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Periodontal Pockets: A Potential Reservoir for SARS-CoV-2?
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The authors hypothesize that periodontal pockets (PP) may represent an environment conducive for the SARS-CoV-2 virus to replicate and continually be shed into gingival crevicular fluid, mixing with saliva or migrating systemically via the capillary periodontal complex. In this way, PP may act as a reservoir for the virus, whether in active or latent state.
- Herpes simplex virus, Epstein-Barr virus, and human cytomegalovirus are known to be prevalent species in PP, finding in them a compatible environment for virus infection and survival. Angiotensin-converting enzyme 2 (ACE-2) receptors, the putative main receptor for SARS-CoV-2 entry into target cells, are highly expressed in oral epithelial cells and periodontal ligament fibroblasts. Another potential mechanism of viral entry into cells is via the cluster of differentiation 147 (CD 147) on cell membranes, and CD 147 expression is increased in gingival epithelial cells from patients with periodontitis. If PP are found to act as reservoirs of SARS-CoV-2, PP gingival crevicular fluid/plaque sampling may emerge as a testing tool for Covid-19, and periodontal therapy may be critical in the global clinical management of Covid-19–positive patients.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPeriodontal pockets are the major clinical manifestation of Periodontitis, a chronic inflammatory oral disease affecting the teeth-supporting tissues and has high prevalence in the adult population. Periodontal pockets are ideal environments for subgingival bacterial biofilms, that interact with the supragingival oral cavity, mucosal tissues of the pocket and a peripheral circulatory system. Periodontal pockets have been found to harbor viral species such as the Herpes simplex viruses' family. Recently, the SARS-CoV-2 has gained major interest of the scientific/medical community as it caused a global pandemic (Covid-19) and paralyzed the globe with high figures of infected people worldwide. This virus behavior is still partially understood, and by analyzing some of its features we hypothesized that periodontal pocket could be a favorable anatomical niche for the virus and thus acting as a reservoir for SARS-CoV-2.
Additional Info
Periodontal Pockets: A Potential Reservoir for SARS-CoV-2?
Med. Hypotheses 2020 Oct 01;143(xx)109907, Z Badran, A Gaudin, X Struillou, G Amador, A SoueidanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Clinical Dentistry
Many unknowns of the novel SARS-CoV-2 pandemic have led to several hypotheses related to the pathogenesis and transmission of this virus. This publication by Badran et al is one such hypothesis that postulates the periodontal pockets as a potential niche for the virus. Earlier work in the periodontal literature has established that the deeper periodontal pockets are conducive environments to harbor the bacteriophages, herpes simplex virus, Epstein-Barr virus, and human cytomegalovirus. Emerging evidence from preprints and preliminary investigations demonstrate that the receptor for the virus entry (angiotensin-converting enzyme-2 receptor) and the key molecule that the spike protein of the virus binds to (cluster of differentiation 147) are both identified in the oral epithelial cells. This emerging new data about the oral expression of SARS-CoV-2 receptors and the previous evidence about the periodontal pocket being a favorable environment for harboring other viruses make it fair to hypothesize that the subgingival environment might be a potential reservoir.
Additionally, if the virus is harbored in the pocket, the gingival crevicular fluid, the exudate (or a serum transudate) in this environment, can also carry the virus. Although the authors discuss the possibility of the gingival crevicular fluid to be used as a testing sample, the viral concentration in this environment, the complexity of obtaining the sample, and the increased cost for sample collection and processing will make it impractical. At this time, case-controlled clinical studies are needed to prove if SARS-CoV-2 can be detected in periodontal pockets. Additionally, if the clinical studies can demonstrate that the presence of the viral concentration is higher in deeper pockets or there is an increase in the viral concentration with an increase in the severity of the periodontal disease, that would signify the role of the gingival crevicular fluid (and, in an extension, the role of periodontal health) in systemic health.