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In dentistry, we rarely come across studies such as this one1—comprehensive, elaborate, and timely—which brings to light findings that have several key implications. We are still in the middle of the coronavirus disease–2019 (COVID-19) pandemic, caused by the different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and, as of October 18, 2021, it has infected close to 241 million people globally and resulted in close to 4.9 million deaths. Studies that will advance the understanding of the transmissibility and pathogenesis of SARS-CoV-2 are the need of the hour. The findings from such investigations could pave the way for effective prevention and intervention strategies, and this is one such study. The oral cavity is an ideal portal for microorganisms in the environment to enter the body, and it is intricately connected to other bodily systems. This study investigated the role played by the oral cavity and the saliva on the transmissibility of the SARS-CoV-2 virus.
Figure depicting the oral cavity as a site for infection and transmission of SARS-CoV-2 to internal organ systems and to others via extraoral transmission. The study validated the importance of preventive strategies used in the clinic to minimize extraoral transmission, some of which are listed in the figure.
The study confirmed the presence of viral entry points of SARS-CoV-2; namely, the angiotensin-converting enzyme 2 (ACE2) receptor and the transmembrane serine protease (TMPRSS) enzyme in salivary glands and oral mucosal epithelium.
Using tissue autopsy and outpatient samples, the authors confirmed that SARS-CoV-2 can infect salivary glands and oral mucosal epithelial cells.
The authors demonstrated the transmissible (infectious) potential of saliva from asymptomatic COVID-19 patients.
Viral burden (levels) in saliva was shown to correlate with taste alteration, raising the possibility of SARS-CoV-2 potentially infecting the taste buds.
A sustained local immune response in saliva was observed following SARS-CoV-2 infection.
The oral cavity is highly susceptive to SARS-CoV-2 infection.
Before this study, in the medical community, emphasis was given mainly to the nasal–lung axis as the portal of entry of SARS-CoV-2. This study highlights the importance of the oral cavity as an important portal of entry as well.
Saliva with viral load from the oral cavity could transmit the virus to other systems (respiratory or gastrointestinal) within the same individual or to other individuals.
Due to the proximity to the external environment and the associated exposure, the oral cavity, and the tissues in it, may play an important role in the asymptomatic spread of COVID-19.
When planning preventive strategies to contain the viral transmission, including SARS-CoV-2, the oral cavity cannot and should not be ignored as the potential portal of entry.