PDF herunterladen
CC BY 4.0 · Eur J Dent 2023; 17(02): 310-318
DOI: 10.1055/s-0042-1757909
Review Article

The Oral Cavity Potentially Serving as a Reservoir for SARS-CoV-2 but Not Necessarily Facilitating the Spread of COVID-19 in Dental Practice

Hironori Tsuchiya
1   Department of Dental Basic Education, Asahi University School of Dentistry, Mizuho, Gifu, Japan
› Institutsangaben Funding This study was supported by JSPS KAKENHI grant number 20K10152.
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Intraoral tissues, secretions, and microenvironments may provide severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with the conditions necessary for viral cellular entry and inhabitation. The aim of the present study is to overview the oral cavity that potentially serves as a reservoir for SARS-CoV-2, and then discuss the possibility that such oral cavity facilitates the spread of coronavirus disease 2019 (COVID-19) in dental practice. Articles were retrieved from PubMed/Medline, LitCovid, ProQuest, Google Scholar, and preprint medRxiv databases. Results of the literature search indicated that SARS-CoV-2 host cell entry-relevant receptor and virus/cell membrane fusion mediators are expressed in major and minor salivary glands, tongue, taste bud, periodontal tissue, and dental pulp, which would be a target and reservoir for SARS-CoV-2. SARS-CoV-2 is present in saliva and gingival crevicular fluid of COVID-19 patients. These secretions would contaminate dental aerosol and droplet with SARS-CoV-2. SARS-CoV-2 inhabits periodontal pocket, gingival sulcus, and dental caries lesion, which could provide SARS-CoV-2 with a habitat. SARS-CoV-2 ribonucleic acid is preserved in dental calculus, which may inform of the previous infection with SARS-CoV-2. Despite involvement of the oral cavity in SARS-CoV-2 transmission and infection, to date, there have been no clusters of COVID-19 in dental practice. Dental settings are much less likely to facilitate the spread of COVID-19 compared with general medical settings, which may be explained by the situation of dentistry that the number of patients to visit dental offices/clinics was decreased during the COVID-19 pandemic, the characteristics of dentistry that dental professionals have maintained high awareness of viral infection prevention, adhered to a strict protocol for infection control, and been using personal protective equipment for a long time, the experimental results that dental devices generate only small amounts of aerosol responsible for the airborne viral transmission, irrigant from the dental unit contributes to the aerosol microbiota much rather than saliva, and the commonly used evacuation or suction system effectively reduces aerosol and droplet generation, and the possibility that human saliva exhibits the antiviral activity and the property to inhibit SARS-CoV-2 infection. It is considered that dental treatment and oral health care can be delivered safely in the COVID-19 era.

Keywords

oral cavity - SARS-CoV-2 reservoir - COVID-19 spread - dental practice - aerosol transmission


Publikationsverlauf

Artikel online veröffentlicht:
20. Dezember 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Johns Hopkins University & Medicine Coronavirus Resource Center Website. . Accessed August 15, 2022, at: https://coronavirus.jhu.edu/map.html
  • 2 Tonkaboni A, Amirzade-Iranaq MH, Ziaei H, Ather A. Impact of COVID-19 on dentistry. Adv Exp Med Biol 2021; 1318: 623-636
    CrossrefPubMedGoogle Scholar
