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Oral manifestations in patients with Covid-19 – literature review

Puyan Heydari, Vladimir Panov


The outcomes of different investigations indicate inconsistency in lesions in the oral cavity associated with COVID-19. Most often we can find dysgeusia, aphthous-like lesions, ulcerations, macules, petechiae, erosions, enanthem, vesicles and pustules, herpetiform lesions and necrosis. Bad oral hygiene, stress, infections, underlying diseases, trauma after intubation, vascular compromise and immunosuppression are probably the most relevant reasons for the appearance of oral lesions in these patients and the etiopathogenesis of these lesions seems to be multifactorial. The lesions could be related to the direct or indirect effect of the virus on the oral mucosa, immunosuppression, drug reactions or coinfections. The tongue, palate and lips were the most frequent locations affected. Older age and the severity of COVID-19 infection are the most common reasons that predict the severity of oral lesions.

Perhaps most oral manifestations are yet to be described, due to the lack of medical attention in lockdown periods. All doctors, in particular dentists and dermatologists, are encouraged to perform regular and proper examination of the oral cavity of all suspected and confirmed patients to identify the disease's possible early symptoms. Spotting these oral lesions is important not only for treating them, but also for detecting the infection. 


COVID-19; oral manifestations; SARS-CoV-2

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Brandão TB, Gueiros LA, Melo TS, Prado-Ribeiro AC, Nesrallah ACFA, Prado GVB, et al. Oral lesions in patients with SARS-CoV-2 infection: could the oral cavity be a target organ? Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;131(2):e45-51. doi: 10.1016/j.oooo.2020.07.014.

Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021;19(3):141-54. doi: 10.1038/s41579-020-00459-7.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.

Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020;277(8):2251-61. doi: 10.1007/s00405-020-05965-1.

Gao Z, Xu Y, Sun C, Wang X, Guo Y, Qiu S, Ma K. A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect. 2021;54(1):12-6. doi: 10.1016/j.jmii.2020.05.001.

Ansari R, Gheitani M, Heidari F, Heidari F. Oral cavity lesions as a manifestation of the novel virus (COVID‐19). Oral Dis. 2020;27 Suppl 3:771-2. doi: 10.1111/odi.13465.

Izquierdo-Domínguez A, Rojas-Lechuga MJ, Mullol J, Alobid I. Olfactory dysfunction during COVID-19 pandemic. Med Clin (Barc). 2020;155(9):403-8. English, Spanish. doi: 10.1016/j.medcli.2020.06.006.

Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol. 2020;92(10):1902-14. doi: 10.1002/jmv.25884.

Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, Acevedo AC, De Luca Canto G, Sugaya N, et al. Oral Manifestations in Patients with COVID-19: A 6-Month Update. J Dent Res. 2021:220345211029637. doi: 10.1177/00220345211029637.

Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M. Oral manifestations of COVID-19 disease: A review article. Dermatol Ther. 2021;34(1):e14578. doi: 10.1111/dth.14578.

Cetinkaya EA. Coincidence of COVID-19 Infection and smell-taste perception disorders. J Craniofac Surg. 2020;31(6):e625-6. doi: 10.1097/SCS.0000000000006601.

Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis. 2020;71(15):889-90. doi: 10.1093/cid/ciaa330.

Carrillo-Larco RM, Altez-Fernandez C. Anosmia and dysgeusia in COVID-19: A systematic review. Wellcome Open Res. 2020;5:94. doi: 10.12688/wellcomeopenres.15917.1.

Costa KVTD, Carnaúba ATL, Rocha KW, Andrade KCL, Ferreira SMS, Menezes PL. Olfactory and taste disorders in COVID-19: a systematic review. Braz J Otorhinolaryngol. 2020;86(6):781-92. doi: 10.1016/j.bjorl.2020.05.008.

Wu YH, Wu YC, Lang MJ, Lee YP, Jin YT, Chiang CP. Review of oral ulcerative lesions in COVID-19 patients: A comprehensive study of 51 cases. J Dent Sci. 2021;16(4):1066-73. doi: 10.1016/j.jds.2021.07.001.

Riad A, Kassem I, Stanek J, Badrah M, Klugarova J, Klugar M. Aphthous stomatitis in COVID-19 patients: Case-series and literature review. Dermatol Ther. 2021;34(1):e14735. doi: 10.1111/dth.14735.

Katz J, Yue S. Increased odds ratio for COVID-19 in patients with recurrent aphthous stomatitis. J Oral Pathol Med. 2021;50(1):114-7. doi: 10.1111/jop.13114.

Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, Acevedo C, De Luca Canto G, Sugaya N, Santos-Silva AR, Guerra ENS. Oral Manifestations in Patients with COVID-19: A Living Systematic Review. J Dent Res. 2021;100(2):141-154. doi: 10.1177/0022034520957289.

