Oral manifestations associated with long COVID: a scoping review

Theodoro, Emylly Lopes; Prediger, Karina Marques; Damacena, Marielle Aparecida; Silva, Camilly Victória da; Cano, Rodrigo das Neves; Uehara, Silvia Carla da Silva Andre

doi:10.1590/0034-7167-2025-0198

person Emylly Lopes Theodoro

final review with critical · intellectual participation in the manuscript · analysis and/or interpretation of data · conception or design of the study/research

schoolUniversidade Federal de São Carlos. São Carlos, São Paulo, Brazil

0009-0009-0517-7597

person Karina Marques Prediger

final review with critical · intellectual participation in the manuscript · analysis and/or interpretation of data · conception or design of the study/research

schoolUniversidade Federal de São Carlos. São Carlos, São Paulo, Brazil

0000-0001-8323-3632

person Marielle Aparecida Damacena

final review with critical · intellectual participation in the manuscript · analysis and/or interpretation of data

schoolUniversidade Federal de São Carlos. São Carlos, São Paulo, Brazil

0009-0006-7759-3766

person Camilly Victória da Silva

final review with critical · intellectual participation in the manuscript · analysis and/or interpretation of data

schoolUniversidade Federal de São Carlos. São Carlos, São Paulo, Brazil

0009-0003-2916-3508

person Rodrigo das Neves Cano

final review with critical · intellectual participation in the manuscript · analysis and/or interpretation of data

schoolUniversidade Federal de São Carlos. São Carlos, São Paulo, Brazil

0009-0002-5570-8279

person Silvia Carla da Silva Andre Uehara

final review with critical · intellectual participation in the manuscript · conception or design of the study/research

schoolUniversidade Federal de São Carlos. São Carlos, São Paulo, Brazil

0000-0002-0236-5025

personCorresponding author: Rodrigo das Neves Cano, E-mail:
rnevesc.prof@gmail.com

EDITOR IN CHIEF:

Antonio José de Almeida Filho

ASSOCIATE EDITOR:

