Salivary diagnostics in COVID-19: Future research implications

Direct detection and identification of viruses in saliva using a SpecID ionization modified mass spectrometer

The COVID-19 (SARS-CoV-2) pandemic has led to a significant mortality globally and persistent health challenges in many survivors. Early accurate diagnosis, surveillance, identification of cohorts, and prophylaxis are considered essential measures to reduce the spread of infectious viral pathogens such as SARS-CoV-2. A reliable, fast, high-throughput screening method that can detect viral particles and identify the pathogenic virus in infected individuals could help to reduce the spread of the next viral threat through quick knowledge and implementation of appropriate prevention strategies. Since respiratory viruses are typically present in nasal and oral secretions, saliva is a good target for testing for viral infections. Saliva testing has slowly gained popularity in the diagnostics based on biomarkers and other constituents ranging from organic compounds (e.g., food additives), peptides, and even microorganisms. Polymerase chain reaction (PCR) remains the gold standard for sensitive detection of SARS-CoV-2 infection in biological samples. However, while PCR testing for COVID is sensitive and widely used by hospitals, the method has a false-negative rate of 15-20% and is kit-based necessitating the development of alternative methods of detection that provide higher accuracy. This paper describes the use of a SpecID Mass Spectrometer that can detect the presence of viral particles in saliva at very low levels (<500 virions/0.5 ml). The main goal of this study was to demonstrate that our previously developed, portable, mass spectrometry based method, SpecID, could also be sued for detecting viruses in saliva, including but not limited to SARS-CoV-2; the SpecID method has the potential to provide a reliable solution that overcomes some of the challenges with molecular testing like PCR.

Deciphering the role of Saliva in COVID 19: A global cross-sectional study on the knowledge, awareness and perception among dentists

OBJECTIVES

The global pandemic outbreak of the coronavirus has instilled the quest amongst researchers on the expedited need for the early detection of viral load. Saliva is a complex oral biological fluid which not only causes the disease transmission but can be an effective alternative sample for detection of SARS-CoV2. This provides an ideal opportunity for dentists to be the frontline healthcare professionals who can collect the salivary samples; however the awareness of this amongst dentists is uncertain. Hence the aim of this survey was to evaluate the knowledge, perception and awareness of the role of saliva in detecting the SARS-CoV2 among dentists worldwide.

METHODS

The online questionnaire comprising of 19 questions was shared to 1100 dentists worldwide and a total of 720 responses was collected. The data was tabulated, statistically analysed using the non- parametric Kruskal-Wallis test (p < 0.05). Based on the principal component analysis, 4 components (knowledge about virus transmission, perception about SARS-CoV2 virus, awareness on the sample collection and knowledge about prevention of the virus) were obtained which was compared with the 3 independent variables (years of clinical experience, occupation and region).

RESULTS

A statistically significant difference was observed in the awareness quotient amongst the dentists with 0-5 years and greater than 20 years of clinical experience. In terms of the occupation, a significant difference was noted when comparing the postgraduate students to practitioners knowledge about the virus transmission. A highly significant difference was seen on comparing academicians and postgraduate students and also between academicians and practitioners. No significant difference was evidenced amongst the different regions, however the mean score was in the range of 3-3.44.

CONCLUSION

This survey highlights the deficiency in the knowledge, perception and awareness among dentists worldwide.

Oral Changes in Hospitalized COVID-19 Patients: A Cross-Sectional Multicentric Study

Background

Coronavirus disease 2019 (COVID-19) has rapidly spread over the globe, and several oral symptoms have been documented. However, it is unclear whether these lesions are the result of coronavirus infection or are secondary symptoms of the patient's systemic illness. The aim of this study was to collect data from various hospitals on COVID-19 patients with oral involvement in order to highlight different oral changes that may be manifested in those patients.

Methods

This observational cross-sectional multicenter study used an online questionnaire covering oral signs and symptoms that were believed to be related to COVID-19 patients who were hospitalized in different hospitals in Egypt.

Results

94.3% of the 210 patients who participated in the current study developed oral symptoms. Altered taste sensation (56.2%), burning sensation (43.3%), and oral candidiasis (40%) were the most prevalent oral symptoms (34.4%) that were found in the studied sample.

Conclusions

COVID-19 has a major influence on the oral cavity, with numerous oral symptoms that may impair quality of life. Thus, considering the need for support, pain control, and management for a better prognosis, the clinical dental evaluation of hospitalized patients with infectious diseases like COVID-19 should be addressed.

