National Institute of Dental and Craniofacial Research (NIDCR) is issuing this Notice of Special Interest (NOSI) to highlight the urgent need for research on Coronavirus Disease 2019 (COVID-19). NIDCR will place a high priority on topics that would be of immediate and high impact to protect and ensure the safety of personnel and patients in dental practices. These topics include prevention of SARS-COV-2 transmission and improvements in the detection and diagnosis of COVID-19; as well as acquisition of a more robust understanding of SARS-CoV-2 pathogenesis. Further, topics addressing influence and interaction of sex (a biological variable) and gender (a social construct), race and ethnicity, and those addressing questions about risk, prevention, and health outcomes are also of interest.
Background
New knowledge about SARS-CoV-2 transmissibility, stability on surfaces, viral particle size, and presence in saliva have catalyzed a need to consider how the practice of dentistry will be performed in the near and long-term future. Dental practice today involves close person-to-person contact and procedures that produce aerosols. Many practice environments are in non-hospital settings and utilize open-concept layouts. These characteristics markedly increase the potential for viral transmission via aerosols or droplets. The American Dental Association has urged dental offices to remain closed during the pandemic except for emergency care, and recent polls have indicated that over 95% of surveyed dentists have followed this recommendation. During this time, the lack of oral care may exacerbate existing oral health problems. Importantly, the practice of dentistry must transform in the presence of COVID-19 and prepare for future pandemics.
ACE2 serves as major receptor for SARS-CoV-2. ACE2 is expressed in many organs vulnerable to SARS-CoV-2 infection. RNA profiling studies reveal that ACE2 is expressed in oral mucosa and is highly enriched in the epithelial cells of the tongue. The correlation of ACE2 expression with SARS-CoV-2 colonization of oral/nasal tissues, local infection of oral/nasal epithelia, viral replication, and viral shedding into oral fluids/nasal secretions is unexplored. To minimize entry of SARS-CoV-2 into oral/nasal epithelium, approaches are urgently needed to reduce ACE2 expression in oral/nasal tissues or block SARS-CoV-2-ACE2 interactions. Further, research on sex, race, ethnic, and age-based differences in ACE2 expression and its interaction with SARS-CoV-2 is also required. This work will be instrumental in developing therapeutic approaches for limiting COVID-19 onset and progression through oral/nasal routes.