A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2

Maximilian J Gottsauner, Ioannis Michaelides, Barbara Schmidt, Konstantin J Scholz, Wolfgang Buchalla, Matthias Widbiller, Florian Hitzenbichler, Tobias Ettl, Torsten E Reichert, Christopher Bohr, Veronika Vielsmeier, Fabian Cieplik, Maximilian J Gottsauner, Ioannis Michaelides, Barbara Schmidt, Konstantin J Scholz, Wolfgang Buchalla, Matthias Widbiller, Florian Hitzenbichler, Tobias Ettl, Torsten E Reichert, Christopher Bohr, Veronika Vielsmeier, Fabian Cieplik

Abstract

Objectives: SARS-CoV-2 is mainly transmitted by inhalation of droplets and aerosols. This puts healthcare professionals from specialties with close patient contact at high risk of nosocomial infections with SARS-CoV-2. In this context, preprocedural mouthrinses with hydrogen peroxide have been recommended before conducting intraoral procedures. Therefore, the aim of this study was to investigate the effects of a 1% hydrogen peroxide mouthrinse on reducing the intraoral SARS-CoV-2 load.

Methods: Twelve out of 98 initially screened hospitalized SARS-CoV-2-positive patients were included in this study. Intraoral viral load was determined by RT-PCR at baseline, whereupon patients had to gargle mouth and throat with 20 mL of 1% hydrogen peroxide for 30 s. After 30 min, a second examination of intraoral viral load was performed by RT-PCR. Furthermore, virus culture was performed for specimens exhibiting viral load of at least 103 RNA copies/mL at baseline.

Results: Ten out of the 12 initially included SARS-CoV-2-positive patients completed the study. The hydrogen peroxide mouthrinse led to no significant reduction of intraoral viral load. Replicating virus could only be determined from one baseline specimen.

Conclusion: A 1% hydrogen peroxide mouthrinse does not reduce the intraoral viral load in SARS-CoV-2-positive subjects. However, virus culture did not yield any indication on the effects of the mouthrinse on the infectivity of the detected RNA copies.

Clinical relevance: The recommendation of a preprocedural mouthrinse with hydrogen peroxide before intraoral procedures is questionable and thus should not be supported any longer, but strict infection prevention regimens are of paramount importance.

Trial registration: German Clinical Trials Register (ref. DRKS00022484).

Keywords: COVID-19; Gargle; Hydrogen peroxide; Intraoral; Mouthrinse; SARS-CoV-2; Viral load.

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow of patients through the stages of this study
Fig. 2
Fig. 2
Copies/mL of SARS-CoV-2 RNA at baseline and 30 min after 1% hydrogen peroxide mouthrinse. All results are depicted as boxplots, which display medians, 1st and 3rd quartiles (box), minima and maxima (whiskers)

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Source: PubMed

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