Use of saliva as an alternative diagnostic method for diagnosis of COVID-19

Background

Mass population testing has been recommended to contain the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, the use of nasopharyngeal swab specimens has caused many logistic challenges. This study investigated the sensitivity and specificity of saliva as a non-invasively-obtained specimen for molecular detection of SARS-CoV-2 RNA.

Methods

In total, 153 patients with confirmed coronavirus disease 2019 (COVID-19) who had been admitted to the regional referral hospital or who self-isolated at home were included in this study. Nasopharyngeal swab specimens and saliva samples were collected on the same day, and were tested for SARS-CoV-2 infection using reverse transcriptase polymerase chain reaction.

Results

The sensitivity and specificity of saliva samples were 81.5% and 76.4%, respectively, in cases that had been confirmed as COVID-19 using nasopharyngeal swab samples. Positive predictive values and negative predictive values were 92.3% and 54.1%, respectively. The highest detection rates were found among samples collected 4-7 days since symptom onset.

Conclusion

Saliva samples showed comparable performance to nasopharyngeal swab specimens for the diagnosis of COVID-19 in adults. The performance of saliva as a diagnostic specimen for COVID-19 testing is particularly significant during the first week of symptoms.

Oral Manifestations Associated with COVID-19 Infection: A Cross-Sectional Study of Recovered Iraqi Patients

Aims

The aim of this study was to determine prevalence of oral manifestations related to COVID-19 infection among a sample of recovered patients in the Basrah province of Iraq. Methodology. This cross-sectional study included a total of 574 individuals from Basrah city, Iraq (196 males and 378 females), who had been previously infected with COVID-19. A questionnaire was developed and used to record the demographic data, medical history, severity of respiratory infection followed by hospitalization along with oral signs and symptoms that occurred during the COVID-19 infection and their persistence after recovery.

Results

Oral manifestations were reported in 88.3% of the studied sample. The most common oral manifestation was ageusia (66.8%), followed by dry mouth (59%), gustatory changes (46%), dysphagia (40.5%), burning sensation (20.8%), oral ulceration (14.5%), and gingival bleeding (3.3%). The findings suggested that ageusia was the only symptom that persisted following recovery from the COVID-19 infection. The results showed a significant statistical correlation between the incidence of oral manifestations and the severity of COVID-19 infection followed by hospitalization. A significant correlation was also found between the age groups and COVID-19 oral manifestations, whereas no significant statistical relationship was observed between gender, smoking, and systemic diseases.

Conclusions

COVID-19 infection has considerable impacts on the oral cavity and salivary glands and after recovery from the infection, some patients continue to complain of ageusia for several months. There is a positive correlation between the incidence of oral signs and symptoms associated with COVID-19 infection and the severity of the infection.

Bibliometric analysis of top-cited articles in Journal of Dental Sciences

Background/purpose

Bibliometric analysis is a method for quantifying the article distribution, impact, and performance. The purpose of this study was to identify the most top-cited articles published in Journal of Dental Sciences (JDS) and further analyze their main characteristics.

Materials and methods

Web of Science, Journal Citation Reports database was searched to retrieve the most-cited articles in JDS published from 2007 to July 31, 2022. Among the included top-cited articles, the following parameters were recorded and analyzed: article title, article type, year, country, number of citations, and average citations pre year. Microsoft Excel was applied for the descriptive bibliometric analysis.

Results

41 top-cited articles were filtered from total 1165 JDS articles in Web of Science database. The results showed that 41 top-cited articles were cited between 20 and 186 times from Journal Citation Reports. Most of the article types are original article (28/41, 68.29%) following by review article (7/41, 17.07%). The majority of articles were originated from Taiwan (23/41, 56.10%). The top 4 most cited articles were relative to the research topic on COVID-19, lateral canal, guided-tissue regeneration barriers, and platelet-rich fibrin, respectively. However, articles analyzed by the average citations per year since publication were focused on COVID-19 followed by artificial intelligence.

Conclusion

This bibliometric analysis illustrates the progress and trend of researches in JDS. The results may also offer a reference for recognizing the hot issues with the most citations in JDS.

