BACKGROUND: Oral adverse events (AEs) following COVID-19 vaccination have been sporadically reported during the previous months, warranting further investigation for their prevalence and suspected relationship with vaccine-elicited immune response. METHODS: A retrospective analysis using the Vaccine Adverse Event Reporting System (VAERS) data was conducted to evaluate AEs within the oral cavity (mucosa, tongue, lips, palate, dentition, salivary glands) and AEs involving taste and other sensations. Oral AEs reported after receiving COVID-19 vaccination (test group) and seasonal influenza vaccination (control group) were extracted and cross-tabulated to assess their relative prevalence. RESULTS: Among the 128 solicited (suspected) oral AEs, oral paresthesia (0.872%) was most reported after receiving COVID-19 vaccines, followed by the swelling of lips (0.844%), ageusia (0.722%), oral hypoesthesia (0.648%), swollen tongue (0.628%), and dysgeusia (0.617%). The reported prevalence of oral AEs was higher in the COVID-19 vaccine group than in the seasonal influenza group. The distribution pattern of the most reported oral AEs was similar for both COVID-19 and seasonal influenza vaccines. Female sex, older age (>39 years old), primer doses, and mRNA-based COVID-19 vaccines exhibited a higher reported prevalence of oral AEs. CONCLUSION: Within the limitations of this study, COVID-19 vaccines were found to be associated with rare oral AEs that are predominantly similar to those emerging following seasonal influenza vaccines. The most commonly reported oral AEs were oral paraesthesia (mouth-tingling), lip swelling, and ageusia, representing various pathophysiologic pathways that remain unclear. Taste-related AEs should be acknowledged in the context of the COVID-19 pandemic and the public should be adequately informed about a potential taste dysfunction after receiving the COVID-19 vaccination. Dentists and dental teams need to be aware of the prevalence, severity, and prognosis of oral AEs to inform their patients and increase public confidence in vaccines.

Department of Oral and Maxillofacial Surgery Justus Liebig University Giessen Germany

Department of Oral Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany

Department of Public Health Faculty of Medicine Masaryk University Brno Czechia

Oral Health Research and Promotion Unit Al Quds University Jerusalem Palestine

Public Policy Center The University of Iowa Iowa City IA United States

Zobrazit více v PubMed

Santos JA, Normando AGC, Silva RLC, Acevedo AC, Canto GDL, Sugaya N, et al. . Oral manifestations in patients with COVID-19: a 6-month update. J Dent Res. (2021) 100:1321–9. 10.1177/00220345211029637 PubMed DOI

Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. (2020) 99:481–7. 10.1177/0022034520914246 PubMed DOI PMC

Machingaidze S, Wiysonge CS. Understanding COVID-19 vaccine hesitancy. Nat Med. (2021) 27:1338–9. 10.1038/s41591-021-01459-7 PubMed DOI

Chun Y, Jang J, Jo JH, Park JW. Various painful oral adverse reactions following COVID-19 vaccination: a case series. BMC Oral Health. (2022) 22:64. 10.1186/s12903-022-02100-w PubMed DOI PMC

CDC . CDC Wonder. Vaccine Advers Event Report System. CDC (2022). Available online at: https://wonder.cdc.gov/controller/datarequest/D8 (accessed May 25, 2022).

ICH . MedDRA Hierarchy. Medical Dictionary Regulation Activites. ICH (2022). Available online at: https://www.meddra.org/how-to-use/basics/hierarchy (accessed May 25, 2022).

CDC . Similarities and Differences between Flu and COVID-19. Influenza (2022). Available online at: https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm (accessed May 25, 2022).

CIA . United States. World Factb. CIA (2022). Available online at: https://www.cia.gov/the-world-factbook/countries/united-states/ (accessed May 25, 2022).

Cohen SR, Gao DX, Kahn JS, Rosmarin D. Comparison of constitutional and dermatologic side effects between COVID-19 and non-COVID-19 vaccines: review of a publicly available database of vaccine side effects. J Am Acad Dermatol. (2022) 86:248–9. 10.1016/j.jaad.2021.09.044 PubMed DOI PMC

Montano D. Frequency and associations of adverse reactions of COVID-19 Vaccines reported to pharmacovigilance systems in the European Union and the United States. Front Public Health. (2022) 9:2237. 10.3389/fpubh.2021.756633 PubMed DOI PMC

Riad A, Abdulqader H, Morgado M, Domnori S, Koščík M, Mendes JJ, et al. . Global prevalence and drivers of dental students' COVID-19 vaccine hesitancy. Vaccines. (2021) 9:566. 10.3390/vaccines9060566 PubMed DOI PMC

CDC . Symptoms of COVID-19. CDC (2022). Available online at: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html (accessed May 10, 2022).

