LAUSR

The ACE-2 receptor is abundantly expressed on the epithelial cells of the salivary glands, and when infected by SARSCoV2, these receptors are over expressed [1]. It is speculated that signaling of the ACE-2 receptor by the virus triggers a cascade of inflammatory processes, ending in acute and chronic sialoadenitis and causing disruption in salivary secretion and dry mouth [2, 3]. However, there is a dearth of information on the extent of the association between COVID-19 and dry mouth. Most of the existing literature is comprised of individual case reports or surveys reporting on symptoms from COVID -19 patients [4, 5]. It was suggested that the reported xerostomia is caused by fibrosis repairment [4] or due to the neuroinvasive and neurotropism potential of SARS-CoV-2 [6]. COVID -19 is an infectious disease with a strong inflammatory response as demonstrated by the phenomenon of “cytokines storm” [7]; therefore, it is intriguing to speculate that the reports on positive SSA antibodies in these patients [8, 9] may indicate the existence of autoimmune inflammatory response similar to the one described in Sjogren’s syndrome [10, 11] that can result in dry mouth as well. The purpose of the present study was to evaluate the prevalence of the association between COVID-19 and dry mouth in Sicca and non-Sicca patients, as well as to evaluate the association between SSA and COVID-19 and CRP and COVID-19. The study was exempted by the University of Florida Institutional Review Board (IRB). We used the University of Florida Health Center Integrated Data i2b2 provided by the University of Florida Health Office of the Chief Data Officer for the period of June 2015– September 2020. Diagnoses of COVID-19 (ICD10 U07.1), Sicca syndrome ( ICD10 M35.0), Dry mouth (ICD10, R62.8), positive SSA antibody (CPT 86235), elevated CRP (CPT 86140), and total hospital population by age and sex were searched by using the appropriate international classification of diseases (ICD 10). The total hospital population was 987849 patients, 46% male and 54% females. From 889 patients that were diagnosed with COVID-19, 43% were male and 57% were females. A total of 1772 (0.18%) of patients were diagnosed with dry mouth, 30% were males and 70% females. Nine patients (1.01%) were diagnosed with both COVID-19 and dry mouth. Most of the patients were adults and 100% of both COVID-19 and dry mouth were adults (Table 1). The OR for COVID-19 with dry mouth was 5.153 (95%CI 2.9220 to 10.9008, p < 0.001). The OR for COVID-19 in the presence of Sicca syndrome dry mouth was 2.01, not statistically significant (0.7525 to 5.3753, p = 0.1636). The OR for COVID-19 in the presence of non-Sicca dry mouth was 3.5661 (95% CI 1.4786 to 8.6009, p = 0.0046) (Table 2). The OR for COVID-19 in the presence of positive SSA was 2.2519 (95% CI 1.2418 to 4.0835, p = 0.0075. The OR for COVID-19 in the presence of elevated CRP was 4.3237 (95% CI 2.0523 to 9.1091, p < 0.0001) (Table 3).