Dental Implants And Orthodontics In Patients With Ectodermal Dysplasia: A Systemic Review

Ectodermal dysplasia is a hereditary disease that is associated with the involvement of organs with embryonic ectodermal structure such as teeth, nails, hair and sweat glands, lacrimal and salivary glands. The prevalence rate of this disease is 1 in every 100,000 people. The most common and severe form of ectodermal dysplasia is the X-linked hypo hidrotic type. The second common type of hidrotic ectodermal dysplasia is autosomal dominant, unlike the first type, sweat glands are not involved. Small and fragile nails, hyperkeratosis of the palms and feet, dry mouth, decreased tear production are some of the clinical symptoms of ectodermal dysplasia, which are the result of intolerance to heat. The facial features of the patient include a prominent forehead, sunken nose bridge, protruding ears, prominent lips, hypoplasia of the middle part of the face, and skin pigment around the eyes and mouth. Dental involvement is one of the most prominent features of ectodermal dysplasia, which can be seen in both primary and permanent tooth systems. Reduction in the number of teeth, delay in tooth growth, abnormal shape of anterior teeth in peg-shaped or conical form, smaller size of posterior teeth and enamel defects are observed. Alveolar ridge hypoplasia is also common due to the lack of teeth, followed by a decrease in the vertical height of the occlusion. A child with ectodermal dysplasia faces many problems in feeding, chewing, and speaking. Early treatment with dental prostheses can significantly reduce these problems.Copyright © 2023 Authors. All rights reserved.

A case of sublingual ranula that successfully responded to micro-marsupialisation under COVID-19 infection: A case report

Ranula is a mucous retention cyst caused by the extravasation of mucus from the sublingual gland. We present a case of sublingual ranula that was successfully treated with micro-marsupialisation under COVID-19 infection. The patient was a 17-year-old Japanese male suffering from a sublingual ranula that did not improve after several rounds of puncture-aspiration therapy. The patient underwent OK-432 injection therapy under hospitalisation. However, the swelling worsened. Thus, micro-marsupialisation was subsequently performed. After micro-marsupialisation, the lesions flattened out, but 14 days after treatment, the patient was found to have asymptomatic COVID-19 infection when he underwent polymerase chain reaction testing as a close contact person. Simultaneously, the lesion re-swelled and became painful, so non-steroidal anti-inflammatory drugs were prescribed. The next day, the sutures spontaneously detached, viscous saliva and blood overflowed, and the ranula disappeared. Micro-marsupialisation is effective and useful even if the patient has a COVID-19 infection.Copyright © 2022 The Authors

What's up in Whatsapp - Telecytopathology Experience Connecting Rural Districts of Punjab to a Tertiary Care Center in India

Introduction: The telemedicine center of our hospital provides expert consultation services to two rural districts of Punjab. The aim of this study was to assess its utility in Fine needle aspiration Cytology (FNAC) diagnostic service. Material(s) and Method(s): A 2-year retrospective audit from April 2020-2022 covering the COVID pandemic time was carried out on all cases of telecytopathology consultation files of the E-sanjeevani platform. A total of 75 cases whose FNAC smear images clicked by android smartphones with 48MP cameras and sent by Whatsapp to the E-Sanjeevani administrator were included. The images along with brief case clinical details were e-mailed for expert opinion to the cytopathologist (RS). The image quality, ability to provide a diagnosis, site-wise differences and comparison of the referral and expert review diagnosis was made. Result(s): The ages of the patients ranged from 4-80 years (2 children, 73 adults), with 25 males and 50 females. The sites of FNA performed at the district hospital were lymph nodes (22), breast (21), thyroid (15), soft tissue (8), salivary gland (2), skin (4), lip (2) and glans penis (1). The number of Whatsapp images evaluated ranged from 3-20 with median of 11 per case. They were in JPEG file format with size ranging from 40-163kb. Image quality was rated visually as good, medium, and poor in 46 (61%), 21m (28%) and 8(11%) cases respectively. There was no distortion of images upon enlarging them for better visualization on a large monitor. Best accuracy was obtained in breast and lymph nodes FNA. Soft tissue FNA was difficult to interpret and was inconclusive in 3/8 cases. Conclusion(s): Telecytopathology by Whatsapp is simple, quick, feasible and very useful to provide expert opinion in FNAC of various sites thereby enabling the pathologist in the district hospital setting. (Figure Presented).

