A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2

Abstract

Objectives SARS-CoV-2 is mainly transmitted by inhalation of droplets and aerosols. This puts healthcare professionals from specialties with close patient contact at high risk of nosocomial infections with SARS-CoV-2. In this context, preprocedural mouthrinses with hydrogen peroxide have been recommended before conducting intraoral procedures. Therefore, the aim of this study was to investigate the effects of a 1% hydrogen peroxide mouthrinse on reducing the intraoral SARS-CoV-2 load. Methods Twelve out of 98 initially screened hospitalized SARS-CoV-2-positive patients were included in this study. Intraoral viral load was determined by RT-PCR at baseline, whereupon patients had to gargle mouth and throat with 20 mL of 1% hydrogen peroxide for 30 s. After 30 min, a second examination of intraoral viral load was performed by RT-PCR. Furthermore, virus culture was performed for specimens exhibiting viral load of at least 103 RNA copies/mL at baseline. Results Ten out of the 12 initially included SARS-CoV-2-positive patients completed the study. The hydrogen peroxide mouthrinse led to no significant reduction of intraoral viral load. Replicating virus could only be determined from one baseline specimen. Conclusion A 1% hydrogen peroxide mouthrinse does not reduce the intraoral viral load in SARS-CoV-2-positive subjects. However, virus culture did not yield any indication on the effects of the mouthrinse on the infectivity of the detected RNA copies. Clinical relevance The recommendation of a preprocedural mouthrinse with hydrogen peroxide before intraoral procedures is questionable and thus should not be supported any longer, but strict infection prevention regimens are of paramount importance. Trial registration German Clinical Trials Register (ref. DRKS00022484)

Review of the Use of Nasal and Oral Antiseptics During a Global Pandemic

“…Hydrogen peroxide mouthwash in one study reduced viral titers in three separate strains of SARS-CoV-2 but the reduction was not significant [ 18 ]. In one clinical pilot study of ten SARS-CoV-2 positive patients hydrogen peroxide 1% was not shown to reduce intraoral viral load [ 48 ].…”

“…However, the in vitro data available for hydrogen peroxide suggests, it is less effective than PVP-I and Listerine in reducing the viral load of SARS-CoV-2 in the oral cavity [ 18 ]. One small study of hydrogen peroxide in ten patients reported no significant reduction of intraoral viral load in SARS-CoV-2 positive patients [ 48 ]. Hydrogen peroxide has been considered safe to use as a tooth-whitening treatment, but may cause tooth sensitivity and gingival irritation which is concentration dependent [ 74 ].…”

Antiviral Activity of Reagents in Mouth Rinses against SARS-CoV-2

“…In a prospective, in vivo, clinical pilot study, Gottsauner et al (2020) used RT-PCR to analyze the effect of gargling in the mouth and throat with 20 mL of 1% hydrogen peroxide for 30 s. No control group (e.g., a placebo mouth rinse without hydrogen peroxide) was included. Among the 10 COVID-19 patients included, there was no significant decrease in SARS-CoV-2 viral load.…”

Auswirkungen der SARS-CoV‑2-Pandemie auf die universitäre Hals-Nasen-Ohren-Heilkunde im Bereich der Forschung, Lehre und Weiterbildung

“…Aber auch epidemiologische Themen, wie das Auftreten von COVID-Fällen unter HNO-Ärzten [ 15 ], infektiologische Grundlagenarbeiten, wie z. B. die Entstehung und Verteilung von Aerosolpartikeln [ 16 , 17 ], oder auch Interventionsstudien zum Effekt von Mundspülungen auf die Viruslast [ 18 ] wurden bearbeitet. Ebenfalls wurden Publikationen zur Einführung digitaler Medien für die Patientenversorgung [ 19 ] und die studentische Lehre [ 20 , 21 ] erstellt.…”