Infection of the oral cavity with SARS-CoV-2 variants: Scope of salivary diagnostics

Coronaviruses, including SARS-CoV-2, have caused pandemics in the past two decades. The most prevalent SARS-CoV-2 variants of concern can re-infect individuals who have been previously infected with other variants or had protection from vaccines targeting the original SARS-CoV-2 variant. Given the high risk of transmission of coronavirus via aerosols produced during dental procedures, it is important to understand the future risk of coronavirus infection for oral health professionals and to diagnose quickly early stages of outbreaks. Testing of saliva for coronavirus may be the least invasive and most convenient method for following the outbreak at the individual and community level. This review will describe strategies for diagnosis of coronavirus in saliva.

The Effect of Hydrogen Peroxide and Povidone-Iodine on the Shear Bond Strength of Orthodontic Brackets: An In Vitro Study

BACKGROUND: Chlorhexidine, which is the gold-standard antimicrobial mouthwash, cannot effectively decrease the count of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the causative agent for coronavirus disease-2019 (COVID-19). Since SARS-CoV-2 is susceptible to oxidation, mouthwashes containing oxidizing agents such as hydrogen peroxide (H2O2) or Povidone-iodine (PVP-I) are recommended to decrease the viral count. AIM: This study aimed to assess the effects of H2O2 and PVP-I mouthwashes on the shear bond strength (SBS) of metal orthodontic brackets to the enamel. MATERIALS AND METHODS: This in vitro experimental study evaluated 45 freshly extracted maxillary premolars. The teeth were cleaned and randomized into three groups (n = 15) for rinsing with distilled water (control group), 1% PVP-I (betadine), and 1.5% H2O2 for 60 s. All teeth were etched with 37% phosphoric acid gel, and metal orthodontic brackets were bonded to the teeth using the Transbond XT bonding system. The teeth were mounted in auto-polymerized acrylic resin and incubated in water at 37°C for 72 h. The teeth were then thermocycled for 48 h, and their SBS was measured in a universal testing machine. The adhesive remnant index (ARI) score was also calculated. The groups were compared by ANOVA and Chi-square Monte Carlo test. RESULTS: No significant difference was noted among the three groups in SBS (p = 0.938) or the ARI score (p = 0.780). CONCLUSION: Use of H2O2 and PVP-I mouthwashes has no adverse effect on SBS or mode of failure of metal orthodontic brackets bonded to enamel.

COVID-19 pandemic-related mortality, infection, symptoms, complications, comorbidities, and other aspects of physical health among healthcare workers globally: An umbrella review

BACKGROUND

The COVID-19 pandemic has continued to cause unprecedented concern across the globe since the beginning of the outbreak. Healthcare workers, particularly those working on the front line, remain one of the most affected groups. Various studies have investigated different aspects of the physical health of healthcare workers; however, limited evidence on the overall physical health of healthcare workers has been collectively examined.

AIM

To examine the various aspects of physical health and well-being of healthcare workers during the COVID-19 pandemic.

DESIGN

An umbrella review.

METHODS

We conducted a comprehensive literature search on Academic Search Premier, CINAHL, Cochrane Library and MEDLINE and supplemented the search with Google Scholar. Key terms related to 'COVID-19', 'physical health', 'healthcare worker' and 'systematic review' were used in the search. Systematic reviews with or without meta-analyses were included if they were published in the English language, could be obtained in full-text format, and assessed the physical health impacts of the COVID-19 pandemic on healthcare workers were included. The methodological quality of eligible studies was assessed using the Joanna Briggs Institute's checklist for systematic reviews. The data were narratively synthesised in line with the 'Synthesis Without Meta-analysis' guideline.

RESULTS

Thirteen systematic reviews (represented as K = 13) that synthesized data from 1230 primary studies/reports and 1,040,336 participants met the inclusion criteria. The findings indicate a death rate of between 0.3 and 54.2 per 100 infections (K = 4). The overall case-fatality rate was estimated to be 0.87% (approximately 9 deaths per 1000 infections, K = 3). The overall infection rate among healthcare workers ranged from 3.9% to 11% (K = 5), with the highest rate associated with healthcare workers involved in screening. Considering geographic regions, the highest number of infections was reported in Europe (78.2% of 152,888 infected healthcare workers, K = 1). More nurses and female healthcare workers were infected, while deaths occurred mainly among men and medical doctors. The commonly reported symptoms included cough (56-80%, K = 3), fever (57-85%, K = 3), and headache (7-81%, K = 3), while hypertension was the most prevalent comorbidity (7%, K = 1). Additionally, a high prevalence of poor sleep quality (41-43%, K = 2), work-related stress (33-44.86%, K = 5) and personal protective equipment-associated skin injuries (48.2-97%, K = 2) affected the healthcare workers. The most reported preventive measures included laboratory testing, clinical diagnosis, adequate personal protective equipment, self-isolation, and training/orientation for infection control.