Waldemar Brandão Neto

Database	Reference	Total articles
PubMed	((((((((((((((“Long COVID”[Title]) OR “Post-Acute COVID-19 Syndrome”[Title]) OR “Post-COVID Conditions”[Title]) AND (“Signs[Title] AND Symptoms”[Title])) OR “Oral Manifestations”[Title]) OR “Periodontal Diseases”[Title]) OR “Parodontosis”[Title]) OR “Periodontal Atrophy”[Title]) OR “Gingivo-Osseous Atrophies”[Title]) OR “Stomatognathic Diseases”[Title]) OR “Dental Diseases”[Title]) OR (“Mouth[Title] AND Tooth Diseases”[Title])) OR “Pathology, Oral”[Title]) OR (“Oral[Title] AND Maxillofacial Pathology”[Title])) OR “Tooth Loss”[Title]	573
Virtual Health Library	(ab:(“Long COVID” OR “Post-Acute COVID-19 Syndrome” OR “Post-COVID Conditions” OR “Síndrome de COVID-19 Pós-Aguda” OR “Síndrome Post Agudo de COVID-19”)) AND (ab:(“Signs and Symptoms” OR “Sinais e Sintomas” OR “Signos y Síntomas”)) AND (ab:(“Oral Manifestations” OR “Manifestações Bucais” OR “Manifestaciones Bucales”)) OR (ab:(“Periodontal Diseases” OR Parodontosis OR “Doenças Periodontais” OR “Enfermedades Periodontales”)) OR (ab:(“Periodontal Atrophy” OR “Gingivo-Osseous Atrophies” OR “Atrofia Periodontal”)) OR (ab:(“Stomatognathic Diseases” OR “Dental Diseases” OR “Mouth and Tooth Diseases” OR “Doenças Estomatognáticas” OR “Enfermedades Estomatognáticas”)) OR (ab:(“Pathology, Oral” OR “Oral and Maxillofacial Pathology” OR “Patologia Bucal” OR “Patología Bucal”)) OR (ab:(“Tooth Loss” OR “Perda de Dente” OR “Pérdida de Diente”))	95
Scopus	( ABS ( “Long COVID” ) OR ABS ( “Post-Acute COVID-19 Syndrome” ) OR ABS ( “Post-COVID Conditions” ) AND ABS ( “Signs and Symptoms” ) OR ABS ( “Oral Manifestations” ) OR ABS ( “Periodontal Diseases” ) OR ABS ( parodontosis ) OR ABS ( “Periodontal Atrophy” ) OR ABS ( “Gingivo-Osseous Atrophies” ) OR ABS ( “Stomatognathic Diseases” ) OR ABS ( “Dental Diseases” ) OR ABS ( “Mouth and Tooth Diseases” ) OR ABS ( “Pathology, Oral” ) OR ABS ( “Oral and Maxillofacial Pathology” ) OR ABS ( “Tooth Loss” ) )	95
Scientific Electronic Library Online	BY TITLE: (ti:(^”Long COVID” OR “Post-Acute COVID-19 Syndrome” OR “Post-COVID Conditions” OR “Síndrome de COVID-19 Pós-Aguda” OR “Síndrome Post Agudo de COVID-19” )) AND (ti:(“Signs and Symptoms” OR “Sinais e Sintomas” OR “Signos y Síntomas” )) AND (ti:(“Oral Manifestations” OR “Manifestações Bucais” OR “Manifestaciones Bucales” )) OR (ti:(“Periodontal Diseases” OR Parodontosis OR “Doenças Periodontais” OR “Enfermedades Periodontales” )) OR (ti:(“Periodontal Atrophy” OR “Gingivo-Osseous Atrophies” OR “Atrofia Periodontal” )) OR (ti:(“Stomatognathic Diseases” OR “Dental Diseases” OR “Mouth and Tooth Diseases” OR “Doenças Estomatognáticas” OR “Enfermedades Estomatognáticas” )) OR (ti:(“Pathology, Oral” OR “Oral and Maxillofacial Pathology” OR “Patologia Bucal” OR “Patología Bucal”)) OR (ti:(“Tooth Loss” OR “Perda de Dente” OR “Pérdida de Diente*”))	40
Web of Science	(((((((TI=(“Long COVID” OR “Post-Acute COVID-19 Syndrome” OR “Post-COVID Conditions”)) AND TI=(“Signs and Symptoms”)) AND TI=(“Oral Manifestations”)) OR TI=(“Periodontal Diseases” OR “Parodontosis”)) OR TI=(“Periodontal Atrophy” OR “Gingivo-Osseous Atrophies” )) OR TI=(“Stomatognathic Diseases” OR “Dental Diseases” OR “Mouth and Tooth Diseases”)) OR TI=(“Pathology, Oral” OR “Oral and Maxillofacial Pathology”)) OR TI=(“Tooth Loss”)	888
Excerpta Medica dataBASE	((‘long Covid’:ti OR ‘post-acute Covid-19 syndrome’:ti OR ‘post-Covid conditions’:ti) AND ‘signs and symptoms’:ti AND ‘oral manifestations’:ti OR ‘periodontal diseases’:ti OR ‘parodontosis’:ti OR ‘periodontal atrophy’:ti OR ‘gingivo-osseous atrophies’:ti OR ‘stomatognathic diseases’:ti OR ‘dental diseases’:ti OR ‘mouth and tooth diseases’:ti OR ‘pathology, oral’:ti OR ‘oral and maxillofacial pathology’:ti OR ‘tooth loss’:ti) AND [2020-2024]/py	927

