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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 93-95

Coronavirus disease and its oral implications: A diagnostic realm


1 Department of Pedodontics, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
2 Zulekha Hospital, Sharjah, UAE
3 Department of Oral Medicine and Radiology, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
4 Clinical practioner, Tezpur, Assam, India
5 Department of Oral & Maxillofacial Pathology and Microbiology, Pacific Dental College & Hospital, Udaipur, Rajasthan, India

Date of Submission28-Jun-2021
Date of Acceptance21-Jul-2021
Date of Web Publication27-Sep-2021

Correspondence Address:
Dr. Sugandha Arya
Department of Oral Medicine and Radiology, Vyas Dental College and Hospital, Jodhpur 342005, Rajasthan.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_26_21

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  Abstract 

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the type of β-coronavirus that is responsible for the coronavirus disease 2019 pandemic across the world. Human-to-human transmission of this disease may occur through respiratory droplets, sneezing, and touch. The most common symptoms of patients include fever, fatigue, dry cough, and diarrhea. Dysgeusia is the first recognized oral symptom. Reverse transcriptase-polymerase chain reaction remains the standard test along with chest X-rays as the first-line imaging modality for the detection of SARS-CoV-2. Despite many treatment options are under trial still none of these can control its virulence potential.

Keywords: Coronavirus, COVID-19, SARS-CoV-2


How to cite this article:
Saurabh S, Miyajiwala JS, Paul S, Arya S, Gogoi A, Soni J. Coronavirus disease and its oral implications: A diagnostic realm. Int J Oral Care Res 2021;9:93-5

How to cite this URL:
Saurabh S, Miyajiwala JS, Paul S, Arya S, Gogoi A, Soni J. Coronavirus disease and its oral implications: A diagnostic realm. Int J Oral Care Res [serial online] 2021 [cited 2021 Nov 29];9:93-5. Available from: https://www.ijocr.org/text.asp?2021/9/3/93/326824




  Introduction Top


Coronaviruses are viruses of Orthocoronaviridae subfamily, in the order Nidovirales of family Coronaviridae.[1] Coronaviridae was first discovered in the 1960s as a group of enveloped single-stranded ribonucleic acid (RNA) viruses with a positive sense. The word corona is derived from Latin meaning “crown” or “halo” as when observed under two-dimensional transmission electron microscopy, it appears as crown; hence it is named as coronavirus. It has a club shape with the surface being covered with spikes of peplomers.[2] A single coronavirus holds more than 10 separate open reading frames (ORFs), which lead to the growth and spread of the virus at an uncontrollable rate. The two-step replication mechanism of coronaviruses is unusual in contrast to the past reported RNA virus genomes.[3],[4]

Coronavirus disease 2019 (COVID-19) is a novel infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).[5] SARS-CoV-2 is a type of β-coronavirus that has the largest RNA virus genome known to mankind with 32kb length.[3],[6],[7] The very first case of COVID-19 was detected in Wuhan, China in December 2019.[7] According to a WHO report on March 25, 2021, this virus has globally infected more than 123 million people and 2,727,837 have succumbed to its fierceness.[8] In 1994, two serogroups of human coronavirus (HCV), HCV-229E and HCV-OC43, had been considered to be the representative strains. Strain B814 was the first human coronavirus isolated but was lost in the laboratory before it could be fully characterized.[9] But, recently multiple SARS-CoV-2 variants are circulating globally. One of these is the B.1.617 lineage, detected in India earlier this year. Viruses keep evolving by mutation and a new form emerges in itself and is not a serious concern. Coronavirus was not deemed dangerous until it underwent mutational change resulting in upper respiratory infections and pneumonia.[10] Human-to-human spread is the main form of transmission of virus that occurs primarily through respiratory droplets, by cough, sneezing, shaking hands, and contact with the infected place.[2],[11] Infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. Aerosol and airborne modes of transmission have marked a responsibility of about 10%–30% of colds occurring worldwide.[3]


  Pathophysiology Top


SARS-CoV-2 infection is caused by the binding of the viral surface spike protein to the human angiotensin-converting enzyme 2 (ACE2) receptor after activation of the spike protein by transmembrane protease serine 2. ACE2 appears to be the predominant portal of entry and is expressed in the lung (principally type II alveolar cells) and the heart as well, counteracting the effects of angiotensin II in states with excessive activation of the renin-angiotensin system, such as hypertension, congestive heart failure, and atherosclerosis. In addition, it is expressed in the intestinal epithelium, vascular endothelium, and kidneys, providing a mechanism for the multiorgan dysfunction that can be seen with SARS-CoV-2 infection.[12],[13],[14]