  • 3 Melo Neto CLM, Bannwart LC, de Melo Moreno AL, Goiato MC. SARS-CoV-2 and dentistry–review. Eur J Dent 2020; 14 (S 01): S130-S139
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 4 Troeltzsch M, Berndt R, Troeltzsch M. Is the oral cavity a reservoir for prolonged SARS-CoV-2 shedding?. Med Hypotheses 2021; 146: 110419
    CrossrefPubMedGoogle Scholar
  • 5 Jackson CB, Farzan M, Chen B, Choe H. Mechanisms of SARS-CoV-2 entry into cells. Nat Rev Mol Cell Biol 2022; 23 (01) 3-20
    CrossrefPubMedGoogle Scholar
  • 6 Hoffmann M, Kleine-Weber H, Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181 (02) 271-280.e8
    CrossrefPubMedGoogle Scholar
  • 7 Tsuchiya H. Characterization and pathogenic speculation of xerostomia associated with COVID-19: a narrative review. Dent J 2021; 9 (11) 130
    CrossrefPubMedGoogle Scholar
  • 8 Sakaguchi W, Kubota N, Shimizu T. et al. Existence of SARS-CoV-2 entry molecules in the oral cavity. Int J Mol Sci 2020; 21 (17) 6000
    CrossrefPubMedGoogle Scholar
  • 9 Yoshimura K, Toya S, Okada Y. Morphological analysis of angiotensin-converting enzyme 2 expression in the salivary glands and associated tissues. J Hard Tissue Biol 2021; 30 (03) 265-272
    CrossrefGoogle Scholar
  • 10 Zhu F, Zhong Y, Ji H. et al. ACE2 and TMPRSS2 in human saliva can adsorb to the oral mucosal epithelium. J Anat 2022; 240 (02) 398-409
    CrossrefPubMedGoogle Scholar
  • 11 Matuck BF, Dolhnikoff M, Duarte-Neto AN. et al. Salivary glands are a target for SARS-CoV-2: a source for saliva contamination. J Pathol 2021; 254 (03) 239-243
    CrossrefPubMedGoogle Scholar
  • 12 Huang N, Pérez P, Kato T. et al; SARS-CoV-2 infection of the oral cavity and saliva. Nat Med 2021; 27 (05) 892-903
    CrossrefPubMedGoogle Scholar
  • 13 Tsuchiya H. Gustatory and saliva secretory dysfunctions in COVID-19 patients with zinc deficiency. Life (Basel) 2022; 12 (03) 353
    Google Scholar
  • 14 To KK, Tsang OT, Yip CC. et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis 2020; 71 (15) 841-843
    CrossrefPubMedGoogle Scholar
  • 15 Tutuncu EE, Ozgur D, Karamese M. Saliva samples for detection of SARS-CoV-2 in mildly symptomatic and asymptomatic patients. J Med Virol 2021; 93 (05) 2932-2937
    CrossrefPubMedGoogle Scholar
  • 16 Beyene GT, Alemu F, Kebede ES. et al. Saliva is superior over nasopharyngeal swab for detecting SARS-CoV2 in COVID-19 patients. Sci Rep 2021; 11 (01) 22640
    CrossrefPubMedGoogle Scholar
  • 17 King KL, Wilson S, Napolitano JM. et al. SARS-CoV-2 variants of concern Alpha and Delta show increased viral load in saliva. PLoS One 2022; 17 (05) e0267750
    CrossrefPubMedGoogle Scholar
  • 18 Chaudhary P, Melkonyan A, Meethil A. et al. Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load: a randomized controlled trial. J Am Dent Assoc 2021; 152 (11) 903-908
    CrossrefPubMedGoogle Scholar
  • 19 Xu J, Li Y, Gan F, Du Y, Yao Y. Salivary glands: potential reservoirs for COVID-19 asymptomatic infection. J Dent Res 2020; 99 (08) 989
    CrossrefPubMedGoogle Scholar
  • 20 Yang JR, Deng DT, Wu N, Yang B, Li HJ, Pan XB. Persistent viral RNA positivity during the recovery period of a patient with SARS-CoV-2 infection. J Med Virol 2020; 92 (09) 1681-1683
    CrossrefPubMedGoogle Scholar
  • 21 Xu H, Zhong L, Deng J. et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020; 12 (01) 8
    CrossrefPubMedGoogle Scholar
  • 22 Park GC, Bang SY, Lee HW. et al. ACE2 and TMPRSS2 immunolocalization and oral manifestations of COVID-19. Oral Dis 2022; ; 28 Suppl 2:2456-2464 DOI: 10.1111/odi.14126.
