In the late 2019, Doctors at Wuhan hospitals received for the first-time cases with unusual viral pneumonia. Clusters of patients with viral pneumonia and acute respiratory distress syndrome (ARDS) were falling every day in China. The symptoms of the disease were quite variant between infected persons and the course of the disease was unclear. The unknown virus was discovered. Corona virus-19. A member of the Corona viruses that has never caused infection in Human before. The structural homology between the new virus and the severe acute respiratory syndrome (SARS) orm CoV-SARS-1 has given it the name CoV-SARS-2 [1]
In no time the disease was all-over the world. This event was the most fetal pandemic crisis since the influenza outbreak in 1918. The number of patients around the world was tremendously increasing. In many countries, the medical condition was fearful and seemed to be out of control [2]. Doctors were facing an unknown enemy. In 2020 The world health organization (WHO) declared a pandemic disease [3].
Scientist all over the world were working day and night to record, observe and analyze each symptom of the disease, as well as recognizing the mutated versions and structure of the virus. Although, in absence of clear pathogenesis this was impossible. In 2019 Chen and colleagues published the structural analysis of receptor binding illustrating the binding of the viral spike to Angiotensin convertase enzyme-2 (ACE-2) [4]. In 2020 Walls and his coresearchers introduced the antigenicity of SARS-CoV-2 spike glycoprotein and confirming the binding to the ACE-2 [5]. Although the ACE-2 receptor expression is higher in the lung tissue being the major target of the disease, and despite that the expression in many other tissues such as renal tissues and gastro-intestinal mucosa and oral mucosa may justify the wide array of symptoms in different individuals, the answer to the question why certain people show symptoms that are not evident for all others is unknown [6–7].
The suggestion of oral manifestations of the disease was introduced and with viral outbreak the demand of oral specialist aid was increasing [8–9].
The oral manifestations of COVID-19 were discussed in many articles representing different researches, most of them are case-reports and retrospective studies.
Trials have been made to answer the question whether these symptoms were due to Co-infections [7] or due to direct infection with the virus [10]. The presence of the virus in the salivary secretions raised many questions whether if the oral mucosa is a target of the virus [11].
As many questions were raised, COVID-19 became a hot topic for publication. The race to introduce new information affected both, the quality of the studies and the publication process as well. Contradiction was present between many of the published articles [12–13]. Many articles were withdrawn after publication due to methodological errors.
What are the oral signs and symptoms that a patient is having during the disease and how to manage these manifestations, these questions must have an accurate answer. With unclear prognostic factors and death rate of 4 to 5% the development of prospective oral screening studies to find out the nature of these symptoms was almost impossible [14–15].
Designing proper research in short time was a challenge. Surveys have been developed with different designs to investigate the nature of oral signs and symptoms avoiding direct contact with the patient during active infection [16]. Patient shaping of their symptoms was extremely variable [17]. Selection of COVID-19 patients of certain population with fair knowledge about the oral lesions, signs and symptoms of specific oral infections was a possible option. Based on the previous observation this survey study targeted doctors who were infected with COVID-19 to investigate the nature of oral manifestations of the disease.