Author, year, and place	Objective	Study design and sample (n)	Study population characterization	Main evidence found
Moradian S.T. et al., 2020, Iran(¹⁴)	Assess the frequency of late symptoms in patients with COVID-19.	Cross-sectional study, n=200	80% of men, with an average age of 55 years	Persistent taste disturbances were reported in 8% of patients six weeks after hospital discharge, indicating gustatory sequels of long COVID.
Asadi-Pooya A.A. et al., 2021, Iran(¹⁵)	Examine risk factors associated with the development of long COVID in a large cohort.	Retrospective study, n=4,681	52.9% of men, with an average age of 52 years	Loss of taste occurs in 3% of cases, more frequently in women, people with respiratory illnesses, and those with prolonged hospital stays.
Zayet S. et al., 2021, France(¹⁶)	Describe patients with post-COVID-19 syndrome with persistent symptoms and compare them to the control group.	Retrospective study, n=354	63% of women, aged between 19 and 98 years	31.5% reported loss of taste approximately nine months after infection, reinforcing the persistence of gustatory symptoms.
Riestra-Ayora J. et al., 2021, Spain(¹⁷)	Determine the incidence and evolution of olfactory and gustatory dysfunctions related to COVID-19.	Cohort study, n=320	81.9% of women, aged between 18 and 65 years 60.5% presented persistent taste symptoms.	60.5% presented persistent gustatory symptoms, with 12% experiencing no recovery, and 14.4% experiencing partial recovery after six months.
Petersen M.S. et al., 2021, Faroe Islands(¹⁸)	Describe acute and long-term COVID symptoms in non-hospitalized patients.	Longitudinal study, n=180	54% of women, with an average age of 39.9 years.	Loss of taste was reported in 16.4% during the acute phase, persisting in 1.7% in the late follow-up among non-hospitalized patients.
Rafałowicz B. et al., 2022, Poland(¹⁹)	Present, through six case studies, the most common oral symptoms of long COVID in patients with a history of SARS-CoV-2 infection.	Case report, n=6	Four men (66%) and two women (34%) between 43 and 72 years old	Clinical cases have shown dry mouth, oral lesions, tooth loss, and tongue changes associated with long COVID.
Alfadda A.A. et al., 2022, Saudi Arabia(²⁰)	Investigate clinical and biochemical characteristics of patients six months after hospital discharge.	Cohort study, n=98	51 (52%) men, with an average age of 48 years	Loss of taste and appetite was reported by 7.1% six months after hospital discharge.
Muthyam A.K. et al., 2022, India(²¹)	Determine oral manifestations among patients recovered from COVID-19.	Cross-sectional study, n=100	51% of men and 54% of women >35 years old	Xerostomia (11%), ulcerations (12%), taste alterations (11%), gingival bleeding, and chewing difficulties were identified.
Johansson A.K. et al., 2023, Sweden(²²)	Provide information on general and orofacial symptoms of acute and long COVID-19 in Swedish survivors, and to identify predictive/protective factors.	Cohort study, n=283	132 patients with long COVID, 60 women (45%) and 72 men (55%) between 80 and 90 years old	46% presented with oral symptoms, such as difficulty chewing, cracked teeth, dry mouth, eating difficulties, gum bleeding, dysphagia, taste alterations, and ulcers. Moreover, 14% had ≥5 symptoms. Persistent ageusia was observed for up to six months after recovery, although in decreasing proportions over time.
Al-Magsoosi M.J.N. et al., 2023, Iraq(²³)	Determine the prevalence of oral manifestations of COVID-19 in recovered patients.	Cross-sectional study, n=574	378 (88.3%) women and 196 (11.7%) men, aged between 18 and 78 years	Oral manifestations occurred in 88.3% of cases, mainly ageusia, xerostomia, and dysphagia. Only ageusia persisted, with an association to severity and age, but no relation to sex, smoking, or comorbidities.
Araújo A.D.D.G. et al., 2023, Brazil(²⁴)	Analyze factors related to long COVID in the adult population of Brazil.	Analytical cross-sectional study, n=288	71.9% of women, aged between 18 and 91 years	The clinical manifestations associated with persistence were fever, chills, headache, cough, anosmia, ageusia, dyspnea, and diarrhea. Among those with persistent symptoms, headache (24.65%), cough (21.88%), and fever (21.18%) were prevalent, while diarrhea and dyspnea occurred less frequently (13.19%).
Gujral H.S. et al., 2023, India(²⁵)	Study long-term effects up to 12 months after acute COVID-19 and analyze risk predictors.	Cohort study, n=120	63.3% of men, with an average age of 41 years	3.3% experienced persistent loss of taste after hospitalization, regardless of admission to the Intensive Care Unit.
Nair C.V. et al., 2023, India(²⁶)	Determine the incidence of post-COVID-19 symptoms in hospitalized patients and compare those in the Intensive Care Unit and those not in the Intensive Care Unit.	Cohort study, n=120	55% of men, with an average age of 54 years	Older adults (80-90 years old) presented with dry mouth, dysphagia, taste alterations, gingival bleeding, ulcers, and feeding difficulties. In addition, 3.3% reported persistent loss of taste, both in the Intensive Care Unit and non-Intensive Care Unit groups.
Patel D. et al., 2024, United Kingdom(²⁷)	Investigate oral manifestations of long COVID and gather opinions and practices of healthcare professionals regarding these conditions.	Cross-sectional study, n=104	89.4% of women, aged between 18 and 79 years	47.1% reported oral symptoms lasting > three months: taste/smell alterations (58%), dry mouth (48.1%), and ulcers (45.7%).
Louisa M. et al., 2024, Indonesia(²⁸)	Assess the distribution and severity of periodontal diseases in COVID-19 survivors with and without long COVID.	Cross-sectional study, n=40	Patients aged between 21 and 66 years The study did not consider gender.	Long COVID was associated with greater severity of periodontal diseases, such as gingivitis and generalized periodontitis (70%).

Oral manifestations associated with long COVID: a scoping review

Manifestaciones bucales asociadas a COVID prolongado: revisión de alcance