CONCLUSION

Healthcare workers experienced considerable COVID-19-related physical health issues, including mortalities. This requires targeted interventions and health policies to support healthcare workers worldwide to ensure timely management of the pandemic.

TWEETABLE ABSTRACT

This umbrella review highlights the global mortalities, infections, and other aspects of physical health of healthcare workers during the COVID-19 pandemic.

Efficacy of Pre-Procedural Mouthwashes against SARS-CoV-2: A Systematic Review of Randomized Controlled Trials

The oral mucosa is one of the first sites to be affected by the SARS-CoV-2. For this reason, healthcare providers performing aerosol-generating procedures (AGPs) in the oral cavity are at high risk of infection with COVID-19. The aim of this systematic review is to verify whether there is evidence in the literature describing a decrease in the salivary viral load of SARS-CoV-2 after using different mouthwashes. An electronic search of the MEDLINE database (via PubMed), Web of Science, SCOPUS, and the Cochrane library database was carried out. The criteria used were those described by the PRISMA® Statement. Randomized controlled trial studies that have used mouthwashes as a form of intervention to reduce the viral load in saliva were included. The risk of bias was analyzed using the Joanna Briggs Institute Critical Appraisal Tool. Ultimately, eight articles were included that met the established criteria. Based on the evidence currently available in the literature, PVP-I, CHX and CPC present significant virucidal activity against SARS-CoV-2 in saliva and could be used as pre-procedural mouthwashes to reduce the risk of cross-infection.

Immune Responses in SARS-CoV-2, SARS-CoV, and MERS-CoV Infections: A Comparative Review

Coronavirus, discovered in the 1960s, is able to infect human hosts and causes mild to serious respiratory problems. In the last two decades, the severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been recognized. It has long been demonstrated that MERS-CoV binds to dipeptidyl peptidase 4 and SARS-CoV binds to angiotensin-converting enzyme 2. A "cytokine storm" is the main pathophysiology of aforementioned viruses. Infiltration of neutrophils at the site of the infection is a risk factor for the development of acute respiratory distress syndrome and death. The new coronavirus, SARS-CoV-2, has infected more people than SARS-Cov and MERS-CoV as it can easily be transmitted from person to person. Epidemiological studies indicate that majority of individuals are asymptomatic; therefore, an effective and an efficient tool is required for rapid testing. Identification of various cytokine and inflammatory factor expression levels can help in outcome prediction. In this study we reviewed immune responses in SARS-CoV, Mers-CoV, and SARS-COV-2 infections and the role of inflammatory cells.

Bibliometric analysis of articles published in journal of dental sciences from 2009 to 2020

The bibliometric analysis was conducted to evaluate the publication characteristics of Journal of Dental Sciences (JDS) from ScienceDirect Online between 2009 and 2020. The most common published article type in JDS was original articles. The top four highest number of published articles were related to oral and maxillofacial surgery, periodontology, endodontology, and oral pathology. The most productive geographic region for articles was Asia. Taiwan ranked in the highest country in terms of successful publication in JDS. The impact factor of JDS ranged from 0.107 in 2009 to 2.080 in 2020. As compared with years between 2009 and 2014, there was a significant increase in impact factor during 2015–2020 (P = 0.026). By this bibliometric analysis, JDS needs to attract more audience outside the Asia to gain the higher international influence.

