Use of mouthwashes against COVID-19 in dentistry

A Vergara-Buenaventura, C Castro-Ruiz, A Vergara-Buenaventura, C Castro-Ruiz

Abstract

The proximity to the patient during dental care, high generation of aerosols, and the identification of SARS-CoV-2 in saliva have suggested the oral cavity as a potential reservoir for COVID-19 transmission. Mouthwashes are widely-used solutions due to their ability to reduce the number of microorganisms in the oral cavity. Although there is still no clinical evidence that they can prevent the transmission of SARS-CoV-2, preoperative antimicrobial mouth rinses with chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), povidone-iodine (PVP-I), and hydrogen peroxide (H2O2) have been recommended to reduce the number of microorganisms in aerosols and drops during oral procedures. This paper therefore aims to provide a comprehensive review of the current recommendations on the use of mouthwashes against the COVID-19 pandemic and to analyse the advantages and disadvantages of most conventional antiseptic mouthwashes used in dentistry.

Keywords: COVID-19; Coronavirus; Dentistry; Mouthwashes; Oral health.

Copyright © 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

References

    1. Kosutic D., Uglesic V., Perkovic D., et al. Preoperative antiseptics in clean/contaminated maxillofacial and oral surgery: prospective randomized study. Int J Oral Maxillofac Surg. 2009;38:160–165.
    1. Dominiak M., Shuleva S., Silvestros S., et al. A prospective observational study on perioperative use of antibacterial agents in implant surgery. Adv Clin Exp Med. 2020;29:355–363.
    1. Marui V.C., Souto M.L.S., Rovai E.S., et al. Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: a systematic review. J Am Dent Assoc. 2019;150:1015–1026. e1.
    1. Peng X., Xu X., Li Y., et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12:9.
    1. Ather A., Patel B., Ruparel N.B., et al. Coronavirus disease 19 (COVID-19): implications for clinical dental care. J Endod. 2020;46:584–595.
    1. Yoon J.G., Yoon J., Song J.Y., et al. Clinical significance of a high SARS-CoV-2 viral load in the saliva. J Korean Med Sci. 2020;35:e195.
    1. Li F. Structure, function, and evolution of coronavirus spike proteins. Annu Rev Virol. 2016;3:237–261.
    1. Chen Y., Guo Y., Pan Y., et al. Structure analysis of the receptor binding of 2019-nCoV. Biochem Biophys Res Commun. 2020;525(February):135–140.
    1. Xu H., Zhong L., Deng J., et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12:8.
    1. Wan Y., Shang J., Graham R., et al. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol. 2020;94:e00127–e220.
    1. Hamming I., Timens W., Bulthuis M.L., et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203:631–637.
    1. Li Y., Ren B., Peng X., et al. Saliva is a non-negligible factor in the spread of COVID-19. Mol Oral Microbiol. 2020;35:141–145.
    1. Badran Z., Gaudin A., Struillou X., et al. Periodontal pockets: a potential reservoir for SARS-CoV-2? Med Hypoth. 2020;143:109907.
    1. Siqueira W.L., Moffa E.B., Mussi M.C., et al. Zika virus infection spread through saliva – a truth or myth? Braz Oral Res. 2016;30 S1806-83242016000100801.
    1. Anschau V., Sanjuán R. Fibrinogen gamma chain promotes aggregation of vesicular stomatitis virus in saliva. Viruses. 2020;12:282.
    1. Baghizadeh Fini M. Oral saliva and COVID-19. Oral Oncol. 2020;108:104821.
    1. American Dental Association . 2020. ADA interim guidance for minimizing risk of COVID-19 transmission. Available from URL: [last accessed 13.08.20]
    1. Centers for Disease Control and Prevention. Interim infection prevention and control guidance for dental settings during the COVID-19 response. Available from URL: [last accessed 13.08.20]
    1. Milstone A.M., Passaretti C.L., Perl T.M. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis. 2008;46:274–281.
    1. Vitkov L., Hermann A., Krautgartner W.D., et al. Chlorhexidine-induced ultrastructural alterations in oral biofilm. Microsc Res Tech. 2005;68:85–89.
    1. Da Costa L.F.N.P., Amaral C.D.S.F., Barbirato D.D.S., et al. Chlorhexidine mouthwash as an adjunct to mechanical therapy in chronic periodontitis: a meta-analysis. J Am Dent Assoc. 2017;148:308–318.
    1. Bernstein D., Schiff G., Echler G., et al. In vitro virucidal effectiveness of a 0.12%-chlorhexidine gluconate mouthrinse. J Dent Res. 1990;69:874–876.
    1. Fehr A.R., Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1–23.
