The COVID-19 Pathway: A Proposed Oral- Vascular-Pulmonary Route of SARS-CoV-2 Infection and the Importance of Oral Healthcare Measures

Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in late 2019, the world has faced a major healthcare challenge. There remains limited understanding of the reasons for clinical variability of coronavirus disease 2019 (COVID-19), and a lack of biomarkers to identify individuals at risk of developing severe lung disease. This article aims to present a hypothesis on a vascular route of transfer of SARS-CoV-2 from the oral cavity to the lungs. Saliva is a reservoir of SARS-CoV-2, thus any breach in the immune defenses of the mouth may facilitate entrance of the virus to the vasculature through the gingival sulcus or periodontal pocket. From the oral vasculature, the virus would pass through veins of the neck and chest, and reach the heart, being pumped into pulmonary arteries, and to the small vessels in the