Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load: A randomized controlled trial

PremPrashant Chaudhary, Arsen Melkonyan, Archana Meethil, Shweta Saraswat, David L Hall, James Cottle, Mark Wenzel, Nadine Ayouty, Spenser Bense, Fabiola Casanova, Matthew Chaney, Hannah Chase, Rebecca Hermel, Matthew McClement, Claire Sesson, Bryce Woolsey, Purnima Kumar, PremPrashant Chaudhary, Arsen Melkonyan, Archana Meethil, Shweta Saraswat, David L Hall, James Cottle, Mark Wenzel, Nadine Ayouty, Spenser Bense, Fabiola Casanova, Matthew Chaney, Hannah Chase, Rebecca Hermel, Matthew McClement, Claire Sesson, Bryce Woolsey, Purnima Kumar

Abstract

Background: Many people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) never develop substantial symptoms. With more than 34 million people in the United States already infected and highly transmissible variants rapidly emerging, it is highly probable that post- and presymptomatic people will form an important fraction of those seeking dental care. Salivary carriage rates in these populations are not known. Moreover, although preventing transmission is critical for controlling spread, the efficacy of mouthrinses in reducing oral viral load is poorly studied.

Methods: The authors recruited 201 asymptomatic, presymptomatic, postsymptomatic, and symptomatic people and measured copy numbers of SARS-CoV-2 in unstimulated saliva using real-time reverse transcriptase quantitative polymerase chain reaction. Subsequently, the authors inducted 41 symptomatic people into a randomized, triple-blinded study and instructed them to rinse with saline, 1% hydrogen peroxide, 0.12% chlorhexidine, or 0.5% povidone-iodine for 60 seconds. The authors measured viral load 15 and 45 minutes after rinsing.

Results: Salivary SARS-CoV-2 was detected in 23% of asymptomatic, 60% of postsymptomatic, and 28% of presymptomatic participants. Neither carriage rate nor viral load correlated with COVID-19 symptomatology, age, sex, or race or ethnicity. All 4 mouthrinses decreased viral load by 61% through 89% at 15 minutes and by 70% through 97% at 45 minutes. The extent of reduction correlated significantly with initial viral load.

Conclusions: Nonsymptomatic people can pose a risk of transmitting the virus, and mouthrinses are simple and efficacious means of reducing this risk, especially when the load is less than 104 copies per milliliter.

Practical implications: At a time when resources are stretched, the findings of this study contribute to evidence-based selection of personal protection equipment and simple infection-control practices to reduce contagion at source. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04603794.

Keywords: Aerosol; SARS-CoV-2; chlorhexidine; dental; hydrogen peroxide; mouthrinse; povidone-iodine; saline; saliva.

Copyright © 2021 American Dental Association. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Patient selection workflow. SARS-CoV-2: .Severe acute respiratory syndrome coronavirus 2.
Figure 2
Figure 2
Reduction of severe acute respiratory syndrome coronavirus 2 load 15 and 45 minutes after rinsing for 1 minute with 15 milliliters of normal saline, 1% hydrogen peroxide, 0.12% chlorhexidine gluconate, or 0.5% povidone-iodine. Bars represent median reduction from baseline at each time point, and error bars indicate standard error of the mean.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8193024/bin/fx1_lrg.jpg

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Source: PubMed

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