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CLINICAL COURSE AND TREATMENT METHODS OF TROPHIC ULCERS OF
THE ORAL MUCOSA IN POST-COVID PATIENTS
Saidova M.A.
https://doi.org/10.5281/zenodo.14058752
Annotation
: This article highlights the results of a study conducted in patients with
trophic ulcers after COVID-19. It also describes the pathomorphological changes in patients
with trophic ulcers of the oral mucosa who have experienced COVID-19, and the
pathogistological composition of swabs taken from these ulcers. Clinical changes in patients
with trophic ulcers of the oral mucosa after COVID-19 were also investigated in this study.
Key words:
trophic ulcers, oral mucosa, necrotization, inflammatory reaction, clinical
examination.
Abstract
: In post-COVID patients, there is a long latent period between systemic
manifestations of COVID-19 and symptoms from the oral cavity, which is apparently
associated with the indirect effect of the SARS-CoV-2 virus on the oral mucosa. Various studies
report that post-COVID-19 patients have erythematous macules, papules, or plaques on the
tongue, lip mucosa, hard palate, and oropharynx. [1,2,4,5]. In confirmed cases in patients who
have had COVID-19, trophic lesions of the oral mucosa have been reported along with white
and red spots and plaques on the back and side of the tongue, gums and palate [3,6].
Purpose of the study.
Clinical changes in the oral mucosa in trophic ulcers in post-
COVID patients.
Material and research methods.
The study involved patients of both sexes who
underwent COVID-19 and the appearance of a trophic ulcer on the oral mucosa in the post-
COVID period. 125 people were examined, of which 104 were patients with trophic oral ulcers
after COVID-19 and 21 were healthy individuals not infected with the virus. The study
included people aged 18-70 years, including 61 men and 43 women. The average age of the
subjects was 56.7±0.9 years. The study participants (104) were divided according to the
following criteria: group 1 (main) - patients with trophic oral ulcers, having traumatic factors
in the oral cavity (52 patients), group 2 (comparison) - patients with trophic oral ulcers, with
sanitized oral cavity of the mouth, without traumatic factors in the oral cavity (52 patients),
group 3 (control) - healthy individuals with a sanitized oral cavity, who are not sick (21
people). Clinical (questioning; collection of anamnesis of life, illness; examination; palpation of
the lesion), dental: (hygienic - IG-HB, determination of CPUz) research methods were carried
out.
Results.
Clinical examination of trophic ulcers on the lateral surface of the tongue and
mucous membrane of the hard palate showed that the ulcer has uneven edges. On palpation,
slight pain is noted, the ulcer has an infiltrated bottom, covered with a white-gray coating,
sometimes with elevated tissue areas above the wound, combined with foci of putrefactive
tissue necrosis. Characteristic is the absence of an inflammatory reaction in the surrounding
tissues. The saliva is thick, viscous, there is an unpleasant smell from the mouth.
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Fig.1 Trophic ulcer in the sky
Fig. 2 Trophic ulcer on the tongue
The index score is an objective factor that determines the hygienic state of the oral
cavity. In the patients included in the study, we assessed the oral hygiene status using the
Green-Vermillion Hygiene Index (GV-GV). This interpretation of the Green-Vermillion index
was carried out according to gradations of the total value of IG-HS.
Initial - the highest rate of IG-HB was observed in the main group (1) (4.5+0.3), which
demonstrates a significantly higher rate than in the comparison group (2) (2.3+0.3) and the
control group (3) (1.2+0.4). In the comparison group, there was also a significant difference
(р
0,05) in the initial indicators of the hygienic state of IG-HV compared with the control
group (Table 1).
Table 1
Determination of the hygienic index of IG-HB in the oral cavity in the examined patients,
identification of the hygienic state of the oral cavity in the examined patients.
Groups (М+m)
IG-HV
R in the group
Main (1)
4,5+0,3
* ð
0,05
Comparisons (2)
2,3+0,3
*
0,05
Control (3)
1,2+0,4
0,05
As can be seen from Table 1, the best hygienic condition was noted in healthy
individuals of the control group (3) and amounted to 1.2 + 0.4, which allows us to assess it as
good. The worst hygienic condition of the oral cavity was observed in patients of the main
group (1) who had a history of COVID-19 and amounted to 4.5+0.3, the score corresponded to
the value of poor. It should be noted that in the main group, patients had traumatic factors in
the oral cavity. In the comparison group (2) patients who had, in the history of COVID-19, the
hygienic state of the oral cavity was 2.3+0.3, the hygienic level was assessed as satisfactory.
However, these patients did not have traumatic factors in the oral cavity.
Thus, the hygienic condition of the oral cavity in patients of the main group (1) was
assessed as poor, in the comparison group (2) it was assessed as satisfactory, which has a
negative effect in maintaining unfavorable factors leading to necrotization of trophic ulcers in
the oral cavity and having a negative effect on the quality of life of patients. This fact requires
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a significant correction of the hygienic state of the cavity in both clinical groups, especially in
the main (1) group.
The highest KPI index was found in patients of the main group (1) (23.2+1.5). This
indicator was significantly (р
0,05) higher than in the comparison group (2) (12.5+0.6) and
the control group (3) (8.0+0.5).
A significant difference (р
0,05) was also revealed between the indicators of CPUz in
patients of the comparison group and the control group (Table 2).
Table 2
Indicators of the DMFt index in the examined patients
Groups (М+m)
DMFt
Main (1)
23,2+1,5
* ð
Comparisons (2)
12,5+0,6
*
Control (3)
8,0+0,5
Note: * - - р
0,05 compared to the control group
ð - р
0,05 compared with the comparison group
It should be noted that teeth with carious cavities, defective fillings with a broken crown
can cause chronic traumatization of the oral mucosa, which is an unfavorable factor for the
healing of trophic ulcers.
Thus, in patients of the main (1) group with a history of COVID-19, there is a high
intensity of caries, which consists in the presence of traumatic factors in the oral cavity
(carious cavities, chips and sharp edges of teeth, poor-quality fillings, poor-quality crowns and
prostheses, non-carious lesions, defects in the dentition, etc.). Subsequently, the intervention
of dentists of various profiles (general practitioners, surgeons, orthopedists and
orthodontists) is required to eliminate the listed traumatic factors and create conditions for
favorable epithelialization of trophic ulcers in patients who have previously had COVID-19.
Conclusions
:
1.
The level of hygienic condition of the oral cavity in patients of the main group and the
comparison group was assessed as poor and satisfactory, respectively, leading to
necrotization of trophic ulcers on the oral mucosa.
2.
High rates of caries intensity in patients with trophic ulcers with a history of COVID-19
create additional traumatic factors in the oral cavity, exacerbate the ulcerative-necrotic
process of the oral mucosa and have a negative effect on the quality of life of patients.
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