The COVID-19 pandemic has notably elevated the importance of saliva in both viral transmission and diagnostic strategies, particularly within the context of dental practice. The oral cavity, as current research underscores, serves as a significant reservoir for SARS-CoV-2; saliva, in particular, harbours high viral loads and is readily dispersed through aerosol-generating dental procedures.1,2 Recent studies, such as those by Silvestre et al., point to the elevated risk of cross-infection within dental clinics, necessitating strict infection control measures - including enhanced personal protective equipment, pre-procedural mouth rinses, and improved ventilation protocols.1

Saliva's significance extends beyond transmission risks; it is also emerging as a valuable diagnostic medium. Evidence from Wyllie et al. demonstrates that saliva samples can be as sensitive as nasopharyngeal swabs for detecting SARS-CoV-2, providing a non-invasive alternative that reduces potential exposure for healthcare professionals.3 Casillas Santana and colleagues advocate for the adoption of saliva-based testing in dental settings to streamline patient triage and monitor viral load dynamics, which have been linked to disease progression.4 Notably, elevated lactate dehydrogenase (LDH) levels in saliva appear inversely correlated with viral load, offering potential prognostic value.4

The interplay between COVID-19 and oral health further complicates clinical management. Bellocchio et al. report that oral manifestations - including dysgeusia, xerostomia, and mucosal lesions - are observed in approximately half of COVID-19 patients, suggesting that the oral cavity may serve as a conduit for systemic viral dissemination.2 Additionally, periodontal pockets may function as viral reservoirs, potentially exacerbating systemic inflammation and contributing to more severe disease outcomes.2 These findings underscore the necessity of integrating comprehensive oral examinations into COVID-19 assessments and prioritising oral hygiene interventions to mitigate viral shedding.

In conclusion, dental professionals are required to balance the dual roles of saliva as both a transmission risk and a diagnostic asset. The integration of teledentistry and at-home saliva collection kits represents a promising strategy to minimise in-person exposure.1,4 Ongoing collaborative research will be crucial for optimising saliva-based diagnostics and developing targeted interventions to limit oral viral entry. By addressing these multifaceted challenges, the dental community can position saliva as a cornerstone of effective pandemic response and resilience.