Preprocedural Mouthwashes for Reduction of SARS-CoV-2 Viral Load and Infectivity

Jakubovics, Nicholas S.

doi:10.1177/00220345221110444

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…Furthermore, CPC does not affect the integrity of viral RNA but the viral envelope ( Muñoz-Basagoiti et al 2021 ; Meister et al 2022 ). Therefore, qRT-PCR cannot be considered a sufficient method to evaluate the clinical efficacy of antiseptics such as CPC against SARS-CoV-2 ( Gottsauner et al 2020 ; Ferrer et al 2021 ; Barrueco et al 2022 ; Cieplik and Jakubovics 2022 ; Meister et al 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…Notably, we observed at least a trend toward reduced infectivity after gargling with 0.9% NaCl, so the process of gargling alone seems to have an effect. It must further be considered that it is still unclear whether the observed reductions of SARS-CoV-2 infectivity after gargling with mouthwashes containing CPC or other active ingredients can lead to clinically relevant reductions in the risk of transmission of SARS-CoV-2 ( Cieplik and Jakubovics 2022 ). Furthermore, it must be kept in mind that the frequent use of antiseptics may also exert some negative effects such as inducing potentially detrimental ecological shifts in the oral microbiota ( Mao et al 2022 ) or development of antiseptic resistance in oral bacteria ( Verspecht et al 2019 ; Auer et al 2022 ; Muehler et al 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…The few clinical trials that have been conducted come to different conclusions: some advocate the use of antiseptic mouthwashes in SARS-CoV-2–positive individuals, while others do not ( Gottsauner et al 2020 ; Chaudhary et al 2021 ; Domênico et al 2021 ; Ferrer et al 2021 ; Huang and Huang 2021 ; Seneviratne et al 2021 ; Alemany et al 2022 ; Barrueco et al 2022 ; Meister et al 2022 ). This is mainly due to the lack of virus rescue in cell culture, which is essential to assess viral infectivity, whereas quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) just detects viral RNA copies by their presence but cannot give an indication on whether these particles are infectious or not ( Ferrer et al 2021 ; Barrueco et al 2022 ; Cieplik and Jakubovics 2022 ; Meister et al 2022 ).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2–Positive Patients: A Randomized Controlled Clinical Trial

Bonn

Rohrhofer

Audebert³

et al. 2023

J Dent Res

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Soon after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, preprocedural mouthwashes were recommended for temporarily reducing intraoral viral load and infectivity of individuals potentially infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to protect medical personnel. Particularly, the antiseptic cetylpyridinium chloride (CPC) has shown virucidal effects against SARS-CoV-2 in vitro. Therefore, the aim of this randomized controlled clinical trial was to investigate the efficacy of a commercially available mouthwash containing CPC and chlorhexidine digluconate (CHX) at 0.05% each in SARS-CoV-2–positive patients as compared to a placebo mouthwash. Sixty-one patients who tested positive for SARS-CoV-2 with onset of symptoms within the last 72 h were included in this study. Oropharyngeal specimens were taken at baseline, whereupon patients had to gargle mouth and throat with 20 mL test or placebo (0.9% NaCl) mouthwash for 60 s. After 30 min, further oropharyngeal specimens were collected. Viral load was analyzed by quantitative reverse transcriptase polymerase chain reaction, and infectivity of oropharyngeal specimens was analyzed by virus rescue in cell culture and quantified via determination of tissue culture infectious doses 50% (TCID50). Data were analyzed nonparametrically (α = 0.05). Viral load slightly but significantly decreased upon gargling in the test group ( P = 0.0435) but not in the placebo group. Viral infectivity as measured by TCID50 also significantly decreased in the test group ( P = 0.0313), whereas there was no significant effect but a trend in the placebo group. Furthermore, it was found that the specimens from patients with a vaccine booster exhibited significantly lower infectivity at baseline as compared to those without vaccine booster ( P = 0.0231). This study indicates that a preprocedural mouthwash containing CPC and CHX could slightly but significantly reduce the viral load and infectivity in SARS-CoV-2–positive patients. Further studies are needed to corroborate these results and investigate whether the observed reductions in viral load and infectivity could translate into clinically useful effects in reducing COVID-19 transmission (German Clinical Trials Register DRKS00027812).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2–Positive Patients: A Randomized Controlled Clinical Trial

