LETTER TO THE EDITOR

Dear Editor We recently attended an informative webinar organised by the British Society of Paediatric Dentistry (BSPD) on Covid-19 in children and the hyperinflammatory response. It was delivered by Dr Julia Kenny, Consultant in Paediatric Infectious Diseases and Immunology at Evelina London Children’s Hospital (ELCH). Although the majority of children with Covid-19 exhibit mild symptoms or are asymptomatic, recent evidence has been published regarding a Covid-19-associated syndrome in children. Over a six-week period during the initial wave of the pandemic, a small influx of patients were admitted to the paediatric intensive care unit at ELCH. These patients presented with a history of fever and many suffered gastrointestinal symptoms such as diarrhoea, vomiting and abdominal pain, and shared common features with Kawasaki disease. The patients had high inflammatory markers and multisystem involvement including cardiac, renal and neurological manifestations. Microbiological investigation of these patients did not reveal any pathogenic cause. There was a mixture of positive and negative results to SARS-CoV-2 PCR testing in these patients; however, a significant proportion were positive for IgG antibodies against SARS-CoV-2. The atypical presentation of these patients prompted multiple consultations with international bodies. The condition was later termed paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). It has been reported that some children with PIMS-TS also presented with oral manifestations such as mucositis, swelling of the lips, cracked lips and oral ulceration. Although the exact link between PIMS-TS and oral characteristics has not been determined, we feel that it is important for dental care professionals to be aware of this evolving condition, as it is possible that children may present to dental appointments with similar oral manifestations and symptoms. Guidance has been published by The Royal College of Paediatrics and Child Health1 regarding the presentation and management of these patients. Although this is not directly aimed at dentists, we feel it is useful to be aware of it, should further management be required of a potential dental patient.

Yours faithfully A. Shah, E. Holden Guy’s and St Thomas’ NHS Foundation Trust, London

Reference

1. Royal College of Paediatrics and Child Health. Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. 2020. Available from: https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatricmultisystem-%20inflammatory%20syndrome-20200501.pdf.