Herpesviruses and SARS-CoV-2: Viral Association with Oral Inflammatory Diseases

Abstract

The oral cavity is a niche for diverse microbes, including viruses. Members of the Herpesviridae family, comprised of dsDNA viruses, as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an ssRNA virus, are among the most prevalent viruses infecting the oral cavity, and they exhibit clinical manifestations unique to oral tissues. Viral infection of oral mucosal epithelia triggers an immune response that results in prolonged inflammation. The clinical and systemic disease manifestations of HHV have been researched extensively, and several recent studies have illuminated the relationship between HHV and oral inflammatory diseases. Burgeoning evidence suggests the oral manifestation of SARS-CoV-2 infection includes xerostomia, dysgeusia, periodontal disease, mucositis, and opportunistic viral and bacterial infections, collectively described as oral post-acute sequelae of COVID-19 (PASC). These diverse sequelae could be a result of intensified immune responses initially due to the copious production of proinflammatory cytokines: the so-called “cytokine storm syndrome”, facilitating widespread oral and non-oral tissue damage. This review explores the interplay between HHV, SARS-CoV-2, and oral inflammatory diseases such as periodontitis, endodontic disease, and peri-implantitis. Additionally, the review discusses proper diagnostic techniques for identifying viral infection and how viral diagnostics can lead to improved overall patient health.

SARS‐CoV‐2, periodontal pathogens, and host factors: The trinity of oral post‐acute sequelae of COVID‐19

“…The interactions between periodontopathogenic bacteria and viruses in the oral cavity represent a complex and multifaceted relationship with significant implications for oral and systemic health. 131,312 Above…”

“…SARS-CoV-2, all likely etiologic agents of oral diseases such as PD, oral pharyngitis, mucositis, xerostomia, dysgeusia, dysphagia, vesicularbullae disorders, keratotic lesions, dental pulpitis, and a variety of acute and chronic inflammatory presentations. [129][130][131][132][133] Heparan sulphate can interact with a variety of ligands mediating additional receptor activations. 134 Some membrane receptors are also regulatory for cell-to-cell communication, tissue integrity, oral mucosal infection, inflammatory and neoplasia responses associated with pathogen pattern recognition (e.g., pattern recognition receptor, PRR) producing an amplification of transcriptional inflammatory signalling through NF-kB leading to cytokine expressions.…”

A Low-Cost Protocol Using the Adjunctive Action of Povidone–Iodine Irrigations and Sodium Hypochlorite Rinsing Solution in Step 2 of Periodontal Therapy for Patients with Stage III–IV Periodontitis: A Single-Blind, Randomized Controlled Trial

“…Several authors assume that virtually all cases of aggressive periodontitis involve an active herpesvirus infection, which has the potential to impair periodontal host defenses and induce an overgrowth of pathogenic bacteria [4][5][6][7][8][9][10][11][12]. Viral DNA has been detected in gingival tissue, gingival crevicular fluid, and subgingival plaque from periodontally affected sites [13].…”