Oral cavity manifestations by COVID-19 infections: a review


  • Santosh Kumar Swain Department of Otorhinolaryngology and Head and Neck Surgery, IMS and SUM Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India
  • Priyanka Debta Department of Oral Pathology and Microbiology, IDS and SUM Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India
  • Ansuman Sahu Department of Otorhinolaryngology and Head and Neck Surgery, IMS and SUM Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India
  • Smarita Lenka Department of Otorhinolaryngology and Head and Neck Surgery, IMS and SUM Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India




COVID-19 patient, SARS-CoV-2, Oral cavity, Aphthous like lesions, Dysgeusia


Coronavirus disease 2019 (COVID-19) is a threat to the global health caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The lungs are the primary site of infection in COVID-19 patient and the symptoms ranges from mild flu like manifestations to fulminant pneumonia and respiratory failure. COVID-19 infection also significantly affects the oral cavity and salivary glands with oral mucosal manifestations. Other than airway manifestations, COVID-19 patients are presenting with oral cavity lesions such as aphthous like ulcers, glossitis, oral mucositis or stomatitis, oral candidiasis and herpetic recurrences. These oral lesions are often associated with immunocompromised patients and elderly age. Direct involvement of the SARS-CoV-2 virus for development of oral ulcers remains uncertain. The salivary gland related symptoms and taste disturbances are highly common in COVID-19 patients. In COVID-19 patient, certain presentations like ulcers or blisters or diffuse reddish lesions affect both keratinized and non-keratinized tissues of the oral cavity. These lesions are found in palate, lip mucosa, buccal mucosa and tongue. The ulceration and blisters of the oral cavity are more often seen. There is still a gap of knowledge related to the oral manifestations of the COVID-19 infections and its impact on the oral cavity. This review article discussed the details of the oral cavity lesions in COVID-19 patients.


Swain SK, Jena PP. Clinical implications and future perspective of COVID-19 pandemic-a review. Int J Adv Med. 2021;8(2):334-40.

Dziedzic A, Wojtyczka R. The impact of coronavirus infectious disease 19 (COVID‐19) on oral health. Oral Dis. 2021;27:703-6.

Swain SK, Behera IC. Performing laryngotracheobronchial procedure in coronavirus disease 2019 pandemic: a highly aerosol generating event in clinical practice. Matrix Science Medica. 2021;5(1):1-6.

Swain SK, Acharya S, Sahajan N. Otorhinolaryngological manifestations in COVID-19 infections: an early indicator for isolating the positive cases. J Sci Soc. 2020;47(2):63-8.

Brandão TB, Gueiros LA, Melo TS, Prado-Ribeiro AC, Nesrallah AC, Prado GV, 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):45-51.

Swain SK, Pani SR. Incidence of hearing loss in COVID-19 patients: a COVID hospital-based study in the eastern part of India. Int. J Curr Res Rev. 2021;13:103-7.

Haynes BF, Corey L, Fernandes P, Gilbert PB, Hotez PJ, Rao S, et al. Prospects for a safe COVID-19 vaccine. Sci Transl Med. 2020;12(568):948.

Swain SK, Kumar S. Infection control measures during COVID-19 pandemic-an otorhinolaryngological and head-and-neck perspective. Indian J Health Sci Biomed Res. 2021;14(1):3-11.

Donoso-Hofer F. Oral lesions associated with human immunodeficiency virus disease in adult patients, a clinical perspective. Rev Chilena Infectol. 2016;33(1):27-35.

Shet R, Shetty SRMK, Kumar MN, Yadav RD, Soumya S. A study to evaluate the frequency and association of various mucosal conditions among geriatric patients. J Contem Dent Pract. 2013;14(5):904-10.

Fidan V, Koyuncu H, Akin O. Oral lesions in COVID-19 positive patients. Am J Otolaryngol. 2021;42(3):102905.

Chiu JS, Lahoud-Rahme M, Schaffer D, Cohen A, Samuels-Kalow M. Kawasaki disease features and myocarditis in a patient with COVID19. Pediatr Cardiol. 2020;41(7):1526-8.

Ciaglia E, Vecchione C, Puca AA. COVID-19 infection and circulating ACE2 levels: protective role in women and children. Frontiers Pediatr. 2020;8:206.

Swain SK, Agrawala R. Mastoid surgery: a high-risk aerosol generating surgical procedure in COVID-19 pandemic. Int J Otorhinolaryngol Head Neck Surg. 2020;6(10):1941-6.

Tapia ROC, Labrador AJP, Guimaraes DM, Valdez LHM. Oral mucosal lesions in patients with SARS‐CoV‐2 infection. Report of four cases. Are they a true sign of COVID‐19 disease? Spec Care Dentist. 2020;40(6):555-560.

Swain SK, Choudhury J, Acharya S. Herpes zoster oticus among pediatric patients: Our experiences at a tertiary care teaching hospital. Indian Journal of Health Sciences and Biomedical Research (KLEU). 2020;13(3):215-20.

Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):1-6.

Sakaida T, Isao T, Matsubara A, Nakamura M, Morita A. Unique skin manifestations of COVID‐19: is drug eruption specific to COVID‐19? J Dermatol Sci. 2020;99(1):62‐4.

Chi AC, Neville BW, Krayer JW, Gonsalves WC. Oral manifestations of systemic disease. Am Fam Physic. 2010;82(11):1381-8.

Hindson J. COVID-19: Faecal-oral transmission? Nature Rev Gastroenterol Hepatol. 2020;17(5):259.