    CrossrefPubMedGoogle Scholar
  • 23 Doyle ME, Appleton A, Liu QR, Yao Q, Mazucanti CH, Egan JM. Human type II taste cells express angiotensin-converting enzyme 2 and are infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Am J Pathol 2021; 191 (09) 1511-1519
    CrossrefPubMedGoogle Scholar
  • 24 Zhong M, Lin B, Pathak JL. et al. ACE2 and furin expressions in oral epithelial cells possibly facilitate COVID-19 infection via respiratory and fecal-oral routes. Front Med (Lausanne) 2020; 7: 580796
    CrossrefPubMedGoogle Scholar
  • 25 Almeida-da-Silva CLC, Matshik Dakafay H, Liu K, Ojcius DM. Cigarette smoke stimulates SARS-CoV-2 internalization by activating AhR and increasing ACE2 expression in human gingival epithelial cells. Int J Mol Sci 2021; 22 (14) 7669
    CrossrefPubMedGoogle Scholar
  • 26 Okui T, Matsuda Y, Karino M, Hideshima K, Kanno T. Oral mucosa could be an infectious target of SARS-CoV-2. Healthcare (Basel) 2021; 9 (08) 1068
    CrossrefPubMedGoogle Scholar
  • 27 Ohnishi T, Nakamura T, Shima K, Noguchi K, Chiba N, Matsuguchi T. Periodontitis promotes the expression of gingival transmembrane serine protease 2 (TMPRSS2), a priming protease for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). J Oral Biosci 2022; 64 (02) 229-236
    CrossrefPubMedGoogle Scholar
  • 28 Fernandes Matuck B, Dolhnikoff M, Maia GVA. et al. Periodontal tissues are targets for Sars-Cov-2: a post-mortem study. J Oral Microbiol 2020; 13 (01) 1848135
    CrossrefPubMedGoogle Scholar
  • 29 Adam M. Is SARS-CoV-2 present in the periodontium? A post-mortem study. Evid Based Dent 2021; 22 (02) 60-61
    CrossrefPubMedGoogle Scholar
  • 30 Grigoriadis A, Räisänen IT, Pärnänen P, Tervahartiala T, Sorsa T, Sakellari D. Is there a link between COVID-19 and periodontal disease? A narrative review. Eur J Dent 2022; 16 (03) 514-520
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Basso L, Chacun D, Sy K, Grosgogeat B, Gritsch K. Periodontal diseases and COVID-19: a scoping review. Eur J Dent 2021; 15 (04) 768-775
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 32 Takahashi Y, Watanabe N, Kamio N, Kobayashi R, Iinuma T, Imai K. Aspiration of periodontopathic bacteria due to poor oral hygiene potentially contributes to the aggravation of COVID-19. J Oral Sci 2020; 63 (01) 1-3
    CrossrefPubMedGoogle Scholar
  • 33 Gupta S, Mohindra R, Chauhan PK. et al. SARS-CoV-2 detection in gingival crevicular fluid. J Dent Res 2021; 100 (02) 187-193
    CrossrefPubMedGoogle Scholar
  • 34 Pallos D, Ruivo GF, Ferrari-Junior SH. et al. Periodontal disease and detection of human herpesviruses in saliva and gingival crevicular fluid of chronic kidney disease patients. J Periodontol 2020; 91 (09) 1139-1147
    CrossrefPubMedGoogle Scholar
  • 35 Kheur S, Kheur M, Gupta AA, Raj AT. Is the gingival sulcus a potential niche for SARS-corona virus-2?. Med Hypotheses 2020; 143: 109892
    CrossrefPubMedGoogle Scholar
  • 36 Elisetti N. Periodontal pocket and COVID-19: could there be a possible link?. Med Hypotheses 2021; 146: 110355
    CrossrefPubMedGoogle Scholar
  • 37 Natto ZS, Afeef M, Bakhrebah MA. et al. Can periodontal pockets and caries lesions act as reservoirs for coronavirus?. Mol Oral Microbiol 2022; 37 (02) 77-80
    CrossrefPubMedGoogle Scholar
  • 38 Badran Z, Gaudin A, Struillou X, Amador G, Soueidan A. Periodontal pockets: a potential reservoir for SARS-CoV-2?. Med Hypotheses 2020; 143: 109907
    CrossrefPubMedGoogle Scholar
  • 39 Galicia JC, Guzzi PH, Giorgi FM, Khan AA. Predicting the response of the dental pulp to SARS-CoV2 infection: a transcriptome-wide effect cross-analysis. Genes Immun 2020; 21 (05) 360-363
    CrossrefPubMedGoogle Scholar
  • 40 Gomes SC, Fachin S, da Fonseca JG. et al. Dental biofilm of symptomatic COVID-19 patients harbours SARS-CoV-2. J Clin Periodontol 2021; 48 (07) 880-885
    CrossrefPubMedGoogle Scholar
