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    Oral manifestations in young adults infected with COVID-19 and impact of smoking: A multi-country cross-sectional study
    (PeerJ Inc., 2022) Tantawi, Maha El; Sabbagh, Heba Jafar; Alkhateeb, Nada Abubakor; Quritum, Maryam; Abourdan, Joud; Qureshi, Nafeesa; Qureshi, Shabnum; Hamoud, Ahmed; Mahmoud, Nada; Odeh, Ruba; Khanati, Nuraldeen Maher Al; Jaber, Rawiah; Balkhoyor, Abdulrahman Loaie; Shabi, Mohammed; Folayan, Morenike O.; Gomaa, Noha; Nahdi, Raqiya Al; Mahmoud, Nawal; Wazziki, Hanane El; Alnaas, Manal; Samodien, Bahia; Mahmoud, Rawa; Assab, Nour Abu; Saad, Sherin; Al-Hachim, Sondos; Alshaikh, Ali; Abdelaziz, Wafaa
    Background: Oral manifestations and lesions could adversely impact the quality of people's lives. COVID-19 infection may interact with smoking and the impact on oral manifestations is yet to be discovered. Objectives: The aim of this study was to assess the self-reported presence of oral lesions by COVID-19-infected young adults and the differences in the association between oral lesions and COVID-19 infection in smokers and non-smokers. Methods: This cross-sectional multi-country study recruited 18-to-23-year-old adults. A validated questionnaire was used to collect data on COVID-19-infection status, smoking and the presence of oral lesions (dry mouth, change in taste, and others) using an online platform. Multi-level logistic regression was used to assess the associations between the oral lesions and COVID-19 infection; the modifying effect of smoking on the associations. Results: Data was available from 5,342 respondents from 43 countries. Of these, 8.1% reported COVID-19-infection, 42.7% had oral manifestations and 12.3% were smokers. A significantly greater percentage of participants with COVID-19-infection reported dry mouth and change in taste than non-infected participants. Dry mouth (AOR=, 9=xxx) and changed taste (AOR=, 9=xxx) were associated with COVID-19-infection. The association between COVID-19-infection and dry mouth was stronger among smokers than non-smokers (AOR = 1.26 and 1.03, p = 0.09) while the association with change in taste was stronger among non-smokers (AOR = 1.22 and 1.13, p = 0.86). Conclusion: Dry mouth and changed taste may be used as an indicator for COVID-19 infection in low COVID-19-testing environments. Smoking may modify the association between some oral lesions and COVID-19-infection.