Head and neck imaging manifestations in COVID-19: collective experience of 17 months during 2nd wave of the pandemic

Background: COVID-19 is well known to result in pulmonary and multiple extra-pulmonary manifestations. Among them, head and neck manifestations were commonly recognized in the 2nd wave of the pandemic. With the growing global COVID-19 burden, imaging is of utmost importance in diagnosing the disease and its related complications. The study aims to enumerate the various head and neck manifestations and their complications in COVID-19. Additionally, in sinusitis patients, the invasion was correlated with the neutrophil-lymphocyte ratio (NLR). Result(s): A cross-sectional observational study in which total of 78 COVID-19 cases that underwent head and neck imaging were retrospectively evaluated. The cohort included 52 males (66.7%) and 26 females (33.3%) with a mean age of 46.19 years (median = 49.0, SD = 16.47). The various head and neck manifestations included non invasive rhinosinusitis (n = 48), invasive sinusitis and its complications (n = 25), nasal septal abscess (n = 1), dacryoadenitis (n = 1), pre-septal and post-septal orbital cellulitis and its complications (n = 13), otitis media, mastoiditis and its complications (n = 6), parotitis (n = 2), neck vessel thrombosis (n = 2) and cervical lymphadenopathy (n = 3). An increase in the invasive nature of sinusitis was demonstrated among patients with comorbidities and elevated NLR. Conclusion(s): Early diagnosis and management of head and neck manifestations of COVID-19 are aided by prompt imaging. It is imperative that we are armed with the knowledge of various head and neck manifestations and how they may bear semblance to other pathologies for us to ensure COVID as a differential, especially in the background of known infection. Copyright © 2023, The Author(s).

The Role of the Plasminogen/Plasmin System in Inflammation of the Oral Cavity.

The oral cavity is a unique environment that consists of teeth surrounded by periodontal tissues, oral mucosae with minor salivary glands, and terminal parts of major salivary glands that open into the oral cavity. The cavity is constantly exposed to viral and microbial pathogens. Recent studies indicate that components of the plasminogen (Plg)/plasmin (Pm) system are expressed in tissues of the oral cavity, such as the salivary gland, and contribute to microbial infection and inflammation, such as periodontitis. The Plg/Pm system fulfills two major functions: (a) the destruction of fibrin deposits in the bloodstream or damaged tissues, a process called fibrinolysis, and (b) non-fibrinolytic actions that include the proteolytic modulation of proteins. One can observe both functions during inflammation. The virus that causes the coronavirus disease 2019 (COVID-19) exploits the fibrinolytic and non-fibrinolytic functions of the Plg/Pm system in the oral cavity. During COVID-19, well-established coagulopathy with the development of microthrombi requires constant activation of the fibrinolytic function. Furthermore, viral entry is modulated by receptors such as TMPRSS2, which is necessary in the oral cavity, leading to a derailed immune response that peaks in cytokine storm syndrome. This paper outlines the significance of the Plg/Pm system for infectious and inflammatory diseases that start in the oral cavity.

