COVID-19, caused by the pathogen SARS-CoV-2, emerged as a global health crisis when it was first identified in Wuhan, China, in December 2019. The World Health Organization declared it a pandemic in March 2020. As of February 21, 2023, there have been 761,071,826 confirmed cases and 6,879,677 deaths worldwide, reflecting a mortality rate of 0.9%. Initially recognized for its respiratory symptoms—fever, cough, and headache—the virus has revealed a broader spectrum of effects, including systemic manifestations that extend beyond the respiratory system.
Recent studies have shown that COVID-19 can induce symptoms resembling systemic diseases. These include loss of smell and taste, cardiovascular issues, and musculoskeletal disorders (MSD). For instance, an Austrian study found that the incidence of MSD following COVID-19 was 27.5%, while another article reported that chronic pain persisted in 63.3% of cases. Such symptoms, often lasting beyond the acute phase of the infection, are sometimes referred to as post-COVID-19 infection symptoms or long COVID.
Among the diverse symptoms reported, orofacial pain—pain affecting the mouth, jaw, and face—has emerged as a notable concern. This type of pain encompasses tooth sensitivity, toothache, periodontal pain, temporomandibular joint (TMJ) pain, facial pain, and oral mucosal pain. Japan reported a 9.8% incidence of toothache during COVID-19 infections in 2021, while a study in Germany observed that 21% of patients experienced toothache, 23% had oral mucosal pain, 31% reported tooth sensitivity, and 27% suffered from facial pain. These figures highlight the prevalence of orofacial pain among COVID-19 patients, a condition that has been exacerbated by the pandemic’s impact on dental care practices.
One significant challenge has been the reluctance of patients to seek oral treatment due to concerns about aerosol transmission in dental clinics. Studies suggest that this fear has led many patients to delay necessary dental care, worsening their conditions. Halenur Altan’s research indicates a correlation between toothache and psychological factors such as depression and anxiety triggered by the pandemic.
| Concept | Simplified Explanation | Relevant Details | Examples |
|---|---|---|---|
| SARS-CoV-2 | The virus that causes COVID-19. It spreads mainly through the air when someone with the virus coughs or sneezes. | SARS-CoV-2 is a type of coronavirus. | Similar to the common cold but more severe. |
| COVID-19 | A disease caused by the SARS-CoV-2 virus. Symptoms can include fever, cough, and headache, and it can affect various parts of the body, not just the lungs. | First identified in Wuhan, China, in December 2019. | Mild symptoms like a cold or severe symptoms needing hospitalization. |
| Pandemic | A global outbreak of a disease that affects a large number of people across multiple countries or continents. | COVID-19 was declared a pandemic by the WHO in March 2020. | Examples include the 1918 flu pandemic. |
| Mortality Rate | The percentage of people who die from a disease out of those who have it. | Calculated by dividing the number of deaths by the number of confirmed cases. | For COVID-19, it was approximately 0.9% as of February 2023. |
| Long COVID | Persistent symptoms or health issues that continue long after the initial COVID-19 infection has resolved. | Also called post-COVID-19 syndrome. | Symptoms like chronic fatigue or joint pain. |
| Orofacial Pain | Pain that occurs in the mouth, jaw, and face. It can include toothache, jaw pain, or pain in the facial muscles. | Can be caused or worsened by COVID-19. | Toothache or jaw pain experienced by some COVID-19 patients. |
| ACE2 Receptors | Proteins found on the surface of cells that the SARS-CoV-2 virus binds to in order to enter and infect the cells. | ACE2 receptors are present in many tissues, including the mouth. | Plays a role in the virus’s ability to cause symptoms in the oral area. |
| Systemic Symptoms | Symptoms that affect the entire body rather than just one area, such as fever or muscle aches. | COVID-19 can cause symptoms beyond just respiratory issues. | Fever, headache, and body aches. |
| Mutation | A change in the virus’s genetic material that can alter its properties, such as how easily it spreads or how well it evades immunity. | SARS-CoV-2 has mutated to form new variants like Omicron. | Omicron variant has high infectivity and immune escape. |
| Prevalence | The total number of cases of a disease in a population at a given time. | Indicates how common the disease is in a specific area. | High prevalence in countries during peak waves. |
| Risk Factors | Factors that increase the likelihood of developing a condition or experiencing a negative outcome. | Includes age, sex, and pre-existing health conditions. | Older adults and people with chronic illnesses are at higher risk. |
| Preventive Measures | Actions taken to reduce the chance of getting a disease or its spread. | Includes vaccination, wearing masks, and social distancing. | Washing hands frequently and staying home when sick. |
As SARS-CoV-2 has mutated, the Omicron variant has become predominant, noted for its high infectivity and immune escape characteristics. According to the global SARS-CoV-2 database GISAID, Omicron strains now constitute 99.37% of global COVID-19 cases and 100% of cases in China. Following China’s policy shift in December 2022, which led to the lifting of epidemic prevention measures, the number of confirmed cases in China surged to 99,299,372 by February 21, 2023. Despite these numbers, orofacial pain remains a significant symptom of long COVID, impacting the quality of life for many patients.
