Table 1.
The summary of the available data on COVID-19 vaccines oral side effects.
| Author | Type of article | Participant(s) receiving vaccines | Vaccine | Dose number | Side effect(s) | Time of onset following vaccination | Healing time | Treatment | Related mechanisms |
|---|---|---|---|---|---|---|---|---|---|
| Azzi et al. [37] | Letter to the editor | A 31‐year‐old woman | ChAdOx1 | First dose | Oral mucositis | 24 hours | 3 days | Topical corticosteroids (i.e., Betamethasone effervescent tablets 1 mg three times per day, with progressive dose reduction) and topical miconazole oral gel 2% | Heterozygous Factor V Leiden mutation as a risk factor, mucosal hypersensitivity and autoimmunity |
| Thongprasom et al. [38] | Letter to the editor | A 38‐year‐old woman | ChAdOx1 | First dose | Oral pemphigus lesion | 1 week | 1 week | a potent topical steroid, fluocinolone acetonide 0.05% mouthwash | - |
| Solimani et al. [16] | Letter to the editor | A 40‐year‐old female | BNT162b2 | First and second dose | Pemphigus vulgaris | 5 days after the first and 3 days after the second dose | - | Oral prednisone (1 mg per kg body weight, eventually tapered) and azathioprine (100 mg/day) | Autoimmunity (molecular mimicry, inflammatory dysregulation, epitope spreading or bystander activation) |
| Kulkarni et al. [39] | Letter to the editor | A 65‐year‐old female patient with multifocal lichen planus | - | First dose | Symptomatic recurrence of multifocal lichen planus | Immediately following the administration | 3 weeks | - | T-cell activation |
| Manfredi et al. [13] | Letter to the editor | A 34-year‐old healthy woman | BNT162b2 | First dose | Diffuse ulcerative lesions on the floor of the mouth, oral erythema, angular cheilitis | 2 days | 15 days | Topical antibacterial agents and moisturizing lip balm | Hypersensitivity due to a cross‐link reaction between Polysorbate 80 and Poly(ethylene glycol) (PEG) |
| Riad et al. [40] | Cross-sectional survey | 522 participants | BNT162b2 | First and second dose | The most common oral side effect was burning or bleeding gingiva (3.3%), followed by blisters (2.1%), ulcers (1.9%), and vesicles (1.5%). | 1–21 days | - | - | The allergy to mRNA-based vaccine ingredients, inflammatory response, direct infiltration of SARS-CoV-2 to the lining epithelium of the oral cavity and secondary infection |
| Young et al. [19] | Case report | A 68‐year‐old man | BNT162b2 | First and second dose | Bullous pemphigoid | 3 days after first dose and 3 weeks after second dose | 3 months after the first dose | Topical treatment of corticosteroids | Age‐induced thymic atrophy and autoimmunity |
| Klugar et al. [15] | Cross-sectional survey | 599 participants | BNT162b2 (386 participants), mRNA-1273 (88 participants) and ChAdOx1 (125 participants) | First and second dose | The most prevalent oral side effect was vesicles (6.3%), followed by bleeding gingiva (4.3%), halitosis (3.7%), oral paranesthesia (2.2%), swollen mucosa (2.2%), and ulcers (2%). | 1 to 28 days (More than three-fourths of oral side effects emerged within the first week after vaccination) |
- | - | - |
| Mazur et al. [35] | Cross-sectional survey | 223 participants |
BNT162b2 (217 participants), ChAdOx1 (5 participants) and mRNA-1273 (1 participants) | First and second dose | No significant correlation between vaccine administration for COVID-19 and facial and oral manifestations was observed. | 1–28 days | - | - | - |
| Riad et al. [41] | Cross-sectional survey | 539 participants | mRNA-based COVID-19 vaccines | First and second dose | Oral paraesthesia (1.3%) was the most common side effect, followed by oral ulcers (1.1%), taste disturbance (0.4%), skin rash (0.4%), and skin eruptions (0.4%). | - | - | - | - |
| Sharda et al. [10] | Letter to the editor | A 35-year-old female | BNT162b2, | - | Oral lichen planus erythematous base lesions with white reticular streaks over them, some of them had erosions |
2 weeks |
- | Short term course of steroids | - |
| Babazadeh et al. [28] | Case report | A 52‐year‐old woman | BBIBP-CorV | Second dose | Oral lichen planus Buccal lesions/ Desquamation of the lips |
1 week | - | Oral antihistamines and topical corticosteroids | The Th1 response is elicited, increase in IL-2, TNF-α, and IFN-γ levels |
| Elboraey et al. [29] | Case report | A middle-aged female | BNT162b2 | Second dose | SJS Large, red-colored bullae at the left retromolar area Whitish-yellow patches all over the tongue dorsal surface and upper and lower lips Multiple large ulcers at the buccal mucosa, labial mucosa, tongue, and palate |
5 days | - | Mouthwash corticosteroids with addition of triamcinolone acetonide to 100 mL of sterile saline | Specific drugs stimulate immune cells such as cytotoxic T cells and natural killer cells that secrete granulysin, which destroys cells in the skin and mucous membrane by dysregulation of specific transmembrane protein pathways |
| Dash et al. [30] | Case report | A 60‐year‐old male | - | First dose | SJS Hemorrhagic crusting lesions over the lips, epidermal keratinocyte necrosis. |
3 days | 7 days | Oral cyclosporine 300 mg | Virotpes of the vaccine has been believed to cause SJS. CD8+ T-lymphocyte response against epidermal cells causes apoptosis of keratinocytes and detachment of dermo-epidermal junction |
| Tagini et al. [32] | Letter to the editor | A woman in her late 20s | mRNA-1273 | Second dose | Inaugural BD or a BD-like adverse event Painful oral ulcers |
15 days | - | Colchicine 2 × 0.5mg/day Prednisone 1 mg/kg/day At the 1.5-month follow-up visit, azathioprine and acetazolamide were added to her treatment due to persistent papillary edema and intracranial hypertension findings. |
- |
| Foster et al. [25] | Letter to the editor | A 17‐year‐old female with acute lymphoblastic leukemia (ALL) and a 20‐year‐old male with relapsed ALL |
BNT162b2 | First and second dose | VZV reactivation, a cluster of fluid-filled lesions on the face Oral lesions and a right-sided facial droop |
In first case, 2 and 5 days following the first and second dose, respectively. In the second case, 17 days after his second dose. |
7 days for the second case | 2 week course of intravenous acyclovir transitioned to oral valacyclovir, for the first case. A 2-week course of valacyclovir with a steroid taper, in second case. |
A reduction in lymphocytes, especially CD3+ CD8+ lymphocytes, which can occur during infection with SARS‐CoV‐2, has been proposed as a potential mechanism triggering reactivation of herpesviruses. |
| Fukuoka H., et al. [26] | Report of five cases | Five Japanese patients (four females and one male), whose age range was 59–97 years |
BNT162b2 | First and second dose | Oral herpes zoster Unilateral acute rash |
Ranged from 1–3 weeks | - | Four patients did not receive any treatment for their oral HZ, but one patient also had skin reactions on her right orbit and ear and was thus treated with an antiviral drug. |
- |