Sars-Cov-2 Induces a Sjogren's Syndrome-Like Phenotype

Sjogren's syndrome (SS) is a chronic and systemic autoimmune disease characterized by lymphocytic infiltration and the development of dry eyes and dry mouth due to the secretory dysfunction of the lacrimal and salivary glands. In recent years, infectious pathogens have been proved to be associated with SS, including Cytomegalovirus, Coxsackie, EBV, and lymphotropic virus-1 (HTLV-1). Studies suggest that infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger an autoimmune response, as evidenced by increased autoantibodies in patients diagnosed with Coronavirus disease 2019 (COVID-19). To investigate the relationship between SARS-CoV-2 and SS, the study was performed by infecting humanized ACE2 mice with SARS-CoV-2. Mice infected with the virus showed a decreased saliva flow rate, elevated antinuclear antibodies (ANAs) and anti-SSB/La, and lymphocyte infiltration in the lacrimal and salivary glands. We detected the viral nucleocapsid protein in mice exocrine glands with significant apoptotic bodies by the acinar cells. Confirmed with clinical data, we also observed the elevation of SS-specific autoantibodies (ANA, anti-SSB/Ro52, and anti-SSA/La) and specific ANA patterns in sera from COVID-19 patients. One unique aspect of SS is the high degree of sexual dimorphism, with women being affected 10-20 times more than men. To determine whether COVID-19 patients exhibited an element of sexual dimorphism in the autoantibody response, we grouped the sera by sex. We found the male patients showed elevated anti-SSA/Ro52 compared to female patients (p=0.0029), and female patients had more diverse ANA patterns. Lastly, monoclonal antibodies isolated from recovered patients using singlecell antibody nanowells technology were shown to recognize the nuclear antigens. Overall, by observing SS-like phenotypes in mouse models and patients, our study confirms a direct pathogenic role of SARS-CoV-2 in SS.

How to Evaluate Ultrasound Abnormalities of Salivary Glands in Sjogren Syndrome Using Web Training Session during Covid 19 Period? An International Reliability Exercise

Background. Salivary glands ultrasonography (SGUS) is an emerging tool to evaluate damages in primary sjogren patients (pSS). Up to date, SGUS has demonstrated its metric properties as an outcome measure for diagnosing pSS. As New therapeutics protocols are in developing it seems mandatory to use validated SGUS scoring systems. Objectives. The goal of our study was to evaluate international SGUS reliability exercise before beginning an international SGUS study to evaluate Modification Abnormalities of Salivary glands in pSS According to disease duration (MASAI study). Methods. Fourteen sonographers with different levels of SGUS participated in the exercise, evaluating 60 grey scale static images (30 parotid and 30 submandibular glands). Before the exercise, training was done by videoconferencing showing the different pathological SGUS findings and explaining the new OMERACT scoring system. We evaluated homogeneity (yes/no), location of hypoechogenity (0 to 3), hyperechoic band (0-3), comprehensive OMERACT scoring system (0-3), binary comprehensive OMERACT (0-1 versus 2-3) and diagnosis appreciation (No/yes). Intra-reader and interreader reliability were estimated by computing Cohen's kappa coefficients using SPSS 25.0 (SPSS Inc., Chicago, IL), and was interpreted as follows: slight, 0-0.20;fair, 0.21-0.40;moderate, 0.41-0.60;substantial, 0.61-0.80;and almost perfect, 0.81-1. The most experienced sonographer (P4) was considered as the gold standard. Results. Intra-reader reliability of the most experienced was perfect and substantial for the OMERACT scoring system. Intra-reader reliability of the other sonographers was fair to almost perfect for homogeneity and diagnosis whereas the reliability was fair to substantial for other items. Inter-reader reliability between the two most experienced sonographers (P4 and P12) was almost perfect for homogeneity, substantial for diagnosis and moderate for OMERACT scoring system. Changing OMERACT scoring system in binary items, the reliability of the most experienced sonographer was good 0.65 (9 images with homogeneity and low OMERACT, 42 had heterogeneity and high OMERACT, 9 had no homogeneity but low OMERACT and none had homogeneity with high OMERACT), clearly lower that of homogeneity. Compared to the most experienced sonographer, reliabilities of other sonographers were moderate to almost perfect for both homogeneity and diagnosis but only fair to moderate for OMERACT (Table I, II). Conclusions. According to the updated literature, we confirmed that homogeneity is the most reliable item, very close to diagnosis appreciation. Structural damages evaluations by the OMERACT scoring systems gave lower kappa values but remain still useful for diagnosing and particularly following parenchymal modifications. (Table Presented).

