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Abstract
The ACE2 receptor, the binding sites for the COVID-19, is expressed abundantly in
the oral cavity, raising the question of whether the mouth is a target for the virus
in addition to organs such as kidneys and lungs. Recently, a flurry of individual
case reports on oral manifestation of COVID-19 including ulceration, blistering lesions,
and stomatitis were published. However, it is not clear whether the oral presentations
that are not unique to the virus are indeed related to the virus and appear at a higher
prevalence than in the general population. We used the i2b2 platform of hospital patient's
registry to determine the odds ratio for COVID-19 in patients that were diagnosed
with recurrent aphthous stomatitis, an entity restricted to the oral cavity. The overall
odds ratio for COVID-19 in patients with recurrent aphthous stomatitis before adjustments
was 14 and after adjustment for gender, race, and age was 13.9, 6.5, and 2.93, respectively.
The odds ratio remained increased after adjustments of the comorbidities such as respiratory
disease, endocrine disease, obesity, diabetes, circulatory disease, and smoking and
was 3.66, 7.46, 4.6, 10.54, 7.37, and 7.52, respectively. When adjusted for recurrent
aphthous stomatitis, the respiratory disease had an odd ratio of 8.56 to be associated
with COVID-19. African American race and age-group 18-34 were additional significant
risk factors. The present study has demonstrated a significant association between
COVID-19 and RAS; however, additional longitudinal and laboratory studies are necessary
to establish a cause and effect relationship between these 2 conditions.