SARS-CoV-2 Detection in Gingival Crevicular Fluid

Abstract

Understanding the pathophysiology of the coronavirus disease 2019 (COVID-19) infection remains a significant challenge of our times. The gingival crevicular fluid being representative of systemic status and having a proven track record of detecting viruses and biomarkers forms a logical basis for evaluating the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The study aimed to assess gingival crevicular fluid (GCF) for evidence of SARS-CoV-2 in 33 patients who were deemed to be COVID-19 positive upon nasopharyngeal sampling. An attempt was also made to comparatively evaluate it with saliva in terms of its sensitivity, as a diagnostic fluid for SARS-CoV-2. GCF and saliva samples were collected from 33 COVID-19–confirmed patients. Total RNA was extracted using NucliSENS easyMAG (bioMérieux) and eluted in the elution buffer. Envelope gene ( E gene) of SARS-CoV-2 and human RNase P gene as internal control were detected in GCF samples by using the TRUPCR SARS-CoV-2 RT qPCR kit V-2.0 (I) in an Applied Biosystems 7500 real-time machine. A significant majority of both asymptomatic and mildly symptomatic patients exhibited the presence of the novel coronavirus in their GCF samples. Considering the presence of SARS-CoV-2 RNA in the nasopharyngeal swab sampling as gold standard, the sensitivity of GCF and saliva, respectively, was 63.64% (confidence interval [CI], 45.1% to 79.60%) and 64.52% (CI, 45.37% to 80.77%). GCF was found to be comparable to saliva in terms of its sensitivity to detect SARS-CoV-2. Saliva samples tested positive in 3 of the 12 patients whose GCF tested negative, and likewise GCF tested positive for 2 of the 11 patients whose saliva tested negative on real-time reverse transcription polymerase chain reaction. The results establish GCF as a possible mode of transmission of SARS-CoV-2, which is the first such report in the literature, and also provide the first quantifiable evidence pointing toward a link between the COVID-19 infection and oral health.

COVID-19 and Dentistry in 72 Questions: An Overview of the Literature

“…Dysgeusia and xerostomia (early symptoms associated with SARS-CoV-2 infection) [ 195 , 207 , 208 , 209 ], but also some oral manifestations such as tongue ulcers [ 210 ], could be related to the presence of SARS-CoV-2 invasion factors (such as ACE2 and TMPRSS2) on the taste buds and dorsal tongue [ 196 ]. Interestingly, the expression of ACE2 and TMPPRSS2 in gingival sulcular epithelium (directly linked to gingivitis or periodontitis) [ 191 ], and the detection of SARS-CoV-2 in the inflammatory gingival crevicular fluid [ 211 ], raise questions on the possible role of this epithelium in SARS-CoV-2 infection. The potential passage of SARS-CoV-2 through the systemic route [ 212 ] could be considered as it has been demonstrated for periodontal bacteria such as Porphyromonas gingivalis [ 213 ].…”

“…Some SARS-CoV-2 positive ciliated cells originating from nasal cavity are found in the saliva [ 196 ]. SARS-CoV-2 infected GCF establishes the possible contribution of this fluid to the viral load of saliva [ 211 ]. Finally, the presence of SARS-CoV-2 on the dorsal tongue and in infected squamous epithelial cells in saliva [ 196 , 206 ] provides a potential cellular mechanism for spread and transmission of SARS-CoV-2 by saliva.…”

Potential implications of SARS-CoV-2 oral infection in the host microbiota

“…These observations of high viral proliferation in the gingival sulci may be due to a symbiotic relationship between microorganisms manifesting in these crevices and the virus [24]. Moreover, gingival crevicular fluid (GCF) has been speculated to harbor SARS-CoV-2 released from infected periodontal cells or by terminal capillary complexes in periodontal tissues, which can subsequently reach the oral cavity by mixing with saliva [25,26]. However, technical limitations of isolating GCF for accurate measurements make validation of this possibility challenging [27].…”

Virus transmission by ultrasonic scaler and its prevention by antiviral agent

“…Although the SARS-CoV issue in 2004 was recognized in dental literature (Li et al 2004a; Li et al 2004b), no research is presently available on virus transmissions associated with dental procedures (Koletsi et al 2020). It is generally acknowledged that dental procedures represent a high risk of SARS CoV-2 virus transmission(Ather et al 2020; Meng et al 2020; Sabino-Silva et al 2020; Izzetti et al 2020) due to its presence in saliva (To et al 2020), gingival crevicular fluid (Gupta et al 2020), nasopharyngeal, oropharyngeal and bronchial excretions (Liu et al 2020). For the provision of safe dental care for dental team members and patients, numerous preventive measures were proposed and included in professional (Ather et al 2020; Meng et al 2020; Sabino-Silva et al 2020; Izzetti et al 2020) and national (Clarkson et al 2020) COVID-19 prevention guidelines.…”