Research progress on oral characterization of Corona Virus Disease 2019

Corona Virus Disease 2019 (Corona Virus Disease 2019，COVID-19) has become a public health emergency that has attracted global attention because of its large-scale outbreak resulting in numerous human infections and deaths. COVID-19 is a highly contagious respiratory disease caused by novel coronavirus 2019-nCoV. Due to a large number of infections and fast transmission speed, it's significant to diagnose the infected people quickly and detect the asymptomatic infected people as soon as possible. At present, the preliminary screening is judged by the clinical manifestations of the patients, mainly involving the respiratory system, but recent studies have found that the patients infected with COVID-19 have unique oral manifestations, such as taste disturbance, xerostomia, halitosis, inflammation of salivary glands, necrotizing periodontal disease and some of them are earlier than typical symptoms such as dry cough, fever, etc. Paying attention to the oral manifestations of patients can further improve the COVID-19 screening procedure. At present, symptomatic treatment is mainly used for these oral symptoms. © 2022, J Prev Treat Stomatol Dis. All rights reserved.

PRIMARY SJÖGREN'S SYNDROME with JUVENILE ONSET: REPORT of 15 CASES

Background: Primary Sjögren's syndrome (pSS) is a chronic and progressive multisystem autoimmune disease which rarely onset in children and adolescents. Diagnostic delay in large part of patients are common due to the non-specifc and variable symptoms and the slow progression of disease. Objectives: To analyse demographic data, specifc extraglandular, salivary and ocular manifestations, laboratory parameters and therapy of pSS with juvenile onset. Methods: Retrospective study of all patients (pts) with pSS in single center. Results: pSS was verifed in 15 pts (6.7% were boys), which amounted to 23.8% of all pts with SS in our pediatric rheumatologic department. The median age of pSS onset was 8.0 y.o. [IQR 7.0;10.2]. The median of disease duration at the time of pSS verifcation was 2.75 years [2.2;5.6]. All patients had systemic manifestations at onset: constitutional abnormalities-33.3%, nonerosive polyarthritis-64.3%, polyarthralgias-26.7%, lymphadenopathy-73.3%, cutaneous involvement-53.3% (2-xerosis, 2-annular erythema, 1-erythema nodo-sum, 2-Raynaud phenomenon, 2-nonspecifc spotty rashes, 1-hemorrhagic rash). At the time of diagnosis 7 pts (46.7%) had isolated involvement of salivary glands, 8 pts (53.3%)-combined with involvement of lacrimal glands. The decrease in salivary gland function was recorded in 80% of cases, hypolacrimia-in 46.7%, 1 patient had isolated hypolacrimia. Recurrent parotitis was present in 6 pts (40.0%). At time of diagnosis pulmonary involvement had 20.0% of pts, 1 patient had renal tubular acidosis. 8 pts (53.3%) had various hematological disorders: anemia-in 3 pts (20.0%), leukopenia-in 6 (40.0%). ANA Hep-2 were detected in 100% pts (in titer 1/640-4, 1/1280-7, 1/2560-3, 1/20480-1, with mixed patterns in all pts: speckled + homogeneous-9 pts, speckled + homogeneous+cytoplasmic-6 pts), anti-Ro-in 12 pts (80.0%), anti-La-in 8 pts (53.3%), RF+-in 9 pts (60.0%). 6 pts (40.0%) had polyclonal hypergammaglob-ulinemia, max 42%. 2 pts (13.3%) had concomitant autoimmune non-rheumatic disease;1-cutaneous psoriasis, 1-autoimmune thyroiditis. The treatment of each patient was justifed by the main individual manifestations: 93.3% received glucocorticoids, 26.7%-methotrexate, 33.3%-hydroxychloroquine, 6.7%-mycophenolate mofetil. Treatment with biologics (B) was received by 13 (93.3%) pts (7-rituximab (RTM), 6-abatacept (ABA)) with a good response in 10 pts, including improvement in the function of the salivary and lacrimal glands in 7 pts. 1 patient received 2B-RTM and ABA sequentially due to the development of MAS 7 days after 1st RTM infusion. B was discontinued in 3 pts: 1 due to development of hemorrhagic vasculitis 2 days after the 1st RTM infusion, 1-COVID-19 with lung involvement (CT 3-4) 2 weeks after the 1st RTM infusion, 1-inefficiency of ABA during 15 months. Conclusion: In our pediatric rheumatologic department pts with pSS made up less than a quarter of all pts with SS. The diagnosis was verifed delayed in all pts, which can be explained by a wide range of nonspecifc manifestations at the onset. However, the manifestations of SS that were present at the time of diagnosis were brought under control on the background of complex therapy, including the prescription of B, with a good efficacy and safety profile of therapy.

