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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.
– Laurie C. Carter, DDS, PhD
This abstract is available on the publisher's site.
Periodontal 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.