Bonn

Rohrhofer

Audebert³

et al. 2023

J Dent Res

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“…Both in our previous work [ 2 ] and in that of Alemany and collaborators [ 20 ], a significant effect on the reduction of infectivity was detected 1 hour after rinsing, but not at 30 min. Future studies should therefore evaluate the combination of this and other compounds on an immediate effect in the prevention of SARS-CoV2 infectivity, which would largely expand its practical application in clinical settings [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

In vivo effect of mouthwashes on viable viral load of SARS-CoV-2 in saliva: a pilot study

Barrueco¹,

Mateos-Moreno

Aubá

et al. 2023

Journal of Oral Microbiology

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Current data on the efficacy of antiseptic mouthwashes to reduce viral load are contradictory. Firstly, in vitro data indicate very strong virucidal effects that are not replicated in clinical studies. Secondly, most clinical studies identify a limited effect, do not include a control/placebo group, or do not evaluate viral viability in an infection model. In the current manuscript, we perform a double-blind, randomized clinical trial where salivary viral load was measured before and after the mouthwash, and where saliva samples were also cultured in an in vitro infection model of SARS-CoV-2 to evaluate the effect of mouthwashes on viral viability. Our data show a 90–99% reduction in SARS-CoV-2 salivary copies with one of the tested mouthwashes, although we show that the remaining viruses are mostly viable. In addition, our data suggest that the active ingredient concentration and the overall excipients’ formulation can play an important role; and most importantly, they indicate that the effect is not immediate, being significant at 15 min and having maximum effectiveness after 1 h. Thus, we show that some oral mouthwashes can be useful in reducing viral transmission, although their efficacy must be improved through refined formulations or revised protocols.

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“…In March 2020, Peng et al published a review article about potential transmission routes of SARS-CoV-2 in dental practice, recommending preprocedural mouthwashes as a potential measure to temporarily reduce infectivity in SARS-CoV-2 positive patients and help protecting dental HCPs [ 18 ]. Despite sparse evidence back then, this recommendation was immediately disseminated by various other publications and professional societies [ 19 – 23 ], and intensively stimulated in vitro as well as clinical research activities in this area [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Preprocedural mouthwashes for infection control in dentistry—an update

et al. 2023

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Objectives Aerosols and splatter are routinely generated in dental practice and can be contaminated by potentially harmful bacteria or viruses such as SARS-CoV-2. Therefore, preprocedural mouthwashes containing antiseptic agents have been proposed as a potential measure for infection control in dental practice. This review article aims to summarize the clinical (and, if insufficient, preclinical) evidence on preprocedural mouthwashes containing antiseptic agents and to draw conclusions for dental practitioners. Methods Literature on preprocedural mouthwashes for reduction of bacterial or viral load in dental aerosols was searched and summarized. Results Preprocedural mouthwashes, particularly those containing chlorhexidine digluconate (CHX), cetylpyridinium chloride (CPC), or essential oils (EO), can significantly reduce the bacterial load in dental aerosols. With respect to viruses such as HSV-1, there are too little clinical data to draw any clear recommendations. On the other hand, clinical data is consolidating that CPC-containing mouthwashes can temporarily reduce the intraoral viral load and infectivity in SARS-CoV-2 positive individuals. Nevertheless, potential risks and side effects due to regular antiseptic use such as ecological effects or adaptation of bacteria need to be considered. Conclusions The use of preprocedural mouthwashes containing antiseptics can be recommended according to currently available data, but further studies are needed, particularly on the effects on other viruses besides SARS-CoV-2. When selecting a specific antiseptic, the biggest data basis currently exists for CHX, CPC, EO, or combinations thereof. Clinical relevance Preprocedural mouthwashes containing antiseptics can serve as part of a bundle of measures for protection of dental personnel despite some remaining ambiguities and in view of potential risks and side effects.

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Preprocedural Mouthwashes for Reduction of SARS-CoV-2 Viral Load and Infectivity

Cited by 11 publications

References 26 publications

Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2–Positive Patients: A Randomized Controlled Clinical Trial

Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2–Positive Patients: A Randomized Controlled Clinical Trial

In vivo effect of mouthwashes on viable viral load of SARS-CoV-2 in saliva: a pilot study

Preprocedural mouthwashes for infection control in dentistry—an update

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