Inhibitory effects of toothpaste and mouthwash ingredients on SARS-CoV-2 infection in vitro

Background and Aim: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2). Recently, some reports indicate that the severity of COVID-19 is associated with periodontal disease. SARS-CoV-2 host cell entry is mediated by viral spike protein binding to the host angiotensinconverting enzyme 2 (ACE2) and its cleavage by transmembrane protease serine 2 (TMPRSS2). ACE2 and TMPRSS2 are expressed in the oral cavity including periodontal pocket epithelium, tongue and saliva glands. Therefore, we hypothesized that inhibiting these two factors may prevent SARS-CoV-2 infections. This study aimed to investigate the inhibitory effects of general ingredients in commercially available toothpaste and mouthwash on SARS-CoV-2 infection. Methods: We evaluated the effects of 30 toothpaste and mouthwash ingredients on the SARS-CoV-2 spike protein-ACE2 interaction and TMPRSS2 protease activity using enzyme-linked immunosorbent assay and an in vitro enzyme activity assay, respectively. We also investigated whether the ingredients were in the presence of saliva. In addition, the binding state of each ingredient to the inhibitor-binding site of ACE2 or TMPRSS2 was evaluated by molecular docking simulation to understand the mechanisms involved. Results: Sodium tetradecene sulfonate, sodium N-lauroyl-N-methyltaurate, sodium N-lauroylsarcosinate, sodium dodecyl sulfate, and copper gluconate inhibited both spike protein-ACE2 interaction and TMPRSS2 activity. Furthermore, these ingredients also showed inhibitory effects on both spike protein-ACE2 interaction and TMPRRS2 activity in the presence of saliva. Molecular docking simulations suggested that these ingredients could bind to the inhibitor-binding site of ACE2. Conclusions: Our findings suggest that five ingredients in commercial toothpaste and mouthwash could inhibit the entry points of SARSCoV- 2 and could help to prevent SARS-CoV-2 infection.

ORAL MANIFESTATIONS ASSOCIATED WITH COVID‑19 PATIENTS IN SAUDI ARABIA

COVID-19 was recognized by the World Health Organization (WHO) as a pandemic disease since most of the countries reported significant numbers of deaths and infected people starting with December 2019 (WHO, 2020). The diversity of COVID-19 manifestations can be attributed to the sites where the SARS-Cov-2 receptors Angiotensin-converting Enzymes 2 (ACE2) were found, which include, but were not limited to, lung, kidney, salivary glands and gastrointestinal tract [1,12-14]. Dealing with COVID-19 had shown that many oral manifestations could be in direct relation to the infection itself. [...]another study [15] reported that at least one oral manifestation concerning the oral cavity and salivary gland was found on 67.2% of the 58 observed patients, in whom a dry mouth had the highest prevalence and gingival bleeding - the lowest. A P-value < 0.05 was considered significant. 3.RESULTS The link was distributed to a total of 515 patients tested positive with COVID-19, 512 of them having responded to the questionnaire (a response rate of 99%).

Mammary analogue secretory carcinoma presenting with cervical lymphadenopathy: A rare case report with review of the literature.