  • 41 Berton F, Rupel K, Florian F, Biasotto M, Pallavicini A, Di Lenarda R. Dental calculus-a reservoir for detection of past SARS-CoV-2 infection. Clin Oral Investig 2021; 25 (08) 5113-5114
    CrossrefPubMedGoogle Scholar
  • 42 Jaffal SM, Abbas MA. TRP channels in COVID-19 disease: potential targets for prevention and treatment. Chem Biol Interact 2021; 345: 109567
    CrossrefPubMedGoogle Scholar
  • 43 Liviero F, Campisi M, Mason P, Pavanello S. Transient receptor potential vanilloid subtype 1: potential role in infection, susceptibility, symptoms and treatment of COVID-19. Front Med (Lausanne) 2021; 8: 753819
    CrossrefPubMedGoogle Scholar
  • 44 Wang B, Danjo A, Kajiya H, Okabe K, Kido MA. Oral epithelial cells are activated via TRP channels. J Dent Res 2011; 90 (02) 163-167
    CrossrefPubMedGoogle Scholar
  • 45 Morgan CR, Rodd HD, Clayton N, Davis JB, Boissonade FM. Vanilloid receptor 1 expression in human tooth pulp in relation to caries and pain. J Orofac Pain 2005; 19 (03) 248-260
    PubMedGoogle Scholar
  • 46 Gibbs JL, Melnyk JL, Basbaum AI. Differential TRPV1 and TRPV2 channel expression in dental pulp. J Dent Res 2011; 90 (06) 765-770
    CrossrefPubMedGoogle Scholar
  • 47 Sobhan U, Sato M, Shinomiya T. et al. Immunolocalization and distribution of functional temperature-sensitive TRP channels in salivary glands. Cell Tissue Res 2013; 354 (02) 507-519
    CrossrefPubMedGoogle Scholar
  • 48 Meng L, Ma B, Cheng Y, Bian Z. Epidemiological investigation of OHCWs with COVID-19. J Dent Res 2020; 99 (13) 1444-1452
    CrossrefPubMedGoogle Scholar
  • 49 Estrich CG, Mikkelsen M, Morrissey R. et al. Estimating COVID-19 prevalence and infection control practices among US dentists. J Am Dent Assoc 2020; 151 (11) 815-824
    CrossrefPubMedGoogle Scholar
  • 50 Epstein JB, Chow K, Mathias R. Dental procedure aerosols and COVID-19. Lancet Infect Dis 2021; 21 (04) e73
    CrossrefPubMedGoogle Scholar
  • 51 Froum SH, Froum SJ. Incidence of COVID-19 virus transmission in three dental offices: a 6-month retrospective study. Int J Periodont Restor Dent 2020; 40 (06) 853-859
    CrossrefPubMedGoogle Scholar
  • 52 Shubayr MA, Mashyakhy M, Al Agili DE, Albar N, Quadri MF. Factors associated with infection-control behavior of dental health-care workers during the COVID-19 pandemic: a cross-sectional study applying the theory of planned behavior. J Multidiscip Healthc 2020; 13: 1527-1535
    CrossrefPubMedGoogle Scholar
  • 53 Tanaka H, Kurita H, Shibuya Y. et al. COVID-19 transmission in dental and oral/maxillofacial surgical practice during pandemic: questionnaire survey in 51 university hospitals in Japan. J Hosp Infect 2022; 125: 21-27
    CrossrefPubMedGoogle Scholar
  • 54 Araujo MWB, Estrich CG, Mikkelsen M. et al. COVID-19 among dentists in the United States: a 6-month longitudinal report of accumulative prevalence and incidence. J Am Dent Assoc 2021; 152 (06) 425-433
    CrossrefPubMedGoogle Scholar
  • 55 COVIDental Collaboration Group. The COVID-19 pandemic and its global effects on dental practice. An international survey. J Dent 2021; 114: 103749
    CrossrefPubMedGoogle Scholar
  • 56 Lee YL, Hu HY, Yen YF. et al. Impact of the COVID-19 pandemic on the utilization of medical and dental services in Taiwan: a cohort study. J Dent Sci 2021; 16 (04) 1233-1240
    CrossrefPubMedGoogle Scholar
  • 57 Barenghi L, Barenghi A, Garagiola U, Di Blasio A, Giannì AB, Spadari F. Pros and cons of CAD/CAM technology for infection prevention in dental settings during COVID-19 outbreak. Sensors (Basel) 2021; 22 (01) 49
    CrossrefPubMedGoogle Scholar
  • 58 Gallagher JE, K C S, Johnson IG. et al. A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19. BDJ Open 2020; 6: 25
    CrossrefPubMedGoogle Scholar
  • 59 Parvez MK, Parveen S. Airborne transmission of SARS-CoV-2 disease (COVID-19). Future Virol 2022; DOI: 10.2217/fvl-2021-0324.
