Prevalence and risk of oral adverse outcomes in patients with COVID-19: a retrospective real-world cohort study.

BACKGROUND

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, affects multiple systems, including the oral cavity, with ulcers, taste changes, and mucosal lesions. Existing studies are limited in scope, highlighting the need for large-scale studies to clarify the prevalence and clinical relevance of these oral outcomes.

MATERIALS AND

METHODS

We conducted a retrospective cohort study using the TriNetX Research Network to analyze COVID-19 patients from 2020 to 2025. Queried oral conditions, including ulcers, taste alterations, salivary disturbances, and mucosal lesions. Propensity score matching was used to balance age, sex, and comorbidities. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with significance set at P < .05.

RESULTS

Among 4,875,258 adults with COVID-19, the most common oral outcomes were taste alteration (0.588%), aphthous ulcers (0.106%), salivary disturbances (0.053%), and stomatitis (0.025%). Compared with age, sex, and co-morbid matched controls, COVID-19 was associated with a higher risk of taste alteration (OR = 10.11; P < .0001) and herpetic oral lesions (OR = 1.46; P < .0001), while other oral conditions were less frequent. Anti-COVID-19 medication use was associated with a lower incidence of taste alteration (0.14% vs 0.54%; P < .0001) and higher records of aphthous ulcers and herpetic lesions.

CONCLUSION

COVID-19 is associated with a significantly increased risk of taste alteration and herpetic oral lesions, while anti-COVID-19 medication use is associated with lower odds of taste alteration.