INTRODUCTION: Mammary analogue secretory carcinoma is a rare malignant tumor of the salivary glands that typically involves the major glands. The aim of the current study is to report a rare case of mammary analogue secretory carcinoma that presented with left cervical lymphadenopathy. CASE REPORT: A 59-year-old lady presented with left cervical lymphadenopathy. Tissue biopsy and immunohistochemistry revealed metastatic carcinoma, favoring ovarian origin. Staging workup was performed and, ultimately, the patient was treated as having a carcinoma of unknown primary. After showing partial response to therapy, left side neck dissection was performed. Based on better assessment of the histologic picture and a broader panel of immunohistochemistry performed on the excision specimen, the final diagnosis was that of mammary analogue secretory carcinoma. DISCUSSION: Mammary analogue secretory carcinoma is usually an indolent salivary gland carcinoma, with the majority of patients presenting with a slow-growing, painless mass measuring approximately 2 cm in size, and a reported duration ranging from 2 months to several years. In certain cases, pain and facial paralysis have been reported. It could also be found incidentally during radiologic assessment for thyroid illness or routine dental screening. CONCLUSION: Diagnosing mammary analogue secretory carcinoma is challenging, and this should be in the differential diagnosis list of metastatic carcinomas to cervical lymph nodes.

Systemic immune response development in Albino rats after retrograde instillation of COVID-19 vaccine to submandibular salivary gland: An experimental study.

Objective: This study aimed to investigate whether using the submandibular gland duct (SMD) as an alternative mucosal route for vaccine administration induced anti-COVID-19 specific immunity. Material and methods: Forty rats were randomized equally into four groups; Group I: Rats did not receive any intervention. Group II: Rats were subjected to intramuscular (IM) injection of COVID-19 vaccine. Group III: Rats were subjected to ductal cannulation by retrograde instillation of sterile saline into right SMD. Group IV: Rats in this group who had 0.5 ml of COVID-19 vaccine retrogradely injected into the right SMD. Subsequently, rats were examined for anti-COVID-19 specific antibodies (IgG). Also, light microscopic observation of glandular changes and immunohistochemical staining for CD20 was performed. Results: The obtained results demonstrated a significant increase in anti-COVID-19 IgG levels in all rats vaccinated via intraductal immunization (group IV) compared to group II. Histologically, ectopic follicles were found within the glandular lobules of the inoculated submandibular gland (SMG) in group IV. In addition, the nearby lymph node in group IV demonstrated reactive follicle characteristics in the form of activated secondary follicles with germinal centers (GCs). Immunohistochemically, CD20 was localized in group IV in GCs of the ectopic lymphoid tissue and the nearby lymph nodes while group I, group II, and III demonstrated negative immunoreactivity. Conclusion: The immune response demonstrated by intraductal SG immunization is generally more significant than that elicited by IM inoculation of the same vaccine.

Candida Infection Associated with Salivary Gland-A Narrative Review.

Candida species are common global opportunistic pathogens that could repeatedly and chronically cause oral mucosa infection and create an inflammatory environment, leading to organ dysfunction. Oral Candida infections may cause temporary or permanent damage to salivary glands, resulting in the destruction of acinar cells and the formation of scar tissue. Restricted function of the salivary glands leads to discomfort and diseases of the oral mucosa, such as dry mouth and associated infection. This narrative review attempts to summarize the anatomy and function of salivary glands, the associations between Candida and saliva, the effects of Candida infection on salivary glands, and the treatment strategies. Overall, clinicians should proactively manage Candida infections by educating patients on oral hygiene management for vulnerable populations, conducting frequent checks for a timely diagnosis, and providing an effective treatment plan.