Aghazadeh N, Homayouni M, Sartori-Valinotti JC. Oral vesicles and acral erythema: report of a cutaneous manifestation of COVID-19. Int J Dermatol. 2020; 59(9):1153-4.

Martín Carreras-Presas C, Amaro Sánchez J, López-Sánchez AF, Jané-Salas E, Somacarrera Pérez ML. Oral vesiculobullous lesions associated with SARS-CoV-2 infection. Oral Dis. 2021;27 Suppl 3:710-2. doi: 10.1111/odi.13382.

Ciccarese G, Drago F, Boatti M, Porro A, Muzic SI, Parodi A. Oral erosions and petechiae during SARS-CoV-2 infection. J Med Virol. 2021;93(1):129-32. doi: 10.1002/jmv.26221.

Villarroel-Dorrego M, Liseth C, Rossana R, Vannessa B, Yesenia P, Henrique V. Hallazgos Bucales En Pacientes Covid-19 [Oral findings in patients with COVID-19]. Actas Dermosifiliogr (Engl Ed). 2021. Spanish. doi: 10.1016/

Cebeci Kahraman F, ÇaŞkurlu H. Mucosal involvement in a COVID-19-positive patient: a case report. Dermatol Ther. 2020;14(6):E272-7.

Galván Casas C, Català A, Carretero Hernández G, García-Doval I. SARS-CoV-2 infection: the same virus can cause different cutaneous manifestations: reply from the authors. Br J Dermatol. 2020. doi: 10.1111/bjd.19321.

Drago F, Ciccarese G, Rebora A, Muzic SI, Parodi A. SARS-CoV-2 infection: the same virus can cause different cutaneous manifestations. Br J Dermatol. 2020;183(4):788. doi: 10.1111/bjd.19311.

Corchuelo J, Ulloa FC. Oral manifestations in a patient with a history of asymptomatic COVID-19. Case Report Int J Infect Dis. 2020.

Fantozzi PJ, Pampena E, Di Vanna D, Pellegrino E, Corbi D, Mammucari S, et al. Xerostomia, gustatory and olfactory dysfunctions in patients with COVID-19. Am J Otolaryngol. 2020;41(6):102721. doi: 10.1016/j.amjoto.2020.102721.

Belchior Fontenele MN, Pedrosa MDS. Xerostomia and taste alterations in COVID-19. Ear Nose Throat J. 2021;100(2_suppl):186S-187S. doi: 10.1177/0145561320982686.

Behzad S, Aghaghazvini L, Radmard AR, Gholamrezanezhad A. Extrapulmonary manifestations of COVID-19: Radiologic and clinical overview. Clin Imaging. 2020;66:35-41. doi: 10.1016/j.clinimag.2020.05.013.

Cebeci Kahraman F, Özen T, Elibol T. Lip necrosis in a patient with paroxysmal nocturnal hemoglobinuria: Can it be triggered by COVID-19? J Cosmet Dermatol. 2020;19(12):3168-70. doi: 10.1111/jocd.13746.

Coke CJ, Davison B, Fields N, Fletcher J, Rollings J, Roberson L, et al. SARS-CoV-2 Infection and Oral Health: Therapeutic Opportunities and Challenges. J Clin Med. 2021;10(1):156. doi: 10.3390/jcm10010156.

Capocasale G, Nocini R, Faccioni P, Donadello D, Bertossi D, Albanese M, et al. How to deal with coronavirus disease 2019: A comprehensive narrative review about oral involvement of the disease. Clin Exp Dent Res. 2021;7(1):101-8. doi: 10.1002/cre2.332.

Nuño González A, Magaletskyy K, Martín Carrillo P, Lozano Masdemont B, Mayor Ibarguren A, Feito Rodríguez M, Herranz Pinto P. Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital. Actas Dermosifiliogr (Engl Ed). 2021;112(7):640–4. English, Spanish. doi: 10.1016/

La Rosa GRM, Libra M, De Pasquale R, Ferlito S, Pedullà E. Association of viral infections with oral cavity lesions: role of SARS-CoV-2 infection. Front Med (Lausanne). 2021;7:571214. doi: 10.3389/fmed.2020.571214.

Paradowska-Stolarz AM. Oral manifestations of COVID-19: Brief review. Dent Med Probl. 2021;58(1):123-6. doi: 10.17219/dmp/131989.



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About The Authors

Puyan Heydari
Medical University of Varna

Department of Conservative Dental Treatment and Oral Pathology, Faculty of Dental Medicine

Vladimir Panov
Medical University of Varna

Department of Conservative Dental Treatment and Oral Pathology, Faculty of Dental Medicine

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