Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review

Background Recent randomized clinical trials suggest that the effect of using cetylpyridinium chloride (CPC) mouthwashes on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in COVID-19 patients has been inconsistent. Additionally, no clinical study has investigated the effectiveness of on-demand aqueous chlorine dioxide mouthwash against COVID-19. Methods We performed a randomized, placebo-controlled, open-label clinical trial to assess for any effects of using mouthwash on the salivary SARS-CoV-2 viral load among asymptomatic to mildly symptomatic adult COVID-19-positive patients. Patients were randomized to receive either 20 mL of 0.05% CPC, 10 mL of 0.01% on-demand aqueous chlorine dioxide, or 20 mL of placebo mouthwash (purified water) in a 1:1:1 ratio. The primary endpoint was the cycle threshold (Ct) values employed for SARS-CoV-2 salivary viral load estimation. We used linear mixed-effects models to assess for any effect of the mouthwashes on SARS-CoV-2 salivary viral load. Results Of a total of 96 eligible participants enrolled from November 7, 2022, to January 19, 2023, 90 were accepted for the primary analysis. The use of 0.05% CPC mouthwash was not shown to be superior to placebo in change from baseline salivary Ct value at 30 min (difference vs. placebo, 0.640; 95% confidence interval [CI], -1.425 to 2.706; P = 0.543); 2 h (difference vs. placebo, 1.158; 95% CI, -0.797 to 3.112; P = 0.246); 4 h (difference vs. placebo, 1.283; 95% CI, -0.719 to 3.285; P = 0.209); 10 h (difference vs. placebo, 0.304; 95% CI, -1.777 to 2.385; P = 0.775); or 24 h (difference vs. placebo, 0.782; 95% CI, -1.195 to 2.759; P = 0.438). The use of 0.01% on-demand aqueous chlorine dioxide mouthwash was also not shown to be superior to placebo in change from baseline salivary Ct value at 30 min (difference vs. placebo, 0.905; 95% CI, -1.079 to 2.888; P = 0.371); 2 h (difference vs. placebo, 0.709; 95% CI, -1.275 to 2.693; P = 0.483); 4 h (difference vs. placebo, 0.220; 95% CI, -1.787 to 2.226; P = 0.830); 10 h (difference vs. placebo, 0.198; 95% CI, -1.901 to 2.296; P = 0.854); or 24 h (difference vs. placebo, 0.784; 95% CI, -1.236 to 2.804; P = 0.447). Conclusions In asymptomatic to mildly symptomatic adults with COVID-19, compared to placebo, the use of 0.05% CPC and 0.01% on-demand aqueous chlorine dioxide mouthwash did not lead to a significant reduction in SARS-CoV-2 salivary viral load. Future studies of the efficacy of CPC and on-demand aqueous chlorine dioxide mouthwash on the viral viability of SARS-CoV-2 should be conducted using different specimen types and in multiple populations and settings.

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Protective effects of mouthwash formulations of <i>Syzygium polyantha</i> (L.) and <i>Piper betel</i> (L.) on oral microbiota-induced gingivitis

Putri,

Nurjanah,

Laela

et al. 2023

Healthc Low-resour S

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Using a combination of natural ingredients as a mouthwash was expected to have a synergistic effect in preventing gingivitis, a common oral disease. The objective of this study was to elucidate the anti-inflammatory effect of different proportions of mouthwash infusions: F1 (75% Syzygium polyantha and 25% Piper betle) and F2 (25% Syzygium polyantha and 75% Piper betle) on oral microbiota causing gingivitis. Twenty-four Rattus norvegicus were divided into four groups, and bacteria were injected into the periodontal sulcus. The anti-inflammatory effect was assessed by calculating the reduced number of polymorphonuclear (PMN) leukocytes. A cytotoxicity test was carried out on the normal fibroblast cell line 3T3-L1. There were no significant differences in the decreased number of PMN leukocytes (p = 0.079 > 0.05). Both F1 and F2 showed results of cell viability approaching 100% of living cells at concentrations of 0.29 ppm and 0.04 ppm, equivalent to 0.058% and 0.029%, respectively. This study concluded that both formulations of Syzygium polyantha and Piper betle have potential effects on gingivitis prevention. They had an effectiveness level almost similar to Chlorhexidine gluconate 2%. The toxicity value of formulation F1 is superior to that of formulation F2. Further studies concerning the toxicity of the mixtures and their effect on oral biofilm are needed.

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Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review

Cited by 3 publications

References 147 publications

Aerosols in Dentistry

Aerosols in Dentistry

Oral mouthwashes for asymptomatic to mildly symptomatic adults with COVID-19 and salivary viral load: a randomized, placebo-controlled, open-label clinical trial

Protective effects of mouthwash formulations of <i>Syzygium polyantha</i> (L.) and <i>Piper betel</i> (L.) on oral microbiota-induced gingivitis

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