Oral Symptoms Common in Children With COVID-Linked Inflammatory Disorder MIS-C

February 22, 2021

Although children infected with COVID-19 typically have mild or no symptoms, a small percentage have developed a condition known as multisystem inflammatory syndrome in children, or MIS-C. As its name suggests, MIS-C affects multiple organ systems—the mouth being one such system—and in some cases is severe enough to warrant hospitalization.

Faculty and residents at Columbia University College of Dental Medicine (CDM) sought to characterize oral issues linked to MIS-C by cataloging symptoms in the mouth and throat. Their study, published in the March 2021 issue of the Journal of the American Dental Association, reports oral or oropharyngeal symptoms in about half of the 47 MIS-C cases examined.

To collect symptom data, the authors reviewed the medical charts of patients diagnosed with MIS-C and treated at Morgan Stanley Children’s Hospital of New York between March 15 and June 1, 2020. Their analysis found that 55% of MIS-C patients experienced symptoms in the mouth or throat, including red or swollen lips in nearly half of all patients. Other changes such as lesions, redness in the inner cheek, and strawberry tongue were present in some individuals but were less common. Patients with oral symptoms were more likely to have general systemic symptoms such as rashes and fever.

MIS-C is often compared to Kawasaki disease, a similar inflammatory condition known to affect children. Because Kawasaki disease has notable oral features, the team thought to look closely at the symptoms of MIS-C; the researchers hoped that their findings could help with early diagnosis and management, said Scott Peters, DDS, assistant professor of dental medicine at CUMC and senior author on the paper.

Although limited by a small sample size, the research is valuable as a pilot study that demonstrates a relationship, said CDM resident and coauthor Kevin Lee, DDS, MD. “It raises a lot of questions about what this means for COVID and COVID management.” Looking forward, he said, “we want to learn the significance of these oral manifestations.”

Even as COVID-19 vaccines become widely administered, research around MIS-C will remain relevant for months to come, said coauthor and resident Steven Halepas, DMD. As of December 2020, he said, “the vaccines aren’t approved for anyone under 16, so it’s still going to be really important for this population.”

More directly, dental providers can offer guidance to primary care teams—for MIS-C and many other illnesses—said Peters. “Especially when patients are presenting with nonspecific or subtle oral lesions, we can certainly help in providing clarification and recommendations in terms of management and treatment. We are here as a resource.”


The study is titled “Oral manifestations of COVID-19 related multi-system inflammatory syndrome in children: a review of 47 pediatric patients.”

Other authors: Aaron Myers (CDM), Richard K. Yoon (CDM), and Wendy Chung (Vagelos College of Physicians and Surgeons).

The authors declare no financial or other conflicts of interest.