Fernandes LL, Pacheco VB, Borges L, Athwal HK, Eduardo FDP, Bezinelli L, et al. Saliva in the diagnosis of COVID-19: a review and new research directions. J Dent Res. 2020;99(13):1435-43.

Rocha BAR, Souto GR, Grossmann SD, Aguiar MCD, de Andrade BA, Romañach MJ, et al. Viral enanthema in oral mucosa: a possible diagnostic challenge in the COVID‐19 pandemic. Oral Diseases. 2021;27:776-8.

Biadsee A, Biadsee A, Kassem F, Dagan O, Masarwa S, Ormianer Z. Olfactory and oral manifestations of COVID-19: sex-related symptoms-a potential pathway to early diagnosis. Otolaryngol Head Neck Surg. 2020:163(4):722-8.

Jimenez-Cauhe J, Ortega-Quijano D, Perosanz-Lobo D, Burgos-Blasco P, Vañó-Galván S, Fernandez-Guarino M, et al. Enanthem in patients with COVID-19 and skin rash. JAMA Dermatol. 2020;156(10):1134-6.

Soares CD, Carvalho RA, Carvalho KA, Carvalho MG, Almeida OP. Oral lesions in a patient with COVID‐19. Med Oral Patol Oral Cir Bucal. 2020;25(4):563‐4.

Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12:1-5.

Putra BE, Adiarto S, Dewayanti SR, Juzar DA. Viral exanthem with “pin and needles sensation” on extremities of COVID-19 patient. Int J Infect Dis. 2020;96:355-8.

Laudenbach JM, Epstein JB. Treatment strategies for oropharyngeal candidiasis. Expert Opin Pharmacother. 2009;10(9):1413-21.

Santos JAD, Normando AG, Silva RLD, Paula RMD, Cembranel AC, Santos-Silva AR, et al. Oral mucosal lesions in a COVID-19 patient: New signs or secondary manifestations? Int J Infect Dis. 2020;97:326-8.

Farshidfar N, Hamedani S. Hyposalivation as a potential risk for SARS-CoV-2 infection: inhibitory role of saliva. Oral Dis. 2021;27(3):750-1.

Swain SK, Das S, Padhy RN. Performing tracheostomy in intensive care unit-a challenge during COVID-19 pandemic. Siriraj Med J. 2020;72(5):436-42.

Han P, Ivanovski S. Saliva-friend and foe in the COVID-19 outbreak. Diagnostics. 2020;10(5):290.

Wang L, Shen Y, Li M, Chuang H, Ye Y, Zhao H, et al. Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis. J Neurol. 2020;267(10):2777-89.

Seirafianpour F, Sodagar S, Mohammad AP, Panahi P, Mozafarpoor S, Almasi S, et al. Cutaneous manifestations and considerations in COVID‐19 pandemic: a systematic review. Dermatolog Ther. 2020;33(6):13986.

Melley LE, Bress E, Polan E. Hypogeusia as the initial presenting symptom of COVID-19. BMJ Case Rep. 2020;13(5):236080.

Swain SK. Smell and taste abnormalities: early clinical biomarkers for isolating the positive cases in COVID-19 pandemic. Int J Otorhinolaryngol Head Neck Surg. 2021;7(1):196-201.

Wang C, Wu H, Ding X, Ji H, Jiao P, Song H, et al. Does infection of 2019 novel coronavirus cause acute and/or chronic sialadenitis? Med Hypotheses. 2020;140:109789.

Carreras‐Presas CM, Sánchez JA, López‐Sánchez AF, Jané‐Salas E, Pérez MLS. Oral vesiculobullous lesions associated with SARS‐CoV‐2 infection. Oral Dis. 2021;27:710-2.

Swain SK, Sahu MC, Behera IC. Management of Ramsay Hunt syndrome among HIV patients: Our experience in a tertiary care hospital of eastern India. Polish Ann Med. 2016;23(2):92-6.

Taşlıdere B, Mehmetaj L, Özcan AB, Gülen B, Taşlıdere N. Melkersson-Rosenthal syndrome induced by COVID-19. Am J Emerg Med. 2021;41:262-5.

Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers Med. 2020;14(2):185-92.

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.

Swain SK, Sahu A. Performing tracheostomy on COVID-19 pediatric patients at intensive care unit: Our experiences. Indian Journal of Health Sciences and Biomedical Research (KLEU). 2021;14(1):131-6.

Kahraman FC, Kurlu HC. Mucosal involvement in a COVID19-positive patient: a case report. Dermatol Ther. 2009;14(6):272-7.

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.

Patel J, Woolley J. Necrotizing periodontal disease: Oral manifestation of COVID‐19. Oral Dis. 2021;27:768-9.

Singh C, Tay J, Shoqirat N. Skin and mucosal damage in patients diagnosed with COVID-19: a case report. J Wound Ostomy Continence Nurs. 2020;47(5):435-8.

Corchuelo J, Ulloa FC. Oral manifestations in a patient with a history of asymptomatic COVID-19: case report. Int J Infect Dis. 2020;100:154-7.

Swain SK, Das S, Lenka S. Sudden Sensorineural Hearing Loss among COVID-19 Patients-Our Experiences at an Indian Teaching Hospital. Siriraj Medical Journal. 2021;73(2):77-83.

Swain SK, Behera IC. Managing pediatric otorhinolaryngology patients in coronavirus disease-19 pandemic-a real challenge to the clinicians. Indian J Child Health. 2020;7(9):357-62.

Hasturk H, Nunn M, Warbington M. Efficacy of a fluoridated hydrogen peroxide-based mouthrinse for the treatment of gingivitis: a randomized clinical trial. J Periodontol. 2004;75(1):57-65.






Review Articles