- The document discusses the oral manifestations of COVID-19 and post-COVID mucormycosis (black fungus infection) from a dentist's perspective. It details various oral symptoms caused by COVID-19 like loss of taste, dry mouth, lesions, pain, and increased risk of oral infections. It explains how the virus affects oral structures by targeting ACE2 receptors in the mouth. It also describes the causes, symptoms, diagnosis and treatment of post-COVID mucormycosis, emphasizing the importance of early diagnosis and antifungal therapy. The document aims to increase awareness of oral signs of COVID-19 and mucormycosis among dental professionals and the public.

1. ORAL MANIFESTATIONS OF
COVID-19 AND POST COVID
MUCORMYCOSIS – Explained.
From a Dentist’s POV
- K.S.S. Geethika BDS.

2. Preface (Please read.)
• The information given in this presentation is strictly through observation and self research,
pre existing case studies and fact cross checks leading me to put together the presentation
of the SARSCOVID, COVID-19 and few newer strains of the virus as is concerning to a
Dentist or an Oral and Maxillofacial Surgeon.
• I hope this information helps fellow BDS graduates, UG, PG students and whoever may
cross this ppt to help clarify the common doubts of regular public, remove unnecessary
panic in and be aware of the different manifestations of the disease, by early recognisation
of the signs and symptoms, help prevent further degradation of a COVID affected person’s
health.
• Laymen terms have been given next to scientific terms to help general public understand.
• IMPORTANT : No one, irrespective of your degree and educational status is to self
diagnose or treat the following symptoms Without the consent or guidance of an
experienced personnel. As the disease is presenting itself in many different forms in
different patients, a very thorough drug, medical and disease history is mandatory to avoid
adverse reactions of any kind. THIS IS PURELY FOR INFORMATION PURPOSE. DO NOT
TAKE ANY ACTION BASED ON THIS PPT.
• Even after education yourself on the Oral presentation of the disease, be sure not to give
careless free advice and instill more panic in the general public.
• Not all symptoms given maybe a cause or sign of COVID19.

3. List of COVID 19 oral manifestations
• Ageusia (Lack of taste)
• Xerostomia (Dry mouth)
• Lesions – erosion
- ulcers
- fissures (on tongue)
- blanching (of oral mucosa fibers)
• Pain and soreness
• Parasthetia (Feeling of numbness)
• Petichiae (Red spots on palate, oropharynx)
• Angular chelitis (Cracks on the corner of mouth)
• Glossitis, glossodynea (Burning tongue)
• Sialorrhea (Increased saliva flow)

4. • Gingivitis
• Co-infections ( eg. Candidiasis)
• MUCOR-MYCOSIS

5. Rough Pathophysiology, Why and How
the virus affects the oral structures.
• The SARS- COVs , COVID19 Virus and its strains have an
affinity to target Angiotensin Convertase Enzyme2
(ACE2) releasing cells as its entry receptor.
• Sites where ACE2 producing cells are concentrated in the
body : – Respiratory tract
- Oral mucosa
- Epithelial cells of
tongue
- Salivary glands
• The ACE2 producing cells are concentrated more in the
oral cavity, leading to the presentation of following
clinical features.

6. 1. The infamous “Lack of taste”
• Can be complete, lowered, or altered loss of taste
sensation.
• Ageusia – Complete loss of taste sensation
• Dysgeusia / Parageusia – Altered taste sensation
• Hypogeusia – lowered taste sensation
• Etiology / cause :
– due to ‘Depapillation’ (loss of papillae of
tongue.
- The taste receptor cells are located in
taste buds seen around and on tongue papillae. Papillae
being affected is one of the major contributors to the lack
of taste sensation.

7. - reduced saliva flow can also aid in lack of taste
perception.
• Clinically presented as :
- In image, difference between regions with and
without papillae can be clearly appreciated. Smooth,
shiny atrophic lateral surfaces of this particular
tongue have been
depapillated.
- Tongue may sometimes
even occur erythematous
(reddenned)

8. 2. XEROSTOMIA / DRY MOUTH
• Decreased saliva flow, due to indirect activity of the
virus on salivary glands, may lead to dry mouth
conditions, which in turn lead to various complications
like fissured tongue, cracked lips, lack of taste, angular
chelitis (cracks at corner of the mouth) and
oppurtunistic infections like candidiasis.
• Common complaint in Covid patients, ‘Tingling /
irritation of lips, tongue’ can be due to Xerostomia.
• - fissured dry tongue in image

9. 3.Lesions.
• Caused – due to decreased Immunity
• Common lesions seen – Ulcers
- erosions
- fissures
- blanching of oral
mucosa fibers – leading to Difficulty in
mastication (chewing) and deglutition
(swallowing)
• Pain and Parasthesia (partial numbness) can
also be seen.