Saliva is superior over nasopharyngeal swab for detecting SARS-CoV2 in COVID-19 patients

Scaling up of diagnostic capacity is needed to mitigate the global pandemic of SARS-CoV2. However, there are challenges including shortage of sample collection swabs and transport medium. Saliva has been recommended as a simple, low-cost, non-invasive option. However, data from different populations and settings are limited. Here, we showed that saliva could be a good alternative sample to diagnose COVID-19 patients. Pair of NPS-saliva samples was collected from 152 symptomatic; confirmed COVID-19 patients, and compared their positivity rate, viral load, and duration of viral shedding. From 152 patients, 80 (52.63%) tested positive and 72 (47.37%) were negative for SARSA-CoV2 in NPS sample. In saliva, 129 (92.14%) were tested positive and 11 (7.86%) were negative on the day of admission to hospital. The overall percent agreement of RT-PCR result of Saliva to NPS was 70% (196/280). A comparison of viral load from 72 NPS-saliva pair samples on day of admission shows saliva contains significantly higher viral load (P < 0.001). In conclusion, saliva has higher yield in detecting SARS-CoV2, and COVID-19 patients show higher viral load and prolonged period of viral shedding in saliva. Therefore, we recommend saliva as a better alternative sample to NPS to diagnose COVID-19 patients.

Diagnostic Performance of Self-Collected Saliva Versus Nasopharyngeal Swab for the Molecular Detection of SARS-CoV-2 in the Clinical Setting

Coronavirus disease 19 (COVID-19)-caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-has spread rapidly around the world. The global shortage of equipment and health care professionals, diagnostic cost, and difficulty in collecting nasopharyngeal swabs (NPSs) necessitate the use of an alternative specimen type for SARS-CoV-2 diagnosis. In this study, we investigated the use of saliva as an alternative specimen type for SARS-CoV-2 detection. Participants presenting COVID-19 symptoms and their contacts were enrolled at the COVID-19 Screening Unit of Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from July to November 2020. Paired NPS and saliva specimens were collected from each participant. Reverse transcription-quantitative PCR (RT-qPCR) was performed to detect SARS-CoV-2. Of the 596 suspected COVID-19-positive participants, 231 (38.7%) were detected as COVID-19 positive by RT-qPCR from at least 1 specimen type. Among the positive cases, 184 (79.6%) patients were identified to be positive for SARS-CoV-2 based on NPS and saliva samples, whereas 45 (19.65%) patients were positive for SARS-CoV-2 based on NPS samples but negative for SARS-CoV-2 based on the saliva samples. Two (0.5%) patients were positive for SARS-CoV-2 based on saliva samples but negative for SARS-CoV-2 based on NPS samples. The sensitivity and specificity of the saliva samples were 80.3% and 99.4%, respectively. SARS-CoV-2 detection was higher in saliva (85.1%) among the patients who visited the clinic after 1 to 5 days of symptom onset. A lower median cycle threshold (C_T) value indicated a higher SARS-CoV-2 viral load in NPS than that in saliva for target genes among the positive specimens. The study findings suggest that saliva can be used accurately for diagnosis of SARS-CoV-2 early after symptom onset in clinical and community settings. IMPORTANCE As the COVID-19 pandemic erupted, the WHO recommended the use of nasopharyngeal or throat swabs for the detection of SARS-CoV-2 etiology of COVID-19. The collection of NPS causes discomfort because of its invasive collection procedure. There are considerable risks to health care workers during the collection of these specimens. Therefore, an alternative, noninvasive, reliable, and self-collected specimen was explored in this study. This study investigated the feasibility and suitability of saliva versus NPS for the detection of SARS-CoV-2. Here, we showed that the sensitivity of saliva specimens was 80.35%, which meets the WHO criteria. Saliva is an easy-to-get, convenient, and low-cost specimen that yields better results if it is collected within the first 5 days of symptom onset. Our study findings suggest that saliva can be used in low-resource countries, community settings, and vulnerable groups, such as children and elderly people.

Oral manifestations of COVID-19 patients: An online survey of the Egyptian population

OBJECTIVES

This pilot survey aims to study the oral manifestations associated with COVID-19 infection and report the prevalence of oral signs and symptoms in COVID-19 patients.

MATERIALS AND METHODS

From May 15 to June 10, 2020, we used an online questionnaire containing the oral manifestations that are expected to be associated with the COVID-19 infection. Adults in our survey who have been diagnosed with COVID-19 positive were confirmed with reverse transcriptase PCR (RT-PCR), and isolated in various hospitals in Cairo, Egypt.

RESULTS

This pilot study included 58 (53.4% males and 46.6% females) COVID-19 patients ages 18-46 years, and 13 (22.4%) were healthcare workers. Our results showed that 67.2% of the patients had at least one manifestation related to the oral cavity and salivary glands, and 32.8% (n = 19) did not have any symptoms associated with the oral cavity. The highest prevalence symptoms were dry mouth 39.7% (n = 23), gustatory dysfunction as 34.5% (n = 20) loss of salt sensation, 29.3% (n = 17) loss of sweet sensation, and 25.9% (n = 15) altered food taste, while the least prevalent symptoms were tongue redness 8.8% (n = 5), and gingival bleeding 7% (n = 4). The most frequently associated symptoms were loss of salt and sweetness, as reported by 27.6% of the participants. However, there was no significant association between the incidence of oral symptoms and demographic data (age, gender, or job) of the patients (p > 0.05).

CONCLUSIONS

Based on limited data, COVID-19 significantly impacts the oral cavity and salivary glands, as salivary gland-related symptoms and taste disorders are highly prevalent in COVID-19 patients.

Sustainable and fast saliva-based COVID-19 virus diagnosis kit using a novel GO-decorated Au/FBG sensor

Monitoring the COVID-19 virus through patients' saliva is a favorable non-invasive specimen for diagnosis and infection control. In this study, salivary samples of COVID-19 patients collected from 6 patients with the median age of 58.5 years, ranging from 34 to 72 years (2 females and 4 males) were analyzed using an Au/fiber Bragg grating (FBG) probe decorated with GO. The probe measures the prevalence of positivity in saliva and the association between the virus density and changes to sensing elements. When the probe is immersed in patients' saliva, deviation of the detected light wavelength and intensity from healthy saliva indicate the presence of the virus and confirms infection. For a patient in the hyperinflammatory phase of desease, who has virus density of 1.2 × 108 copies/mL in saliva, the maximum wavelength shift and intensity changes after 1600 s were shown to be 1.12 nm and 2.01 dB, respectively. While for a patient in the early infection phase with 1.6 × 103 copies/mL, these values were 0.98 nm and 1.32 dB. The precise and highly sensitive FBG probe proposed in this study was found a reliable tool for quick detection of the COVID-19 virus within 10 s after exposure to patients' saliva in any stage of the disease.

Evaluation of saliva as a complementary technique to the diagnosis of COVID-19: a systematic review

BACKGROUND

Infectious disease coronavirus 2019 (COVID-19) is caused by the SARS-CoV-2 virus, and it mainly affects the upper respiratory tract. The gold standard for its diagnosis is real-time reverse transcription polymerase chain reaction (RT-qPCR) performed on a nasopharyngeal swab. In contrast, testing saliva has significant advantages as a diagnostic method.

MATERIAL AND METHODS

We searched for articles evaluating saliva as a diagnostic method for COVID-19 on the PUBMED/MEDLINE, WEB OF SCIENCE, COCHRANE, and SCIELO platforms. We initially found 233 articles and 20 were selected for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol: 18 cross-sectional studies and 2 case reports, including 8 from America, 8 from Asia, and 4 from Europe. The studies evaluated the presence of viral RNA, IgG, IgM, and IgA in samples of unstimulated saliva from adults with confirmed or suspected COVID-19. The vast majority of the studies performed RT-qPCR on the saliva samples and compared the results with the gold standard (a nasopharyngeal swab of the same patient).

RESULTS

Saliva samples analyzed by RT-qPCR, reverse transcription isothermal amplification (RT-LAMP), spectroscopy, and enzyme-linked immunosorbent assay (ELISA) offer high sensitivity to detect SARS-CoV-2 in the early stages of the disease and among asymptomatic patients as compared to nasopharyngeal swab RT-qPCR. In addition, the self-collection of saliva offers the possibility of receiving telemedicine instructions to carry out the test, reducing the risk of contagion.

CONCLUSIONS

The diagnosis of COVID-19 through saliva is sensitive, non-invasive, and is of low risk for the healthcare professionals. However, further studies are recommended to validate its clinical use.

Is there scientific evidence of the mouthwashes effectiveness in reducing viral load in Covid-19? A systematic review

BACKGROUND

The aim of this research is to verify whether there is evidence in the literature regarding the decrease in viral load present in saliva after using three types of mouthwashes.

MATERIAL AND METHODS

Clinical and/or in vitro experimental studies that have used mouthwashes as a form of intervention to reduce the viral load in saliva were included. Combinations of words and appropriate truncations were adapted for each of the seven selected electronic bases including grey literature.