Saliva in coronavirus disease-2019: A reliable diagnostic tool and imperative transmitter: A review

Coronavirus disease-2019 (COVID-19) caused by zoonotic virus severe acute respiratory syndrome coronavirus-2 was first reported in Wuhan, China, in December 2019, in 41 patients with a perplexing pneumonia. Ever since, it has wreaked havoc in the entire world and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. According to the WHO, 2019-nCoV principally spreads through respiratory droplets and saliva, thus making dental care and other aerosol-generating practices precarious in nature. Saliva is a bio mixture secreted from major and minor salivary glands which plays a vital role in prompt diagnosis and close contact transmission of the disease. In this article, we discuss the role of saliva in the diagnosis and as a potent transmitter of COVID-19 infection.

Epithelial-Myoepithelial Carcinoma of the Minor Salivary Glands: Case Series with Comprehensive Review.

Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor that is histologically characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells, which is especially uncommon in the minor salivary glands (MSG). Because of its histologic variety, complexity, and heterogeneity, it is sometimes challenging to make the accurate diagnosis. Here, we report a literature review of EMC of the MSGs with our experience of two cases. Incisional biopsy was suggestive of pleomorphic adenoma in Case 1 and pleomorphic adenoma or a low-grade salivary gland carcinoma in Case 2. Both cases were performed intraoral tumor resection, and they have good postoperative courses and are alive with no evidence of local recurrence or metastasis at 31 and 16 months, respectively. Considering that the anatomy, structure, and size of salivary glands are quite different from MSGs, it might be difficult to predict EMCs of the MSG similarly to EMCs of the major salivary glands. This comprehensive review also reports the features of EMC of the MSG cases and the trends of diagnosis and discusses treatment strategy.

Pathogenesis of taste impairment and salivary dysfunction in COVID-19 patients.

Coronavirus disease 2019 (COVID-19) is a highly transmissible pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of the disease include a broad range of symptoms from mild to serious to death, with mild pneumonia to acute respiratory distress syndrome and complications in extrapulmonary organs. Taste impairment and salivary dysfunction are common early symptoms in COVID-19 patients. The mouth is a significant entry route for SARS-COV-2, similar to the nose and eyes. The cells of the oral epithelium, taste buds, and minor and major salivary glands express cell entry factors for SARS-COV-2, such as ACE2, TMPRSS2, and Furin. We describe the occurrence of taste impairment and salivary dysfunction in COVID-19 patients and show immunohistochemical findings regarding the cell entry factors in the oral tissue. We review and describe the pathogeneses of taste impairment and salivary dysfunction. Treatment for the oral disease is also described. Recently, it was reported that some people experience persistent and prolonged taste impairment and salivary dysfunction, described as post-COVID-19 syndrome or long COVID-19, after the acute illness of the infection has healed. To resolve these problems, it is important to understand the pathogenesis of oral complications. Recently, important advances have been reported in the understanding of gustatory impairment and salivary dysfunction. Although some progress has been made, considerable effort is still required for in-depth elucidation of the pathogenesis.

ACE2 and TMPRSS2 in human saliva can adsorb to the oral mucosal epithelium.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted through droplets. All human tissues with the angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serines 2 (TRMPRSS2) are potential targets of SARS-CoV-2. The role of saliva in SARS-CoV-2 transmission remains obscure. In this study, we attempted to reveal ACE2 and TRMPRSS2 protein expression in human parotid, submandibular, and sublingual glands (three major salivary glands). Then, the binding function of spike protein to ACE2 in three major salivary glands was detected. The expression of ACE2 and TMPRSS2 in human saliva from parotid glands were both examined. Exogenous recombined ACE2 and TMPRSS2 anchoring and fusing to oral mucosal epithelial cells in vitro were also unraveled. ACE2 and TMPRSS2 were found mainly to be expressed in the cytomembrane and cytoplasm of epithelial cells in the serous acinus cells in parotid and submandibular glands. Our research also discovered that the spike protein of SARS-CoV-2 binds to ACE2 in salivary glands in vitro. Furthermore, exogenous ACE2 and TMPRSS2 can anchor and fuse to oral mucosa in vitro. Thus, the expression of ACE2 and TMPRSS2 in human saliva might have implications for SARS-CoV-2 infection.