Povidone-Iodine as a Pre-Procedural Mouthwash to Reduce the Salivary Viral Load of SARS-CoV-2: A Systematic Review of Randomized Controlled Trials

Abstract

The use of pre-procedural rinses has been investigated to reduce the number of viral particles and bacteria in aerosols, potentially decreasing the risk of cross-infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during medical and dental procedures. This review aims to confirm whether there is evidence in the literature describing a reduction in salivary load of SARS-CoV-2 when povidone-iodine (PVP-I) is used as a pre-intervention mouthwash. An search of the MEDLINE, Embase, SCOPUS, and the Cochrane library databases was conducted. The criteria used followed the PRISMA® Statement guidelines. Randomized controlled trials investigating the reduction of salivary load of SARS-CoV-2 using PVP-I were included. Ultimately, four articles were included that met the established criteria. According to the current evidence, PVP-I is effective against SARS-CoV-2 in saliva and could be implemented as a rinse before interventions to decrease the risk of cross-infection in healthcare settings.

Evaluation of Current Evidence on the Use of Oral Antiseptics Against SARS-CoV-2

“…These differences may be due to the clinical variability (different severity of the disease) of the patients included in these studies or to the variability in the methodology. García-Sánchez et al [ 34 ] conducted a systematic review of RCTs and reported a significant virucidal capacity of povidone-iodine at 0.5% and 1%. However, they did not find a benefit in the reduction of SARS-CoV-2 viral load in saliva with the 2% concentration at 30 and 60 s. However, they state that the evidence is currently uncertain and that more RCTs are required.…”

Povidone iodine as a low cost therapeutic against the SARS-CoV-2 virus and its potential for refugee health

“…Disrupting host cell attachment by inactivating receptors to limit viral infection is an obvious choice for infection control in community and healthcare settings for both unexposed and higher risk staff. 35 Lungs are the prime receptor organs of ACE2 followed by the oral cavity. The oral cavity is the best potential site of SARS-CoV-2 invasion because of saliva.…”

“…21 However multiple studies show that using mouthwash, or the gargle method, or as an oral rinse and even delivery via the nasopharynx can reduce viral load. 21,25,32,33,35 Research trials targeting the nose used 0.5% PVP-I with low-dose volume 0.33ml daily consumption. Used as a mouth wash or as a gargle with PVP-I 1% every 2-3 hours or up to 4 times daily was also effective.…”

“…21 Studies were not only conducted to evaluate PVP-I effectiveness in the community but also in healthcare settings. 35 Lamas 2020 reported encouraging outcomes with in vivo use of PVP-I with 4 Covid-19 positive patients and evaluated its impact on the viral load on the patient's saliva. 30 A study from 2021 by Arefin reported statistically significant outcomes in this domain by conducting research on 189 Covid-19 positive patients.…”

Antiviral effect of cetylpyridinium chloride in mouthwash on SARS-CoV-2

“…Therefore, oral care is important for prevention of transmission of SARS-CoV-2.Mouthwash has been focused on preventing microbiome infection 16 . In addition, several components of mouthwash have recently been reported to reduce SARS-CoV-2 virions in the oral cavity 17,18 . Cetylpyridinium chloride (CPC) is widely used as one of the bactericidal components of mouthwash, tablets, sprays, and drops.…”