypertension. Considering the limited number of available researches and drawback of cross-sectional studies, more high-quality prospective studies of large sample sizes are needed to understand details of this bidirectional association. Since both tooth loss and hypertension are worldwide problems, our study provides new and comprehensive evidence for the prevention in oral complication of hypertensive patients.

Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review

Trismus refers to a person’s inability to normally open his or her mouth. Trismus can occur as a symptom due to tumor ingrowth or it can occur postsurgical following the treatment for head and neck cancer. Radiation-induced trismus is also a relatively common oral complication. This review aimed at reviewing the etiopathogenesis of trismus in patients with head and neck cancer. Of the 16 publications included after final screening, of which one was a nonrandomized control trial, one a randomized control trial, 6 prospective cohort studies, and 8 retrospective cohort studies. Among them, 6 articles addressed the possible mechanism for trismus related to tumor ingrowth, 8 articles suggested the likely reason for trismus in patients who had undergone radiation therapy and 2 articles addressed the postsurgical cause for trismus. This review highlights the possible involvement of infratemporal fossa as a predetermining factor for developing trismus related to tumor extension. The molecular mechanism of radiation-induced fibrosis is well studied in the literature.

Oral Rehabilitation With Dental Implants and the Importance of a Preventive Evaluation for Osteonecrosis of the Jaws Associated With Medications

Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.