    CrossrefPubMedGoogle Scholar
  • 60 Nulty A, Lefkaditis C, Zachrisson P, Van Tonder Q, Yar R. A clinical study measuring dental aerosols with and without a high-volume extraction device. Br Dent J 2020; 1-8 DOI: 10.1038/s41415-020-2274-3.
    CrossrefPubMedGoogle Scholar
  • 61 Pierre-Bez AC, Agostini-Walesch GM, Bradford Smith P. et al. Ultrasonic scaling in COVID-era dentistry: a quantitative assessment of aerosol spread during simulated and clinical ultrasonic scaling procedures. Int J Dent Hyg 2021; 19 (04) 474-480
    CrossrefPubMedGoogle Scholar
  • 62 Harrel SK, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. J Am Dent Assoc 2004; 135 (04) 429-437
    CrossrefPubMedGoogle Scholar
  • 63 Innes N, Johnson IG, Al-Yaseen W. et al. A systematic review of droplet and aerosol generation in dentistry. J Dent 2021; 105: 103556
    CrossrefPubMedGoogle Scholar
  • 64 Onoyama K, Matsui S, Kikuchi M. et al. Particle size analysis in aerosol-generating dental procedures using laser diffraction technique. Front Oral Health 2022; 3: 804314
    CrossrefPubMedGoogle Scholar
  • 65 Meethil AP, Saraswat S, Chaudhary PP, Dabdoub SM, Kumar PS. Sources of SARS-CoV-2 and other microorganisms in dental aerosols. J Dent Res 2021; 100 (08) 817-823
    CrossrefPubMedGoogle Scholar
  • 66 Suwandi T, Nursolihati V, Sundjojo M, Widyarman AS. The efficacy of high-volume evacuators and extraoral vacuum aspirators in reducing aerosol and droplet in ultrasonic scaling procedures during the COVID-19 pandemic. Eur J Dent 2022; 16 (04) 803-808
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 67 Noordien N, Mulder-van Staden S, Mulder R. In vivo study of aerosol, droplets and splatter reduction in dentistry. Viruses 2021; 13 (10) 1928
    CrossrefPubMedGoogle Scholar
  • 68 Malamud D, Abrams WR, Barber CA, Weissman D, Rehtanz M, Golub E. Antiviral activities in human saliva. Adv Dent Res 2011; 23 (01) 34-37
    CrossrefPubMedGoogle Scholar
  • 69 Farshidfar N, Hamedani S. Hyposalivation as a potential risk for SARS-CoV-2 infection: inhibitory role of saliva. Oral Dis 2021; 27 (Suppl. 03) 750-751
    CrossrefPubMedGoogle Scholar
  • 70 Conzelmann C, Groß R, Zou M. et al. Salivary extracellular vesicles inhibit Zika virus but not SARS-CoV-2 infection. J Extracell Vesicles 2020; 9 (01) 1808281
    CrossrefPubMedGoogle Scholar
  • 71 Drozdzik A, Drozdzik M. Oral pathology in COVID-19 and SARS-CoV-2 infection-molecular aspects. Int J Mol Sci 2022; 23 (03) 1431
    CrossrefPubMedGoogle Scholar
  • 72 Tsukinoki K, Yamamoto T, Handa K. et al. Detection of cross-reactive immunoglobulin A against the severe acute respiratory syndrome-coronavirus-2 spike 1 subunit in saliva. PLoS One 2021; 16 (11) e0249979
    CrossrefPubMedGoogle Scholar
  • 73 Seneviratne CJ, Balan P, Ko KKK. et al. Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore. Infection 2021; 49 (02) 305-311
    CrossrefPubMedGoogle Scholar
  • 74 Wang F, Permana I, Chaerasari C, Lee K, Chang T, Rakshit D. Ventilation performance evaluation of a negative-pressurized isolation room for emergency departments. Healthcare (Basel) 2022; 10 (02) 193
    CrossrefPubMedGoogle Scholar
  • 75 Teichert-Filho R, Baldasso CN, Campos MM, Gomes MS. Protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic. Int Endod J 2020; 53 (11) 1588-1597
    CrossrefPubMedGoogle Scholar