COVID-19 survivors at an increased risk of salivary gland ectasia and oral disease

Iveta Ramonaite, Dental Tribune International

Thu. 15 April 2021

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MILAN, Italy: Since the evidence of oral manifestations linked to SARS-CoV-2 is scarce, researchers have recently set out to fill the gap by investigating the presence and prevalence of oral conditions in people who had contracted COVID-19 and successfully recovered from it. They discovered that SARS-CoV-2 directly affects the oral cavity of COVID-19 survivors, which is manifested by a significant number of the patients developing salivary gland ectasia and other oral diseases after clinical recovery.

Lead researcher Prof. Enrico Gherlone, rector of the Vita-Salute San Raffaele University and director of the Department of Dentistry Unit at the IRCCS Ospedale San Raffaele scientific hospital in Milan, told Dental Tribune International (DTI) that the primary motivation for conducting the study was the direct involvement of the doctors at San Raffaele University hospital in the fight against SARS-CoV-2. For that reason, the researchers set out to learn more about the effect of COVID-19 on oral health and performed an extra- and intra-oral examination of the oral cavity in 122 patients admitted to the hospital between 23 July and 7 September 2020.

The participants’ oral health status was assessed approximately three months after hospital discharge. The extra-oral examination involved examining the presence or absence of abnormalities in facial lymph nodes and the temporomandibular joint, as well as any facial asymmetries. With the intra-oral examination, the researchers assessed the patients’ lips, cheeks, salivary glands, hard palate, oropharynx, tongue, mucous membrane and frenula.

According to the researchers, none of the patients reported oral cavity disorders before becoming infected with SARS-CoV-2. However, at follow-up evaluation, 101 COVID-19 survivors (83.6%) experienced oral cavity or facial abnormalities.

Lead author Prof. Enrico Gherlone. (Image: Vita-Salute San Raffaele University)

“We discovered that oral manifestations and, specifically, salivary gland ectasia, are unexpectedly common, being detectable in 83.9% and 43% of COVID-19 survivors, respectively. Salivary gland ectasia reflected the hyperinflammatory response to SARS-CoV-2, as demonstrated by the significant relationship with C-reactive protein and lactate dehydrogenase (LDH) levels at hospital admission, and with the use of antibiotics during acute disease,” Gherlone told DTI.

“Both LDH levels and antibiotic administration are considered independent predictors of salivary gland ectasia at multivariable analysis,” he explained.

Besides salivary gland ectasia, oral symptoms such as temporomandibular joint abnormalities, facial pain and masticatory muscle weakness were also common among the patients. In light of the findings, the researchers commented that COVID-19 causes damage to the oral cavity even after clinical recovery and that the oral cavity constitutes a preferential target for SARS-CoV-2 infection.

Gherlone noted that it is crucial for dental professionals to acquire a vast knowledge of COVID-19 in order to help fight the disease and mitigate its risks. By doing this, they would greatly contribute to improving the quality of prevention and treatment of the disease, he explained.

“Above all, they must investigate the possible consequences in the oral cavity that affect the processes of inflammation, healing and defence in order to develop specific protocols to better treat patients surviving COVID-19 and, thus, to improve their overall health status.”

“From our research, it is clear that there is an abnormality at the level of the salivary glands. Therefore, our patients may have altered salivation resulting in increased cario-receptivity or increased caries accumulation and, consequently, increased inflammation; however, further studies are needed to confirm this hypothesis,” Gherlone concluded.

DTI has recently reported on a different study that found evidence that SARS-CoV-2 infects cells in the mouth. The findings were similar to those of the present study. The researchers concluded that the oral cavity could play an important role in SARS-CoV-2 infection and called for appropriate prevention measures in dental settings.

The study, titled “Frequent and persistent salivary gland ectasia and oral disease after COVID-19”, was published online on 3 March 2021 in the Journal of Dental Research, ahead of inclusion in an issue.

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