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Diagnostic Salivary Tests for SARS-CoV-2.

L Azzi1, V Maurino1, A Baj2

  • 1Unit of Oral Medicine and Pathology, ASST dei Sette Laghi-Ospedale di Circolo e Fondazione Macchi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.

Journal of Dental Research
|November 2, 2020
PubMed
Summary

This review explores the use of saliva as a diagnostic specimen for SARS-CoV-2. Current methods rely on nasopharyngeal swabs, which require trained personnel and can increase transmission risks. Saliva is easier to collect and less invasive, making it a promising alternative. The review distinguishes between oropharyngeal and oral saliva, noting that the former is more suitable for diagnostic testing. Saliva-based tests, including rRT-PCR and rapid molecular assays, have shown comparable accuracy to traditional methods. Point-of-care devices, such as lateral flow assays, offer rapid saliva-based testing in non-clinical settings. However, saliva should be used in conjunction with nasopharyngeal swabs to reduce false negatives. The study suggests that saliva-based diagnostics may improve accessibility and reduce transmission risks during specimen collection.

Keywords:
COVID-19SARS-CoV-2Severe acute respiratory syndrome-related coronaviruscoronaviruspoint-of-care testingsalivaSalivary testingSARS-CoV-2 diagnosticsPoint-of-care testingMolecular diagnosticsNon-invasive testing

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Area of Science:

  • Clinical virology within infectious disease diagnostics
  • Molecular diagnostics in public health
  • Point-of-care testing in medical technology

Background:

Current diagnostic methods for SARS-CoV-2 rely on respiratory specimens collected via nasopharyngeal swabs. These procedures require trained personnel and centralized labs, which can delay results and increase transmission risks. While saliva has been proposed as an alternative, its diagnostic potential remains under investigation. Prior research has shown that saliva is easier to collect and less invasive than nasopharyngeal swabs. However, the distinction between oropharyngeal and oral saliva is important for diagnostic accuracy. Saliva collection can reduce operator exposure and streamline testing processes. Despite these advantages, saliva-based diagnostics have not yet replaced standard methods. The emergence of point-of-care technologies has sparked renewed interest in saliva as a diagnostic specimen.

Purpose Of The Study:

The aim of this review is to evaluate the feasibility of using saliva for SARS-CoV-2 detection. The study focuses on comparing saliva with traditional nasopharyngeal swabs in terms of ease of collection and diagnostic accuracy. It also explores the potential of saliva in reducing transmission risks during specimen collection. The motivation stems from the limitations of current diagnostic methods, including time delays and operator exposure. The review considers both molecular and point-of-care testing approaches. It highlights the need for standardized protocols for saliva collection and analysis. The study also addresses the distinction between oropharyngeal and oral saliva in diagnostic contexts. The goal is to assess whether saliva can complement or replace traditional diagnostic specimens in clinical settings.

Main Methods:

The review approach includes a synthesis of recent scientific papers and industry reports on salivary diagnostics for SARS-CoV-2. It distinguishes between oropharyngeal and oral saliva based on anatomical and functional differences. The literature is analyzed to compare saliva with nasopharyngeal swabs in terms of diagnostic accuracy and ease of use. The study examines the use of standard rRT-PCR and rapid molecular tests for saliva analysis. It also evaluates point-of-care devices, such as lateral flow assays, for saliva-based antigen detection. The review considers the role of saliva in reducing operator exposure and streamlining diagnostic workflows. It assesses the potential of saliva in non-clinical settings, such as airports and schools. The synthesis focuses on the clinical and logistical implications of saliva-based diagnostics.

Main Results:

Saliva can be collected with minimal discomfort and does not require trained personnel. Oropharyngeal saliva is more suitable for diagnostic testing than oral saliva. Saliva-based rRT-PCR tests have shown comparable diagnostic accuracy to nasopharyngeal swabs. Rapid molecular tests, such as direct rRT-PCR without extraction, can be used for saliva analysis. Point-of-care devices, like the Rapid Salivary Test, detect viral antigens in saliva within minutes. These devices are suitable for use in non-clinical settings, such as airports and schools. Saliva-based diagnostics reduce operator exposure and may streamline testing processes. However, saliva should be used in conjunction with nasopharyngeal swabs in clinical settings to minimize false negatives.

Conclusions:

The authors suggest that saliva can serve as a diagnostic specimen for SARS-CoV-2 detection. They propose that saliva may reduce operator exposure and streamline diagnostic workflows. The review highlights the distinction between oropharyngeal and oral saliva in diagnostic accuracy. Saliva-based diagnostics may complement traditional methods in clinical settings. Point-of-care devices, such as lateral flow assays, offer rapid saliva-based testing. These devices are suitable for use in non-clinical environments, including schools and airports. The study emphasizes the need for standardized protocols for saliva collection and analysis. The authors conclude that saliva-based diagnostics may improve accessibility and reduce transmission risks during specimen collection.

Saliva can be self-collected with minimal discomfort and does not require trained personnel.

Oropharyngeal saliva is part of respiratory secretions, while oral saliva is produced by salivary glands.

The authors suggest that saliva should be used in conjunction with nasopharyngeal swabs to minimize false negatives.

It is a lateral flow assay that detects viral antigens in saliva within minutes.

Yes, point-of-care devices are suitable for use in airports, schools, and shopping centers.

Saliva-based tests may produce false negatives and should be used alongside nasopharyngeal swabs.