The role of the oral cavity in SARS-CoV-2- and other viral infections

Abstract

Objective This study aims to review the role of the oral cavity in SARS-CoV-2- and other viral upper respiratory tract infections. Material and methods Data reviewed in the text have been researched online and also reflect personal expertise. Results Numerous respiratory and other viruses replicate in the oral cavity and are transmitted via aerosols (< 5 µm) and droplets (> 5 µm). SARS-CoV-2 replication has been documented in the upper airways as well as in oral mucosa and salivary glands. These sites are also virus reservoirs that can infect other organs, e.g., the lungs and gastrointestinal tract, as well as other individuals. Laboratory diagnosis of viruses in the oral cavity and upper airways focuses on real-time PCR; antigen tests are less sensitive. For screening and monitoring infections, nasopharyngeal and oral swabs are tested; saliva is a good and more comfortable alternative. Physical means like social distancing or masks have been proven successful to reduce the risk of infection. Both wet-lab and clinical studies confirm that mouth rinses are effective against SARS-CoV-2 and other viruses. Antiviral mouth rinses can inactivate all viruses that replicate in the oral cavity. Conclusions The oral cavity plays an important role in viral infections of the upper respiratory tract: it serves as a portal of entry, a site of replication, and a source of infection by droplets and aerosols. Physical means but also antiviral mouth rinses can help reduce the spread of viruses and contribute to infection control.

Cetylpyridinium chloride and chlorhexidine show antiviral activity against Influenza A virus and Respiratory Syncytial virus in vitro

“…All in all, our results confirm the antiviral properties of CPC and CHX against IAV and include RSV as a susceptible microorganism to these two compounds. Given these results, the data available in the literature [5,8,9,11,[13][14][15][19][20][21]34], and the mechanisms of action of both CPC and CHX [10,22,[35][36][37][38] we could expect similar results for other enveloped respiratory viruses.…”

“…Numerous respiratory viruses, including influenza A and B viruses (IAV and IBV, respectively), parainfluenza virus, metapneumovirus, rhinovirus, adenovirus, and respiratory syncytial virus (RSV), replicate in the oral cavity [5][6][7]. The oral cavity constitutes the portal of entry for many of these viruses and serves as a site of replication, more importantly, is the source of droplets and aerosols that facilitate viral transmission.…”

“…facial mask) can reduce the spread of viruses and contribute to infection control. Additionally, the use of mouth rinses with antiviral properties has been shown to reduce symptoms and transmission of respiratory infections [5,8,9].…”

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

“…Accumulating evidence suggests that the oral cavity is a critical player in SARS-CoV-2 infection and severity [73,74]. To enter the human body, SARS-CoV-2 uses its spike protein (S protein) to bind to the angiotensin converting enzyme II (ACE2) receptor, which is highly expressed in the salivary glands of the oral cavity, cellular membrane of mucosal tissue cells in the tongue, surrounding buccal, gingival tissues, and pulp [18,75,76].…”

Oral and periodontal manifestation related during human papilloma virus infections: Update on early prognostic factors

“…The epithelium shows marked hyper- or orthokeratosis, acanthosis and basal cell hyperplasia. Coilocytes, with clear cytoplasm and small nuclei, are found visible in the spinous layer [ 50 , 52 , 64 , 65 ].…”