Fabio Maglitto

Francesco Antonio Salzano

Giacomo De Riu

Giovanni Salzano

Luigi Angelo Vaira

English

Archivio della ricerca - Università degli studi di Napoli Federico II

COMMENTARYAgeusia, a highly specific symptom of COVID-19, for whichan unaware patient may seek dental assistanceGiovanni Salzano1, Fabio Maglitto1, Luigi Angelo Vaira2, Francesco Antonio Salzano3 andGiacomo De Riu21Maxillofacial Surgery Operative Unit, University Hospital of Naples “Federico II”, Naples, Italy; 2Maxillofacial Surgery Unit, UniversityHospital of Sassari, Sassari, Italy; 3Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno,Salerno, Italy.The rapid worldwide spread of severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2) has profoundlychanged dental practice with the initial suspension of allclinical activities except emergent situations. In Europe,many countries are moving toward the so-called ‘phase2’, coexistence with the virus. Of course, the resump-tion of activities will cause a rise in the contagion curve.To slow this rise in cases, it will be essential to be ableto identify suspicious cases and to ensure that suchpatients undergo a nasopharyngeal swab. A knowledgeof the most frequent symptoms in the early stages ofcoronavirus disease 2019 (COVID-19) is mandatory toachieve this goal and dentists, through the anamnesticinformation collected during the triage procedures, willhave a fundamental role in this process.Taste and smell disturbances were reported as rarefindings in these patients, in the Chinese case series,affecting only 5% of patients1. At the end of March,we first realised that in Italian COVID-19 patients theincidence of these conditions was much higher, and,in particular, these symptoms were very frequent inthe early stages of the disease2,3. Subsequently, similarfindings have been reported by several authors in Eur-ope and America4–6, with incidences of around 70%of these patients. Chemosensitive disorders representearly symptoms of COVID-19, commonly occurringwithin 2–3 days after the clinical onset7–9. The latestdata reported by Petrocelli et al.4, evaluating the gus-tatory function in 300 patients in the first 4 days fromthe clinical onset, detected a taste dysfunction in60.4% of the cases. Interestingly, in a large multicen-tre Italian study recently published by our group,chemosensitive symptoms proved to be the first symp-tom of COVID-19 in 29.2% of patients and the onlyone in 9.5% of cases9. In most patients, the recoveryof gustatory function generally occurs within 3 weeks.However, in 7.2% of cases, severe ageusia orhypogeusia can persist for more than 60 days10.The pathogenesis of these disorders is probablyrelated to the infection of the support cells to theolfactory and gustatory receptors, rich in angiotensinconverting enzyme 2 (ACE2) receptors11. In fact, ageu-sia is a well-known side effect of ACE2-inhibitors.Ageusia is a rare condition that is characterised bya complete loss of taste function of the tongue. Thiscondition is one of the typical symptoms of COVID-19 has important implications in dental practice. Atthe beginning of the epidemic in Italy, an abnormalnumber of patients attended our dental, neurologicaland surgical clinics on account of the detection ofsudden onset ageusia, not associated with any othersymptoms. Subsequently, SARS-CoV-2 infection wassoon diagnosed in these patients following the furtheronset of fever and cough. This strange coincidencewas the reason that prompted us to start investigatingthe role of chemosensitive disorders in COVID-19.Based on the growing number of reports that placethese COVID-19 symptoms as the second most fre-quent after fever, several countries are includingchemosensitive disorders in their guidelines for thediagnosis of SARS-CoV-2 infection.Dentists should be warned that in respect ofpatients seeking assistance for the sudden onset ofageusia, a suspicion of ongoing coronavirus infectionshould be considered in a differential diagnosis. In thesame way, chemosensitive disorders should be investi-gated in the anamnestic data collection during pre-triage procedures. If present or recently experienced,the patient should be referred to a COVID-19 hospitalfor a nasal swab for identification of the virus.Based on the frequency of these symptoms, whichcan often be the reason why the patient attends for a© 2020 World Dental Federation. Published by John Wiley & Sons Ltd 1International Dental Journaldoi: 10.1111/idj.12620dental appointment, we think it is essential that theyare included in the dental association national guideli-nes that will be the issued for the resumption ofclinical activity during the post-epidemic era.FUNDINGThis research did not receive any specific grant fromfunding agencies in the public, commercial, or not-for-profit sectors.CONFLICT OF INTERESTSNone declared.REFERENCES1. Mao L, Jin H, Wang M et al. Neurologic manifestations of hos-pitalized patients with Coronavirus Disease 2019 in Wuhan,China. JAMA Neurol 2020 77: 683.2. Vaira LA, Salzano G, Deiana G et al. Ageusia and anosmia:common findings in COVID-19 patients. Laryngoscope 2020130: 1787.3. Vaira LA, Salzano G, De Riu G. The importance of olfactoryand gustatory disorders as early symptoms of coronavirus dis-ease (COVID-19). Br J Oral Maxillofac Surg 2020 58:615–616.4. Petrocelli M, Ruggiero F, Baietti AM et al. patients: theBologna experience of 300 cases. J Laryngol Otol 2020 134:571–576.5. Lechien JR, Chiesta-Estomba CM, De Siati DR et al. Olfactoryand gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a mul-ticenter European study. Eur Arch Otorhinolaryngol 2020 277:2251–2261.6. Xydakis MS, Dehgani-Mobaraki P, Holbrook EH et al. Smelland taste dysfunction in patients with COVID-19. Lancet InfectDis 2020 20: 1015–1016. https://doi.org/10.1016/S1473-3099(20)30293-0.7. Vaira LA, Deiana G, Fois AG et al. Objective evaluation ofanosmia and ageusia in COVID-19 patients: a single-centerexperience on 72 cases. Head Neck 2020 42: 1252–1258.8. Vaira LA, Salzano G, Petrocelli M et al. Validation of a self-ad-ministered olfactory and gustatory test for the remotely evalua-tion of COVID-19 patients in home quarantine. Head Neck2020 42: 1570–1576.9. Vaira LA, Hopkins C, Salzano G et al. Olfactory and gustatoryfunction impairment in COVID-19 patients: An Italian objectivemulticenter-study. Head Neck 2020 42: 1560–1569.10. Vaira LA, Hopkins C, Petrocelli M et al. Smell and taste recov-ery in COVID-19 patients: a 60-day objective and prospectivestudy. J Laryngol Otol 2020 12: 1–14.11. Vaira LA, Salzano G, Fois AF et al. Potential pathogenesis ofageusia and anosmia in COVID-19 patients. Int Forum AllergyRhinol 2020 10: 1103–1104. https://doi.org/10.1002/alr.22593.Correspondence to:Fabio Maglitto,Maxillofacial Department,University of Naples Federico II,Via Pansini 5, 80100 Naples, Italy.Email: fmaglitto@gmail.com2 © 2020 World Dental Federation. Published by John Wiley & Sons LtdGiovanni et al.

Ageusia, a highly specific symptom of COVID-19, for which an unaware patient may seek dental assistance

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Ageusia, a highly specific symptom of COVID-19, for which an unaware patient may seek dental assistance

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