    1. Kampf G., Todt D., Pfaender S., et al. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020;104:246–251.
    1. Marshall M.V., Cancro L.P., Fischman S.L. Hydrogen peroxide: a review of its use in dentistry. J Periodontol. 1995;66:786–796.
    1. Walsh L.J. Safety issues relating to the use of hydrogen peroxide in dentistry. Aust Dent J. 2000;45:257–289.
    1. Rosling B.G., Slots J., Webber R.L., et al. Microbiological and clinical effects of topical subgingival antimicrobial treatment on human periodontal disease. J Clin Periodontol. 1983;10:487–514.
    1. Gusberti F.A., Sampathkumar P., Siegrist B.E., et al. Microbiological and clinical effects of chlorhexidine digluconate and hydrogen peroxide mouthrinses on developing plaque and gingivitis. J Clin Periodontol. 1988;15:60–67.
    1. Mentel R., Shirrmakher R., Kevich A., et al. Virus inactivation by hydrogen peroxide. Vopr Virusol. 1977:731–733. [in Russian]
    1. Gerba C.P. Quaternary ammonium biocides: efficacy in application. Appl Environ Microbiol. 2015;81:464–469.
    1. Mukherjee P.K., Esper F., Buchheit K., et al. Randomized, double-blind, placebo-controlled clinical trial to assess the safety and effectiveness of a novel dual-action oral topical formulation against upper respiratory infections. BMC Infect Dis. 2017;17:74.
    1. Silva M.F., dos Santos N.B., Stewart B., et al. A clinical investigation of the efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium chloride to control established dental plaque and gingivitis. J Clin Dent. 2009;20:55–61.
    1. Feres M., Figueiredo L.C., Faveri M., et al. The effectiveness of a preprocedural mouthrinse containing cetylpyridinium chloride in reducing bacteria in the dental office. J Am Dent Assoc. 2010;141:415–422.
    1. Popkin D.L., Zilka S., Dimaano M., et al. Cetylpyridinium chloride (CPC) exhibits potent, rapid activity against influenza viruses in vitro and in vivo. Pathog Immun. 2017;2:252–269.
    1. Baker N., Williams A.J., Tropsha A., et al. Repurposing quaternary ammonium compounds as potential treatments for COVID-19. Pharm Res. 2020;37:104.
    1. Parhar H.S., Tasche K., Brody R.M., et al. Topical preparations to reduce SARS-CoV-2 aerosolization in head and neck mucosal surgery. Head Neck. 2020;42:1268–1272.
    1. Ader A.W., Paul T.L., Reinhardt W., et al. Effect of mouth rinsing with two polyvinylpyrrolidone-iodine mixtures on iodine absorption and thyroid function. J Clin Endocrinol Metab. 1988;66:632–635.
    1. Kirk-Bayley J, Sunkaraneni VS, Challacombe SJ. The use of povidone iodine nasal spray and mouthwash during the current COVID-19 pandemic may reduce cross infection and protect healthcare workers (May 4, 2020). Available from URL: [last accessed 13.08.20]
    1. Tsuda S., Soutome S., Hayashida S., et al. Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study. BMC Oral Health. 2020;20:62.
    1. Kariwa H., Fujii N., Takashima I. Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions and chemical reagents. Dermatology. 2006;212(Suppl. 1):119–123.
    1. Lachapelle J.M. Allergic contact dermatitis from povidone-iodine: a re-evaluation study. Cont Dermat. 2005;52:9–10.
    1. Slots J. Selection of antimicrobial agents in periodontal therapy. J Periodontal Res. 2002;37:389–398.
    1. Shiraishi T., Nakagawa Y. Evaluation of the bactericidal activity of povidone-iodine and commercially available gargle preparations. Dermatology. 2002;204(Suppl. 1):37–41.
    1. Eggers M., Koburger-Janssen T., Eickmann M., et al. In vitro bactericidal and virucidal efficacy of povidone-iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther. 2018;7:249–259.
    1. Mady L.J., Kubik M.W., Baddour K., et al. Consideration of povidone-iodine as a public health intervention for COVID-19: utilization as “Personal Protective Equipment” for frontline providers exposed in high-risk head and neck and skull base oncology care. Oral Oncol. 2020;105:104724.
    1. Challacombe S.J., Kirk-Bayley J., Sunkaraneni V.S., et al. Povidone iodine. Br Dent J. 2020;228:656–657.
    1. Caruso A.A., Del Prete A., Lazzarino A.I. Hydrogen peroxide and viral infections: a literature review with research hypothesis definition in relation to the current COVID-19 pandemic. Med Hypoth. 2020;144:109910.
    1. Bidra A.S., Pelletier J.S., Westover J.B., et al. Rapid in-vitro inactivation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using povidone-iodine oral antiseptic rinse. J Prosthodont. 2020;29:529–533.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren