Department of Microbiology, School of Dentistry, Nihon University, Chiyoda-ku, Tokyo 101-8310, Japan.
Int J Mol Sci. 2021 Jun 18;22(12):6527. doi: 10.3390/ijms22126527.
More than a year ago, the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization, with the world approaching its fourth wave. During this period, vaccines were developed in a much shorter period than thought possible, with the initiation of the pertinent vaccination. However, oral cavities have come under renewed scrutiny worldwide because saliva, a mixture of salivary secretions, pharyngeal secretions, and gingival crevicular fluid, have not only been shown to contain infective viral loads, mediating the route of SARS-CoV-2 transmission via droplet, aerosol, or contagion, but also used as a sample for viral RNA testing with a usefulness comparable to the nasopharyngeal swab. The oral cavity is an important portal for ingress of SARS-CoV-2, being an entryway to the bronchi, alveoli, and rest of the lower respiratory tract, causing inflammation by viral infection. Moreover, angiotensin-converting enzyme 2, a host receptor for SARS-CoV-2, coupled with proteases responsible for viral entry have been found to be expressed on the tongue and other oral mucosae, suggesting that the oral cavity is the site of virus replication and propagation. Furthermore, there is a possibility that the aspiration of oral bacteria (such as periodontal pathogens) along with saliva into the lower respiratory tract may be a complicating factor for COVID-19 because chronic obstructive pulmonary disease and diabetes are known COVID-19 comorbidities with a greater risk of disease aggravation and higher death rate. These comorbidities have a strong connection to chronic periodontitis and periodontal pathogens, and an oral health management is an effective measure to prevent these comorbidities. In addition, oral bacteria, particularly periodontal pathogens, could be proinflammatory stimulants to respiratory epithelia upon its exposure to aspirated bacteria. Therefore, it may be expected that oral health management not only prevents comorbidities involved in aggravating COVID-19 but also has an effect against COVID-19 progression. This review discusses the significance of oral health management in SARS-CoV-2 infection in the era of "the new normal with COVID-19" and COVID-19 prevention with reference to the hypothetical mechanisms that the authors and the other researchers have proposed.
一年多前,世界卫生组织宣布由严重急性呼吸系统综合征冠状病毒 2 型(SARS-CoV-2)引起的 2019 年冠状病毒病(COVID-19)大流行,全球正处于第四波疫情中。在这期间,疫苗的研发速度远超预期,相关疫苗也已开始接种。然而,由于唾液不仅被证明含有具有感染力的病毒载量,通过飞沫、气溶胶或接触传播了 SARS-CoV-2,而且还被用作病毒 RNA 检测的样本,其有效性可与鼻咽拭子相媲美,因此全世界重新开始审视口腔。口腔是 SARS-CoV-2 进入人体的重要门户,是进入支气管、肺泡和下呼吸道的通道,病毒感染会引起炎症。此外,血管紧张素转换酶 2 是 SARS-CoV-2 的宿主受体,与负责病毒进入的蛋白酶一起,在舌和其他口腔黏膜上表达,这表明口腔是病毒复制和传播的部位。此外,口腔细菌(如牙周病原体)与唾液一起被吸入下呼吸道,这可能是 COVID-19 的一个并发症,因为慢性阻塞性肺疾病和糖尿病是已知的 COVID-19 合并症,其疾病恶化和死亡率较高。这些合并症与慢性牙周炎和牙周病原体密切相关,口腔健康管理是预防这些合并症的有效措施。此外,口腔细菌,特别是牙周病原体,在吸入细菌暴露于呼吸道上皮后可能成为促炎刺激物。因此,可以预期口腔健康管理不仅可以预防 COVID-19 加重的合并症,而且对 COVID-19 的进展也有一定的效果。本文讨论了在“新常态下的 COVID-19”时代,口腔健康管理在 SARS-CoV-2 感染中的重要性,并参考了作者和其他研究人员提出的假设机制,探讨了口腔健康管理在 COVID-19 预防中的作用。
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