  Clinical Features Top


The incubation period of SARS-CoV-2 is 2–14 days.[2],[11] COVID-19 manifests with a wide clinical spectrum ranging from asymptomatic patients to septic shock and multiorgan dysfunction. COVID-19 is classified based on the severity of the presentation as shown in [Table 1].[11],[15],[16] The most common symptoms of patients include fever, fatigue, dry cough, and diarrhea.[3],[17]
Table 1: Classification of COVID-19 clinical features based on severity of the presentation

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  Oral Manifestations of Covid‑19 Infection Top


Dysgeusia is the first recognized oral symptom. Gustatory disorders, sialadenitis, aphthous-like ulcerations, erosive macules, vesicle, pustule, bulla, papule, plaque, pigmentation, halitosis, xerostomia, whitish areas, fissured or depapillated tongue, hemorrhagic crust, necrosis, swelling, erythema, and spontaneous bleeding of the oral mucosa are often seen. The most common sites of involvement in descending order are tongue, labial mucosa, and palate. Oral lesions can be self-limiting and may resolve in 10 days.[18],[19],[20],[21],[22]


  Diagnostic Tests and Management for Covid‑19 Top


The standard test for the detection of SARS-CoV-2 is reverse transcriptase-polymerase chain reaction (RT-PCR), usually done on a sample of nasopharyngeal or respiratory secretions. Though RT-PCR is very specific but its sensitivity rate ranges from 60%–70% to 95%–97%, leading to false-negative results.[8] Other specimens, such as blood and stools, and even saliva are also considered as a reliable diagnostic tool.[22] Molecular techniques are more appropriate for accurate diagnosis as they can target particular pathogens and classify them.[23],[24]


  Radiographic Assessment Top


Since the lungs are the main organ involved, so chest X-rays are the first-line imaging test. The most common radiologic findings in COVID-19 are airspace opacities (consolidations and/or ground-glass opacities), which are typically bilateral, peripheral, and located primarily in the lower fields found on the chest computerized tomography scans.[25],[26]


  Laboratory Features Top


Laboratory findings specific to COVID-19 include elevated prothrombin time, lactate dehydrogenase, d-dimer, alanine transaminase, C-reactive protein, and creatine kinase.[26]


  Management Top


For containment of COVID-19, isolation remains the most effective measure. Early supportive management is required for mild infections with the use of acetaminophen, external cooling, oxygen therapy, nutritional supplements, and antibacterial therapy. Critically ill patients require high flow oxygen, extracorporeal membrane oxygenation, glucocorticoid therapy, and convalescent plasma.[11]

Antivirals such as remdesivir inhibit viral replication by initializing efficient metabolic conversion in cells and tissues to activate nucleoside triphosphate which, in turn, deactivates viral RNA polymerases.[27]

Antibiotics have been prescribed to COVID-19 patients with low immune function, namely, the elderly and medically fragile patients. Cephalosporin, the bactericidal β-lactam antibiotic, disrupts bacterial cell synthesis by inhibiting the enzyme actions in the cell wall of susceptible bacteria.[27]

Nucleic acid-based vaccines consist of DNA or mRNA. The mRNA works by introducing an mRNA sequence that is coded for the S protein or receptor binding domain. Once interacting with the host’s cells, it produces the specific antigen outside the cell surface to activate the immune system.[5]

Fusion Proteins

ACE2-fused protein is hypothesized to exert neutralization potential for SARS-CoV-2.[27]

Cellular Therapy

The use of mesenchymal stromal cells obtained from allogeneic donors in cellular therapy facilitates the regeneration of damaged cells and thus is effective in reducing nonproductive inflammation in patients.[27]


  Conclusion Top


The menacing effect of COVID-19 can be seen globally. Early diagnosis and detection of SARS-CoV-2 can help in reducing the multiorgan damage and the fatality associated with it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  In this article
   Abstract
  Introduction
  Pathophysiology
  Clinical Features
   Oral Manifestati...
   Diagnostic Tests...
   Radiographic Ass...
  Laboratory Features
  Management
  Conclusion
   References
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