Hannum ME, Koch RJ, Ramirez VA, Marks SS, Toskala AK, Herriman RD, et al. . Taste loss as a distinct symptom of COVID-19: a systematic review and meta-analysis. Chem Senses. (2022) 47:bjac001. 10.1093/chemse/bjac001 PubMed DOI PMC

Aziz M, Goyal H, Haghbin H, Lee-Smith WM, Gajendran M, Perisetti A. The association of “loss of smell” to COVID-19: a systematic review and meta-analysis. Am J Med Sci. (2021) 361:216–25. 10.1016/j.amjms.2020.09.017 PubMed DOI PMC

Alhaidari F, Almuhaideb A, Alsunaidi S, Ibrahim N, Aslam N, Khan IU, et al. . E-Triage systems for COVID-19 outbreak: review and recommendations. Sensors. (2021) 21:2845. 10.3390/s21082845 PubMed DOI PMC

Lechien JR, Diallo AO, Dachy B, Le Bon SD, Maniaci A, Vaira LA, et al. . COVID-19: post-vaccine smell and taste disorders: report of 6 cases: Ear Nose Throat J. (2021) 1:01455613211033125. 10.1177/01455613211033125 PubMed DOI

Alkhotani AM, Alsindi TS, Alqurashi AA, Masarit RM, Gazzaz RT, Saggat RZ, et al. . Public awareness of the neurological manifestation of COVID-19 in Saudi Arabia. Neurosci J. (2022) 27:10–5. 10.17712/nsj.2022.1.20210089 PubMed DOI PMC

Aldrees T, Almatrafi S, Aldriweesh T, Mokhatrish M, Salamh A, Alkholaiwi F. Medical students' awareness of smell loss as a predictor for Coronavirus disease 2019. Front Public Health. (2020) 8:863. 10.3389/fpubh.2020.597897 PubMed DOI PMC

Riad A, Pokorná A, Attia S, Klugarová J, Koščík M, Klugar M. Prevalence of COVID-19 vaccine side effects among healthcare workers in the Czech Republic. J Clin Med. (2021) 10:1428. 10.3390/jcm10071428 PubMed DOI PMC

Mazur M, Duś-Ilnicka I, Jedliński M, Ndokaj A, Janiszewska-Olszowska J, Ardan R, et al. . Facial and oral manifestations following COVID-19 vaccination: a survey-based study and a first perspective. Int J Environ Res Public Health. (2021) 18:4965. 10.3390/ijerph18094965 PubMed DOI PMC

Riad A, Hocková B, Kantorová L, Slávik R, Spurná L, Stebel A, et al. . Side effects of mRNA-based COVID-19 vaccine: nationwide phase IV study among healthcare workers in Slovakia. Pharm. (2021) 14:873. 10.3390/ph14090873 PubMed DOI PMC

Lapić I, Šegulja D, Rogić D. Assessment of salivary antibody response to BNT162b2 mRNA COVID-19 vaccination. J Med Virol. (2021) 93:5257–9. 10.1002/jmv.27096 PubMed DOI PMC

Azzi L, Dalla Gasperina D, Veronesi G, Shallak M, Ietto G, Iovino D, et al. . Mucosal immune response in BNT162b2 COVID-19 vaccine recipients. eBioMedicine. (2022) 75:103788. 10.1016/j.ebiom.2021.103788 PubMed DOI PMC

Maltezou HC, Anastassopoulou C, Hatziantoniou S, Poland GA, Tsakris A. Anaphylaxis rates associated with COVID-19 vaccines are comparable to those of other vaccines. Vaccine. (2022) 40:183–6. 10.1016/j.vaccine.2021.11.066 PubMed DOI PMC

Shimabukuro T, Nair N. Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine. JAMA. (2021) 325:780–1. 10.1001/jama.2021.0600 PubMed DOI PMC

