Oral manifestations of COVID-19 vaccinated individuals, post-infection, and different variants: a Brazilian population study

TL;DR

This study examines oral symptoms in Brazilian individuals with COVID-19, comparing vaccinated and unvaccinated groups and different virus variants.

Contribution

The study provides insights into oral manifestations of different SARS-CoV-2 variants and their association with vaccination status and mental health.

Findings

Taste disorder was the most common oral manifestation in the study population.

Vaccinated individuals showed similar oral symptoms as unvaccinated individuals.

Oral symptoms were linked to depression, anxiety, and poor oral hygiene.

Abstract

This cross-sectional study aims to investigate the prevalence of oral manifestations in a sample of the Brazilian population with COVID-19. Adults diagnosed with COVID-19 through real-time PCR/serological tests were invited to participate. The online questionnaires were distributed at different times to analyze and compare SARS-CoV-2 variants considering the period of prevalence of these variants in Brazil. A total of 846 participants were included, of whom 539 were diagnosed before the Omicron variant. In total, 47.28% were vaccinated with at least two doses. The prevalence of oral manifestations was 52.6% (95%CI: 49.23–55.95), and the most common manifestations included taste disorder (38.06%; 95%CI: 34.85–41.38), xerostomia (17.61%; 95%CI: 15.19–20.32), and halitosis (11.58%; 95%CI: 9.59–13.92). The prevalence of persistent symptoms in post-COVID-19 was 12.1% (95%CI: 10.0–14.4) for taste disorder and 5.4% (95%CI: 4.1–7.1) for xerostomia. A significant association was found between females and persistent taste disorder (p = 0.0084) and oral manifestation and depression/anxiety (OR = 1.855, 95%CI: 1.267–2.717, p = 0.002), worse oral hygiene (OR = 1.729, 95%CI: 1.189–2.516, p = 0.004), and medication use (OR = 1.630, 95%CI: 1.123–2.367, p = 0.010) (p < 0.0001). In the Alpha, Beta, Gamma, and Delta variants, compared with the Omicron variant, taste disorder and xerostomia were less present when toothbrushing habits remained unchanged or improved (p < 0.0001). Oral manifestations in patients with COVID-19 were associated with depression/anxiety, worse oral hygiene, and medication, all of which reinforce its multifactorial etiopathogenesis.

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