key: cord-1051617-azualdpx authors: Brandão, Thaís Bianca; Gueiros, Luiz Alcino; Melo, Thayanara Silva; Prado-Ribeiro, Ana Carolina; Boas do Prado, Gladys Villas; Santos-Silva, Alan Roger; Migliorati, Cesar Augusto title: Insights and challenges in the management of oral lesions in COVID-19 patients date: 2021-01-30 journal: Oral Surg Oral Med Oral Pathol Oral Radiol DOI: 10.1016/j.oooo.2021.01.026 sha: d1d5b18d0387f01e57aa6860ac048d44f9a480ab doc_id: 1051617 cord_uid: azualdpx nan The suggestion about using PDT to help the healing of lesions in COVID-19 infected patients has merit. However, it has not yet been investigated. Oral lesions of COVID-19 are currently considered to be uncommon, nonspecific 1 , and mostly characterized by acute onsets secondary to SARS-CoV-2 infection outcomes 2 . In our case series we did not have the opportunity to culture the lesions or show the presence/transcriptional activity of the virus in situ. As stated in our publication, we cannot confirm whether the manifestations were directly related with the virus or other opportunistic agents due to systemic illness affecting the patients 3 . This is being planned for future studies. Our intent was to demonstrate that the COVID-19 infected individuals may develop a variety of oral lesions and, due to the pain associated with the lesions, we aimed to provide support by controlling pain and stimulating wound healing. The suggestion about using PDT in preventive protocols must be studied. One would have to include the entire oral cavity as it cannot be predicted where lesions will develop. That is the reason for using clinical interventions once lesions are established on the mucosa to alleviate pain and stimulate healing. Nevertheless, when the oral cavity lesions develop in the context of COVID-19 they tend to affect multiple oral mucosa sites of patients under mechanical ventilation with endotracheal tube 1,3 , which, in turn, will pose as additional technical challenges for PDT bedside protocols. The aim of the colleagues suggesting to "disinfect the oral cavity" of COVID-19 patients as stated by the authors is being tested currently with the use of mouth rinses that might have antiviral action. The recommendation for new studies using PDT in this context is necessary. For instance, a recent systematic review was unable to confirm the effectiveness of PDT in the treatment of herpetic lesions (cold sores) 4 , which is a much less complex disease entity. We suggest that, according to our initial experience acquired in the management of the reported cases, and with the lack of robust literature, photobiomodulation therapy (PBMT) or other adjuvant treatments should only be employed in COVID-19 patients with symptomatic oral ulcerative lesions that do not respond to conventional therapy. That is what we did 3 . Oral health management has been deeply impacted during the current pandemic because of the high risk of COVID-19 transmission among dentists and patients. Hence, it is important to re-design recommendations to oral medicine and dentists working in the hospital setting on the safe management of oral manifestations in SARS-CoV-2 infected individuals. Protocols must be swift and include safety measures to decrease the risk of transmission by reducing the time of contact with the saliva of contaminated patients 5 . We recommend that Professors Joseph and Prasanth present suggestions to the readers on how they would run the PDT protocol in the above-mentioned challenging scenario, the type of technology indicated, parameters and time of application and whether or not they have clinical experience and results to share. We still have much to learn about the oral manifestations observed in COVID-19 infected individuals and we welcome any type of information that would add to our current knowledge. Sincerely, Oral Manifestations in Patients with COVID-19: A Living Systematic Review Oral mucosal lesions in a COVID-19 patient: New signs or secondary manifestations? Oral lesions in patients with SARS-CoV-2 infection: could the oral cavity be a target organ? Oral Surg Oral Med Oral Pathol Oral Radiol Efficacy of photodynamic therapy on the treatment of herpes labialis: A systematic review Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic 4 Brandão TB, Gueiros LA, Melo TS, Prado-Ribeiro AC, Prado GVB, Santos-Silva AR and Migliorati CA.