A recent study aimed to investigate the incidence, characteristics, and potential risk factors for orofacial pain in China during the Omicron wave, spanning from December 2022 to early 2023. This research utilized a cross-sectional survey conducted via a network platform, focusing on residents in Fujian Province. The study revealed a notable increase in orofacial pain rates before and after COVID-19 infection, with prevalence rates rising from 42.26% to 46.52% post-infection. Specifically, facial pain rates increased from 4.52% to 8.64%, and oral mucosal pain rates rose from 10.74% to 13.24%. Approximately 14.22% of participants reported a worsening of orofacial pain following COVID-19 infection.
Comparatively, the findings align with some international studies but differ in certain aspects. For example, while a German study reported higher rates of orofacial pain symptoms, a Lebanese study indicated a much higher incidence of TMJ disorders compared to the Fujian study. These discrepancies might be attributed to the differing virulence of COVID-19 strains and regional variations in symptom reporting.
SARS-CoV-2’s interaction with angiotensin-converting enzyme 2 (ACE2) receptors, which are abundant in oral tissues, is believed to contribute to orofacial pain. The virus’s impact on oral keratinocytes and salivary glands can lead to painful oral ulcers. Despite this, the biological mechanisms underlying long COVID and orofacial pain remain under-researched, indicating a need for further investigation.
The study also identified potential influencing factors for orofacial pain. Male sex and the number of COVID-19 symptoms were found to be risk factors, while the timing of infection and habits such as tea or coffee consumption appeared to offer some protection. Interestingly, the number of vaccinations did not show a significant correlation with orofacial pain. Factors like male sex, early infection before the policy shift, and multiple COVID-19 symptoms were more likely to result in orofacial pain. Conversely, a preference for tea or coffee might alleviate oral pain, though this hypothesis requires further study.
Psychological factors, such as anxiety and depression, were not strongly correlated with orofacial pain in this study, contrary to findings in other research. Nonetheless, older age was associated with a higher likelihood of orofacial pain, suggesting that psychological status remains a potential factor in pain exacerbation. Addressing patients’ emotional well-being may positively impact pain management.
The study also explored factors influencing the decision to seek medical treatment. Variables such as sex, education and income level, psychological status, the number of medications used, and concerns about COVID-19 transmission in dental settings were significant. Women with higher education and income levels, who were less concerned about transmission risks, and who used more medications were more likely to seek medical care. Psychological status, education, and income levels emerged as crucial determinants of medical treatment access.
Despite its contributions, the study has limitations. The geographical focus on Fujian Province may limit generalizability, and the lack of a comparison group of non-infected individuals affects the study’s scope. Additionally, the sampling method and demographic skew—such as the higher proportion of females and individuals with higher education and income—may influence the results. Future research should address these limitations by incorporating larger, more diverse samples and comparing infected and non-infected populations.
In conclusion, while COVID-19 is primarily a respiratory illness, its impact on systemic and orofacial health underscores the complexity of long COVID. The persistence of orofacial pain highlights the need for continued research and awareness. Addressing long COVID, including orofacial pain, remains a global health priority, requiring concerted efforts from health authorities and public agencies to improve understanding, promote preventive measures, and ensure access to care.
reference : https://www.sciencedirect.com/science/article/pii/S0020653924001989#sec0014
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