CDC . Allergic reactions including anaphylaxis after receipt of the first dose of moderna COVID-19 vaccine — United States, December 21, 2020–January 10, 2021. Morb Mortal Wkly Rep. (2021) 21:1326–31. 10.1111/ajt.16517 PubMed DOI PMC

Somiya M, Mine S, Yasukawa K, Ikeda S. Sex differences in the incidence of anaphylaxis to LNP-mRNA COVID-19 vaccines. Vaccine. (2021) 39:3313. 10.1016/j.vaccine.2021.04.066 PubMed DOI PMC

Yang Q, Jacobs TM, McCallen JD, Moore DT, Huckaby JT, Edelstein JN, et al. . Analysis of pre-existing IgG and IgM antibodies against polyethylene glycol (PEG) in the general population. Anal Chem. (2016) 88:11804–12. 10.1021/acs.analchem.6b03437 PubMed DOI PMC

EMA . Assessment Report: COVID-19 Vaccine Moderna. Union Register Medicinal Products (2021). Available online at: https://ec.europa.eu/health/documents/community-register/html/h1507.htm (accessed May 25, 2022).

ASCIA . Allergy, Immunodeficiency, Autoimmunity and COVID-19 Vaccination Frequently Asked Questions (FAQ). COVID-19 Vaccin FAQ (2022). Available online at: https://www.allergy.org.au/patients/ascia-covid-19-vaccination-faq (accessed May 25, 2022).

Troeltzsch M, Gogl M, Berndt R, Troeltzsch M. Oral lichen planus following the administration of vector-based COVID-19 vaccine (Ad26.COV2.S). Oral Dis. (2021). 10.1111/odi.14025 PubMed DOI PMC

Kaomongkolgit R, Sawangarun W. Oral lichen planus following mRNA COVID-19 vaccination. Oral Dis. (2022). 10.1111/odi.14182 PubMed DOI PMC

Raccampo L, Sembronio S, Tel A, Veronica C, Robiony M. Oral lichen planus arising after BNT162b2 mRNA COVID-19 vaccine: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol. (2022). 10.1016/j.oooo.2022.04.003 PubMed DOI PMC

Hertel M, Schmidt-Westhausen A-M, Wendy S, Heiland M, Nahles S, Preissner R, et al. . Onset of oral lichenoid lesions and oral lichen planus following COVID-19 vaccination: a retrospective analysis of about 300,000 vaccinated patients. Vaccines. (2022) 10:480. 10.3390/vaccines10030480 PubMed DOI PMC

Li C, Tang X, Zheng X, Ge S, Wen H, Lin X, et al. . Global prevalence and incidence estimates of oral lichen planus: a systematic review and meta-analysis. JAMA Dermatology. (2020) 156:172. 10.1001/jamadermatol.2019.3797 PubMed DOI PMC

Fukuoka H, Fukuoka N, Kibe T, Tubbs RS, Iwanaga J. Oral herpes zoster infection following COVID-19 vaccination: a report of five cases. Cureus. (2021) 13:e19433. 10.7759/cureus.19433 PubMed DOI PMC

Iwanaga J, Fukuoka H, Fukuoka N, Yutori H, Ibaragi S, Tubbs RS. A narrative review and clinical anatomy of herpes zoster infection following COVID-19 vaccination. Clin Anat. (2022) 35:45–51. 10.1002/ca.23790 PubMed DOI PMC

McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of Herpes Simplex Virus Type 1 Type 2 in Persons Aged 14–49: United States, 2015–2016. National Center Health Statistics Data Briefs (2018). Available online at: https://www.cdc.gov/nchs/products/databriefs/db304.htm (accessed May 10, 2022). PubMed

Maeda K, Yamashita D, Takenobu T. Ulcers on the bilateral palate mucosa following mRNA-based vaccination for coronavirus disease 2019 (COVID-19): a case report. J Stomatol Oral Maxillofac Surg. (2022) 123:283–6. 10.1016/j.jormas.2022.01.013 PubMed DOI PMC

Kim HK, Kim ME. A case of aphthous stomatitis in a healthy adult following COVID-19 vaccination: clinical reasoning. J Oral Med Pain. (2022) 47:62–6. 10.14476/jomp.2022.47.1.62 DOI

Oral adverse events following COVID-19 and influenza vaccination in Australia