Oral Manifestations of COVID-2019–Related Multisystem Inflammatory Syndrome in Children

 

TAKE-HOME MESSAGE

• In this cross-sectional retrospective review of 47 inpatients diagnosed with COVID-19 with multisystem inflammatory syndrome in children (MIS-C) in one hospital between March 15 and June 1, 2020, charts were reviewed for demographics, laboratory values, and signs and symptoms. Oral or oropharyngeal findings were identified in more than half (55.3%) of patients with MIS-C. A total of 23 patients (48.9%) had red, swollen, or cracked lips and 5 (10.6%) had documented strawberry tongue. Oral/oropharyngeal findings were associated significantly with the presence of a systemic rash (P = .04), conjunctivitis (P = .02), and absence of a cough (P = .02).

• In MIS-C, the precise incidence of oral findings and their clinical and prognostic significance is unknown. Oral/oropharyngeal manifestations may constitute a reproducible clinical manifestation of MIS-C and dentists should be cognizant of these features as well as available to evaluate high-risk patients.

–  Laurie C. Carter, DDS, PhD

BACKGROUND

Although much is still unknown about the full effects of COVID-19, literature from the early stages of the COVID-19 pandemic (spring and summer 2020) supports a postviral immunologic reaction resulting in a multisystem inflammatory syndrome in children (MIS-C). The purpose of this study was to report the rates of documented oral and oropharyngeal manifestations among these patients and to determine the association of these findings with other MIS-C symptoms.

METHODS

The authors conducted a retrospective review of pediatric patients with COVID-19 who were admitted to the Morgan Stanley Children's Hospital of NewYork-Presbyterian. Patients fulfilling the Centers for Disease Control and Prevention criteria for MIS-C were included in this study. The documented signs, symptoms, and laboratory values were collected and compared with the presence of oral or oropharyngeal findings.

RESULTS

The mean (standard deviation) age of MIS-C patients was 9.0 (5.0) years (range, 1.3-20.0 years), and there was no obvious sex difference (51.1% male, 48.9% female). With respect to oral findings, 23 patients (48.9%) had red or swollen lips, whereas only 5 (10.6%) had a strawberry tongue. Oral or oropharyngeal findings were associated significantly with the presence of systemic rash (P = .04) and conjunctivitis (P = .02).

CONCLUSIONS

The presence of oral or oropharyngeal changes may be an early indicator of MIS-C and should be considered suggestive of MIS-C in the setting of COVID-19 infection.

PRACTICAL IMPLICATIONS

Dental care providers may play an integral role both in the early detection of oral manifestations of MIS-C and in the identification of oral lesions in hospitalized patients with confirmed MIS-C.