10. Ulcer - Erosion –

11. 4. PETECHIAE :
- Small red spots seen on palate (roof
of the mouth) and sometimes oropharynx.
- Lesion can be painful
- Area around the lesion may be
numb/parasthetic

12. 5. ANGULAR CHELITIS :
- Cracks on corner of the mouth due to
dryness and deficiencies.
- Patient is asked not to touch, shave, or
stimulate the area more to avoid trauma.

13. 6. GLOSSITIS - inflammation of tongue
7. GLOSSODYNEA - burning sensation of tongue
8. GINGIVITIS - Inflammation leading to
erythematous (red) and edematous (swollen)
gingiva (gums)
9. LOOSENING OF TEETH due to gingival problems
- gingivitis

14. 10. CO – INFECTIONS :
- due to decreased
immunity, the opportunistic fungi and bacteria
living in the oral cavity increase their prevalence
causing infections like,
• CANDIDIASIS : – occurs as white patches on
tongue and mucosa.

15. • COVID tongue :
- All these oral manifestations
seen on the tongue are collectively termed and
called “COVID tongue”.
- May be perceived and told by
patients as ‘bumpy feeling tongue’

16. TREATMENTS
• 1. Topical Triamcinolone Acetonide paste :
- has anti-inflammatory effect
- reverses vascular dilation hence
decreasing edema and erythema.
- is a corticosteriod hence usage
should be in careful doses and steroidal action is
said to interfere and cause adverse effects with
the COVID vaccination, hence doctor
consultation is required.

17. 2. Doxycycline mouthrinses :
- Is a tetracycline based
mouthrinse, hence contraindicated in pregnant
women and other drug allergic patients.
- Has antibacterial effect
3. Benzalkonium mouthrinses :
- Antibacterial effect
4. Lignocaine topical anesthetic :
- Decreases pain
- Has temporary anesthetic
effect

18. MUCORMYCOSIS - Black fungus.
• Etiology / causes :
- It is a fungal infection caused
due to decreased immunity due to the COVID19
virus.
- Due to increased steroidal
administration via the COVID19 treatment drugs.
- Due to increased administration
of antibacterial drugs.
- Poor overall hygiene of the
patient.

19. • Predisposing features :
- COVID19 patients with underlying
diabetes are said to be more vulnerable to this infection.
- Patients with underlying immuno-
compromised diseases such as HIV, Hepatitis B are also
more prone to the infection.
- Patients spending more time in ICUs
are said to develop the infection.
• Types of Mucormycosis :
- Orbital
- Cerebral
- Nasal
- Pulmonary
- Gastro Intestinal

20. • Clinical features :
1. Orbital Mucormycosis :
- Edema (conjuctival)
- Proptosis (bulging of eye)
- Blurred vision
- Diplopia (double vision)
- Impaired eye movements
- Swollen eyelids or eye
- 5th cranial nerve involvement
leading to numbness
- Necrotic lesion (blackened areas
over and around eye region)

21. Images showing necrotic regions, edema of eye and proptosis :

22. 2. Oro – Nasal Mucormycosis :
- Necrotic lesions (black regions)
- Black discharge from nose or oral
cavity
- Pain around nose and cheeks
- Nasal congestion (nose block)
- Loosening of teeth
- Facial swelling
- Numbness
- Foul smell (due to necrotic areas)
- SINUSITIS :- most affected
ethmoid sinus

23. Images showing swollen cheek and nose region, necrotic
areas on palate and nose :

24. 3. Cerebral Mucormycosis :
- Headache
• More about other types of mucormycosis not included as they do not come under oral and maxillofacial regions.
Image showing affected areas :

25. • Diagnostic aids / Investigations :
- Detailed medical,
drug and disease history of patient.
- Potassium
Hydroxide, KOH mount
- Biopsy
- Endoscopy
- CT scan
• Differential Diagnosis :
- Aspergillosis
- Cellulitis
- Lymphomas
- Anthrax

26. • Radiographic features :
> Oro Nasal Mucormycosis :
- Opacification of involved
sinus
- Mucosal lining thickening
of involved sinus
- Other structures like TMJ
appear normal.
- Opacification
of sinus seen in
image :

27. • Treatment :
- Early diagnosis
- Antifungal treatment
- Liposomal Amphotericin B,
given I.V.
- Surgical debrediment.
• Prevention :
- Maintain proper hygiene and
caution.

28. THANK YOU
Do not spread false information.
Stay safe.