RESULTS

The selection of articles was carried out in two phases by two independent reviewers. After removing duplicate articles, 1245 references were maintained, and 2 articles were included in the Systematic Review. Both studies were performed in vitro and tested the virucidal action of the PVP-I solution for mouthwash at two different concentrations, 1% without dilution and 7% with 1:30 dilution, on the SARS-CoV and MERS-CoV viruses. Both showed a viral reduction of ≥ 99.99% with 15 s exposure.

CONCLUSIONS

Based on the evidence currently available in the literature, PVP-I, at concentrations of 1 and 7%, appears to be the most effective mouthwash for reducing the viral load of COVID-19 present in human saliva. However, the guidelines for dental care refer to the use of hydrogen peroxide but there is insufficient scientific evidence to support this recommendation. Key words:COVID-19, Coronavirus, Mouthwash, Chlorhexidine, Hydrogen Peroxide, PVP-I.

Exploring salivary diagnostics in COVID-19: a scoping review and research suggestions

INTRODUCTION

Molecular diagnostics for SARS-CoV-2 infection characteristically involves the sampling of the throat or nasopharyngeal swab (NPS). However, these procedures are invasive, require necessary skills for sample collection, cause patient discomfort, and are non-conducive for extensive scale testing. Saliva is increasingly being suggested as an alternate diagnostic sample in SARS-CoV-2 infection.

OBJECTIVES

This scoping review was done with the objective of exploring the evidence on the role of saliva as an alternate diagnostic sample in SARS-CoV-2 condition.

METHODS

Thorough search of the literature in major databases was undertaken in June 2020 using free text and MESH terms, followed by PRISMA to identify 17 studies for data extraction.

RESULTS AND CONCLUSIONS

Evidence was summarised for study characteristics, salivary sampling characteristics, viral load, and longevity of virus in saliva. The literature supports that saliva offers a simple sample collection method compared to technique-sensitive NPS and has the advantage of point-of-care testing for initial screening in community or hospital-based set-up. The additional highlights of this review are heterogeneity in the current literature and the gaps in methodology. Therefore, a robust study design to generate higher levels of evidence has been proposed.

Dental practice in the era of COVID-19: A review of literature

Dental practitioners confront the highest risk of COVID-19 infection due to constant exposure to saliva, droplets, blood, and aerosols. Despite the suspension of routine dental care in many countries around the world, dental professionals perceive a moral duty to take part in the global fight against the pandemic. Therefore, dental professionals should be vigilant in defending against the transmission of the virus and as well as in the diagnosis of the disease through the oral manifestations of it. We conducted a literature review on publicly available data to outline updates on guidelines and studies of dental settings during the COVID-19 era. In this literature review, the categorization of the patients for dental treatments, protective precautions for the dental practice, considerations for dental drug prescription, and oral manifestations of the disease has been reviewed.

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

The explosion of the new coronavirus (SARS-CoV-2) pandemic has brought the role of the angiotensin converting enzyme 2 (ACE2) back into the scientific limelight. Since SARS-CoV-2 must bind the ACE2 for entering the host cells in humans, its expression and body localization are critical to track the potential target organ of this infection and to outline disease progression and clinical outcomes. Here, we mapped the physiological body distribution, expression, and activities of ACE2 and discussed its potential correlations and mutal interactions with the disparate symptoms present in SARS-CoV-2 patients at the level of different organs. We highlighted that despite during SARS-CoV-2 infection ACE2-expressing organs may become direct targets, leading to severe pathological manifestations, and subsequent multiple organ failures, the exact mechanism and the potential interactions through which ACE2 acts in these organs is still heavily debated. Further scientific efforts, also considering a personalized approach aimed to consider specific patient differences in the mutual interactions ACE2-SARS-CoV-2 and the long-term health effects associated with COVID-19 are currently mandatory.

Rapid and quantitative detection of SARS-CoV-2 specific IgG for convalescent serum evaluation

