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COVID-19 infects the mouth. Could that explain patients' taste loss?

Illustration of an open mouth shown from the inside, looking out through the teeth
(Image: © Shutterstock)

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In the new study, posted Oct. 27 to the preprint database medRxiv, researchers predicted which mouth tissues might be most vulnerable to SARS-CoV-2, the virus that causes COVID-19. So the team examined RNA — a kind of genetic material that tells the cells' protein-making factories what to build — for different cell types in the mouth. They found that, compared with other oral tissues, cells of the salivary glands, tongue and tonsils carry the most RNA linked to proteins that the coronavirus needs to infect cells. Namely, these include the ACE2 receptor, which the virus plugs into, and an enzyme called TMPRSS, which allows the virus to fuse its membrane with that of the host cell and slip inside.

The researchers went on to sample saliva from COVID-19 patients and found that, since mouth cells slough off into our spit, they could detect infected cells floating in the samples. The more virus they found, the more likely a given patient had smell and taste loss as one of their symptoms, although saliva from several asymptomatic people also contained infected cells. In addition, the team examined mouth tissue from COVID-19 patients who had died, and they found more evidence of infection in the vulnerable cell types they had flagged.

"Our study shows that the mouth is a route of infection as well as an incubator for the SARS-CoV-2 virus that causes COVID-19," Dr. Kevin Byrd, a research scholar and manager of Oral and Craniofacial Research at the American Dental Association Science and Research Institute, told Live Science in an email. 

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Thankfully, the study authors helped craft a tool that could make future studies of oral infection easier. Specifically, they created an atlas of different cells in the mouth, which essentially serves as a map of which cells contain what RNA, and where. Byrd and his co-author Dr. Blake Warner, an assistant clinical investigator in the Salivary Disorders Unit at the National Institute of Dental and Craniofacial Research, a branch of the U.S. National Institutes of Health, worked with an organization called the Human Cell Atlas to organize and refine the data.

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For one, the study cannot show how much of the virus found in saliva actually comes from infected mouth cells. It's possible that some virus originates from elsewhere, such as the nose or the lungs, Byrd said. "However, we found these underappreciated but widely distributed salivary glands" — the so-called minor salivary glands — "can make their own virus after infection," he said. The team confirmed this by checking the levels of coronavirus RNA in the cells using PCR, a kind of test often used to detect and diagnose COVID-19, as well as a technique called in situ hybridization that also detects genetic material.

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A better understanding of how the coronavirus infects mouth cells, at the molecular level, could help improve treatments for patients with these symptoms, Byrd said. Several clinical trials are also investigating whether oral rinses could help prevent or treat COVID-19 infection; UCSF researchers plan to conduct one such trial, according to ClinicalTrials.gov, and Villa is working with another team to organize an additional trial of several rinses, he told Live Science.

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