A 38‐year‐old Thai woman
developed painful oral lesions lasting over 8 weeks. The lesions appeared 1 week following the administration of the first dose of AZD1222 vaccine.
Her extraoral examination was unremarkable. The intraoral examination revealed generalized desquamative epithelium, erythematous areas along the marginal gingivae and alveolar mucosa. Pseudomembranes, and erosions and ulceration on the buccal gingiva subjacent to the maxillary and mandibular teeth, and the right lingual dorsum could be seen. Furthermore, generalized desquamative epithelium of the alveolar mucosa of the anterior mandibular teeth as well as the right mandibular and left maxillary posterior molars extending to the mucobuccal folds were present. Erythematous areas also extended from the lingual gingiva of anterior mandibular teeth onto the floor of mouth.
The histopathologic and direct immunofluorescence examination confirmed a diagnosis of pemphigus. After treatment with a potent topical steroid, fluocinolone acetonide 0.05% mouthwash, for one week, her painful oral lesions regressed.
Thai woman was referred to the Oral Medicine Clinic at the Dental Hospital, Faculty of Dentistry, Naresuan University, with a 6-week history of oral mucosal discomfort and burning sensations that had developed one week following the administration of the second dose of mRNA COVID-19 vaccine (BNT162b2, Pfizer/BioNTech). In addition, the patient had suffered from flu-like symptoms for two days immediately after the vaccination. The extraoral examination was unremarkable. However, the intraoral examination revealed white papular and striated bilaterally of the buccal mucosa and tongue. A biopsy at the left buccal mucosa was taken, and the histopathological findings confirmed a diagnosis of Oral Lichen planus (OLP, a T-cell-mediated inflammatory disease involving mucocutaneous). Routine serological investigations for hepatitis B, hepatitis C, and HIV were unremarkable. The patient was prescribed a topical steroid, fluocinolone acetonide 0.1% in orabase paste, for two weeks, which significantly improved her symptoms. OLP was previously demonstrated after several vaccines including Janssen's Ad26.COV2.S
A 34-year-old male patient
experienced malaise, high fever, weakness, tender gums, gingival hypertrophy, rashes on the mucous membrane of the oral
cavity and halitosis the day
after receiving the second dose of the Moderna COVID vaccine.
His previous dose was administered 6 months before receiving the second dose without side effects. The patient took no medications, was a nonsmoker and had no history of oral conditions.
Objective examination revealed lesions on the boundary between the Vermilion
border, the mucous membrane and the gingival area of teeth. The gingiva in the area of the anterior teeth was
edematous. The teeth were covered with dental plaque, as the
patient could not brush his teeth due to tender gingiva. The possible differential diagnosis for the lesion included drug-induced conditioned enlargement or undiagnosed systemic disorders
A microbiome study showed that vaccination increased oral bacterial diversity. This, however, is not always beneficial.
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