Self-Reported Gum Bleeding in COVID-19 Patients: A Questionnaire-Based Study

Background: Coronavirus disease 2019 (COVID-19) has affected a huge number of people around the world. It has increased worldwide mortality and morbidity and is accompanied by different signs and symptoms. Some researchers have linked oral manifestations as introductory signs for COVID-19, such as vesiculobullous lesions, non-specific stomatitis, and oral ulcers. The oral cavity has been perceived as a potential reservoir for asymptomatic COVID-19 infection, specifically the salivary glands and the oral mucosa. This study builds on a previous case report by the authors on COVID-19 associated gingival bleeding in an attempt to investigate the generalization of this relation. Methods: A cross-sectional survey based on a struc­tured, pre-tested, and validated questionnaire that was adapted and modified by the authors was carried out electronically for a minimal sample size of patients that was calculated for this study beforehand. This study was approved by the Batterjee Medical College ethical committee and data collection followed a structured criteria and a clear work plan based on the established inclusion criteria.  Results: The questionnaire had a high response rate of 315 participants. 63.2% (n=199) reported gum bleeding during virus infection time – 25.6% (n=51) of whom reported that this symptom was present prior to COVID-19 infection. 88.9% (n=177) of participants reported only mild bleeding. Gingival bleeding was more prevalent among females 63.8% (n=127) compared to males 36.2% (n=72) (odds ratio: 0.859 [95% CI, 0.530 to 1.394]). Conclusion: Gingival bleeding may be considered as one of the signs of COVID-19 and is a prevalent symptom as reported by infected patients. However, a larger sample size and investigation of hospitalized moderate and severe cases of the disease would help elucidate the actual association.