Correspondence Address:
Deepak Sharma
Department of Periodontology, HP Government Dental College and Hospital, Shimla - 171 001, Himachal Pradesh
India

Full Text



Sir,

Saliva, a dynamic biofluid, contains various enzymes, electrolytes, proteins, nucleic acids, antimicrobial constituents, hormones, cytokines, and antibodies. Its composition virtually reflects the entire state of health and disease in a body, and it has the potential of being a diagnostic medium for a broad range of diseases, such as in the detection of oral, systemic inflammatory, neoplastic, immunologic diseases, and others, and is rightly called the “mirror of body health.”[1]

Personalized medicine, with the help of biosensors, lab-on-chip systems, individual genetics, smartphone monitoring parameters, and microfluidic devices, has improved the primary health-care system. It gives consistent, accurate, quick, efficient results and streamlines the workflow. Salivary diagnostics has an enormous impact on health-care delivery, being noninvasive, operationally and economically suitable, and well credentialed, while bioinformatics further enhances its diagnostic performance. Because the emphasis is switching more toward prevention and early detection of a variety of diseases, salivary point-of-care (PoC) diagnostics is replacing the central laboratory and offers efficient, fast, quick, and easy automation.[2]

The severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) pandemic has affected millions of individuals in >200 countries and regions and has caused >500,000 deaths worldwide till July 2020 and is called public health emergency of international concern by the World Health Organization.[3]

Rapid and accurate detection of COVID-19 is crucial in controlling the outbreak within the community and in hospitals. The current gold standard for COVID-19 diagnosis is real-time reverse transcription-polymerase chain reaction detection of SARS-CoV-2 from nasopharyngeal and oropharyngeal swabs and sometimes from lower respiratory tract samples. Low sensitivity, discomfort to patients, exposure risks to health-care workers, and global shortages of swabs and personal protective equipment, however, necessitate the validation of new diagnostic approaches. As the functional receptor for SARS-CoV-2 is the angiotensin-converting enzyme-2 receptor, significantly lower expression of it has been found in the pharyngeal cells as opposed to salivary glands.[4]

In recent studies, it was found that saliva yielded greater detection sensitivity and consistency than nasopharyngeal samples in the detection of respiratory viruses, including coronaviruses.[5],[6] This makes saliva a relatively better diagnostic specimen for COVID-19 as opposed to pharyngeal specimens. In addition, this noninvasive biofluid can be easily collected from symptomatic and asymptomatic patients without the wastage of gloves and personal protection equipment, does not require trained medical staff, multiple samples can be obtained, it is safer and comfortable for patients, minimizes the risk of cross-contamination and nosocomial transmission, storage and transport is economical, and has easier diagnostic manipulation, so it can be efficiently used in situ ations where pharyngeal sampling is difficult, not possible, or contraindicated.[7] Salivary diagnostics may play a pivotal role in the detection of COVID-19 and can offer mass screening of the population. However, more randomized clinical trials are required to validate the results of preliminary studies on the use of saliva as a specimen for diagnosis of COVID-19 and development of a PoC test.

In challenging time like this, the enforcement of developing PoC diagnostics is of utmost importance due to the limited infrastructure and health-care workers. It would be instrumental in early diagnosis, immediate management, and prompt containment of the diseases like the COVID-19 pandemic.[8],[9] The next decade will bring breakthroughs in terms of precision, efficiency, and bedside monitoring through personalized medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References