Convalescent serum with a high abundance of neutralization IgG is a promising therapeutic agent for rescuing COVID-19 patients in the critical stage. Knowing the concentration of SARS-CoV-2 S1-specific IgG is crucial in selecting appropriate convalescent serum donors. Here, we present a portable microfluidic ELISA technology for rapid (15 min), quantitative, and sensitive detection of anti-SARS-CoV-2 S1 IgG in human serum with only 8 μL sample volume. We first identified a humanized monoclonal IgG that has a high binding affinity and a relatively high specificity towards SARS-CoV-2 S1 protein, which can subsequently serve as the calibration standard of anti-SARS-CoV-2 S1 IgG in serological analyses. We then measured the abundance of anti-SARS-CoV-2 S1 IgG in 16 convalescent COVID-19 patients. Due to the availability of the calibration standard and the large dynamic range of our assay, we were able to identify "qualified donors" for convalescent serum therapy with only one fixed dilution factor (200 ×). Finally, we demonstrated that our technology can sensitively detect SARS-CoV-2 antigens (S1 and N proteins) with pg/mL level sensitivities in 40 min. Overall, our technology can greatly facilitate rapid, sensitive, and quantitative analysis of COVID-19 related markers for therapeutic, diagnostic, epidemiologic, and prognostic purposes.

Antiviral mouthwashes: possible benefit for COVID-19 with evidence-based approach

BACKGROUND

The outbreak, and pandemic of COVID-19 causing widespread concerns in all health systems of countries. Virus-carrying aerosols can penetrate the healthy human body and lungs, resulting in rapid transmission. For the first time, in this evidence-based article, the effects of different types of mouthwashes to reduce the viral load were investigated. Also, another aim of this essay is a reduction in viral load in patients with COVID-19 and prevention developing ventilator-associated pneumonia in critically ill patients.

METHODS

Related databases were comprehensively searched for relevant studies. The present study was performed according to the preferred cases for standard systematic reviews (PRISMA).

RESULTS

Five original studies in which the subject matter was directly evaluated were included. Different types of mouthwashes and viruses were investigated in this study.

CONCLUSIONS

The antiviral mouthwashes play a certainly important role in reducing the viral load of the salivary virus. In the present study, this importance could be proved in two different aspects, that is, the use of mouthwash before dental procedures to reduce the risk of transmission of the virus to the dental team and the use of this mouthwash in COVID-19 patients to help improve systemic problems associated with oral microbial flora.

COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review

SARS-CoV-2 is a member of the family of coronaviruses. The first cases were recorded in Wuhan, China, between December 2019 and January 2020. Italy is one of the most affected countries in Europe. COVID-19 is a new challenge in modern dentistry. New guidelines are required in dental clinics to avoid contagion caused by cross-infections. A narrative review was performed using both primary sources, such as scientific articles and secondary ones, such as bibliographic indexes, web pages, and databases. The main search engines were PubMed, SciELO, and Google Scholar. Twelve articles were selected to develop the bibliographic review by applying pre-established inclusion and exclusion criteria. Precautionary measures should be applied to control COVID-19 in clinical practice. Several authors have highlighted the importance of telephone triage and/or clinic questionnaires, body temperature measurement, usage of personal protective equipment, surface disinfection with ethanol between 62% and 71%, high-speed instruments equipped with an anti-retraction system, four-handed work, and large-volume cannulas for aspiration. Clinically, the use of a rubber dam is essential. FFP2 (or N95) and FFP3 respirators, if compared to surgical masks, provide greater protection for health workers against viral respiratory infections. Further accurate studies are needed to confirm this.

COVID-19 in Smokeless Tobacco Habitués: Increased Susceptibility and Transmission

As the coronavirus disease (COVID-19) pandemic continues to sweep across the globe, the world is responding by implementing public awareness campaigns, social distancing measures, and other preventive strategies to arrest the spread of this lethal disease. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exacts a heavy toll on patients with existing comorbidities. Smokeless tobacco (SLT) consumption is of particular concern in countries in South Asia with high population densities, as it facilitates exposure to SARS-CoV-2 within or between communities by the act of public spitting. Salivary droplets generated in this act are a potential threat because they can transmit this airborne infection. Moreover, large gatherings at tobacco retail outlets, frequent hand-to-mouth contact, and sharing of apparatus by SLT habitués could also aid in increasing the spread of SARS-CoV-2. SLT-induced higher expression of angiotensin-converting enzyme 2 receptors along with the presence of furin in the oral mucosa and dysfunctional immune responses among SLT habitués increase viral dissemination and an individual's susceptibility to COVID-19. Issuing rigorous regulations to restrict the use of various forms of SLT products and the obnoxious act of spitting in public can assist in arresting the spread of COVID-19. Widespread education campaigns enlightening the community regarding the adverse effects of SLT consumption and its relationship with COVID-19, along with providing effective assistance to quit for those who are addicted, would decrease the spread of COVID-19.