Table 1 Summary of previous case reports of delusional infestation with oral manifestation

Maeda [9]

Male

76

Thread emerging from between his teeth, which later evolved into worms

Trial of pimozide, an antipsychotic agent

Ghaffari [3]

Female

31

Lizards, beetles, and crickets infesting the oral cavity

Combination of pimozide and imipramine

Hanihara [14]

Female

64

Oral cavity infested with numerous live worms

Patient treated successfully with sulpiride and amitriptyline

Dovigi [10]

Female

61

Persistent oral lesion with emergence of numerous fibers over a 2-year period. Experienced itching and irritation in the affected area. Later admitted to scratching the site with her fingernail

Oral biopsy performed, showed synthetic polymer fibers

Grosskopf [13]

Female

39

Hair and insects originating from the gingiva causing oral tickling and gingival bleeding

Patient instructed to follow up with a psychiatrist

Davis [11]

Female

66

Dry mouth and parasitic film coating her teeth

An oral surgeon ruled out infection/parasites and diagnosed her with mild gum disease. She was on anti-parkinsonism medications: ropinirole XL (DI symptoms persisted despite discontinuation), and trihexyphenidyl (discontinued to minimize dry mouth). Quetiapine 25 mg/night was ineffective and was replaced with clonazepam 1 mg/night with resolution of symptoms

Ochiai [12]

Female

89

Oral cenesthopathy, which is a feeling of filament structures in her mouth

Combination of donepezil 5 mg/day and aripiprazole 1.5 mg/day

Our case 1

Female

50

Parasitic infection that had worsened in the past 18 months

Referred to PCP¹ and an infectious disease specialist for further evaluation

Our case 2

Male

43

Painful multiple oral lesions with a belief of having active Staphylococcus aureus infection

Oral biopsy showed no specific ulcer. Referral to the PCP¹ was recommended

Our case 3

Male

47

White tongue lesion and self-diagnosis of syphilis

Diagnosis of geographic tongue was made

Our case 4

Female

69

Oral erythema and dryness which she believed were caused by SARS-CoV-22², although not confirmed by a test. She used Lysol^® disinfecting wipe intraorally to clear the infection

Patient was referred to her PCP¹ for further evaluation and management