Clinical evaluation of antiseptic mouth rinses to reduce salivary load of SARS-CoV-2
Maria D Ferrer, Álvaro Sánchez Barrueco, Yolanda Martinez-Beneyto, María V Mateos-Moreno, Verónica Ausina-Márquez, Elisa García-Vázquez, Miguel Puche-Torres, Maria J Forner Giner, Alfonso Campos González, Jessica M Santillán Coello, Ignacio Alcalá Rueda, José M Villacampa Aubá, Carlos Cenjor Español, Ana López Velasco, Diego Santolaya Abad, Sandra García-Esteban, Alejandro Artacho, Xavier López-Labrador, Alex Mira, Maria D Ferrer, Álvaro Sánchez Barrueco, Yolanda Martinez-Beneyto, María V Mateos-Moreno, Verónica Ausina-Márquez, Elisa García-Vázquez, Miguel Puche-Torres, Maria J Forner Giner, Alfonso Campos González, Jessica M Santillán Coello, Ignacio Alcalá Rueda, José M Villacampa Aubá, Carlos Cenjor Español, Ana López Velasco, Diego Santolaya Abad, Sandra García-Esteban, Alejandro Artacho, Xavier López-Labrador, Alex Mira
Abstract
Most public health measures to contain the COVID-19 pandemic are based on preventing the pathogen spread, and the use of oral antiseptics has been proposed as a strategy to reduce transmission risk. The aim of this manuscript is to test the efficacy of mouthwashes to reduce salivary viral load in vivo. This is a multi-centre, blinded, parallel-group, placebo-controlled randomised clinical trial that tests the effect of four mouthwashes (cetylpyridinium chloride, chlorhexidine, povidone-iodine and hydrogen peroxide) in SARS-CoV-2 salivary load measured by qPCR at baseline and 30, 60 and 120 min after the mouthrinse. A fifth group of patients used distilled water mouthrinse as a control. Eighty-four participants were recruited and divided into 12-15 per group. There were no statistically significant changes in salivary viral load after the use of the different mouthwashes. Although oral antiseptics have shown virucidal effects in vitro, our data show that salivary viral load in COVID-19 patients was not affected by the tested treatments. This could reflect that those mouthwashes are not effective in vivo, or that viral particles are not infective but viral RNA is still detected by PCR. Viral infectivity studies after the use of mouthwashes are therefore required. ( https://ichgcp.net/clinical-trials-registry/NCT04707742 ; Identifier: NCT04707742).
Conflict of interest statement
The authors declare no competing interests.
© 2021. The Author(s).
Figures
References
- Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J. Dent. Res. 2020;99:481–487. doi: 10.1177/0022034520914246.
- Mohan SV, Hemalatha M, Kopperi H, Ranjith I, Kumar AK. SARS-CoV-2 in environmental perspective: Occurrence, persistence, surveillance, inactivation and challenges. Chem. Eng. J. 2021;405:126893. doi: 10.1016/j.cej.2020.126893.
- Whitworth J. COVID-19: A fast evolving pandemic. Trans. R. Soc. Trop. Med. Hyg. 2020;114:227–228. doi: 10.1093/trstmh/traa025.
- Chan JF, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet. 2020;395(10223):514–523. doi: 10.1016/S0140-6736(20)30154-9.
- Wang W, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA J. Am. Med. Assoc. 2020 doi: 10.1001/jama.2020.3786.
- Xu H, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int. J. Oral Sci. 2020;12(1):1–5. doi: 10.1038/s41368-019-0067-9.
- Xu J, Li Y, Gan F, Du Y, Yao Y. Salivary glands: Potential reservoirs for COVID-19 asymptomatic infection. J. Dent. Res. 2020;99(8):989. doi: 10.1177/0022034520918518.
- Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin. Oral Investig. 2020;24(4):1619–1621. doi: 10.1007/s00784-020-03248-x.
- Popkin DL, et al. Cetylpyridinium chloride (CPC) exhibits potent, rapid activity against influenza viruses in vitro and in vivo. Pathog. Immun. 2017;2(2):252–269.
- Eggers M, Koburger-Janssen T, Ward LS, Newby C, Müller S. Bactericidal and virucidal activity of povidone-iodine and chlorhexidine gluconate cleansers in an in vivo hand hygiene clinical simulation study. Infect. Dis. Ther. 2018;7(2):235–247. doi: 10.1007/s40121-018-0202-5.
- Wood A, Payne D. The action of three antiseptics/disinfectants against enveloped and non-enveloped viruses. J. Hosp. Infect. 1998;38:283–295. doi: 10.1016/S0195-6701(98)90077-9.
- Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In vitro bactericidal and virucidal efficacy of povidone-iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect. Dis. Ther. 2018;7(2):249–259. doi: 10.1007/s40121-018-0200-7.
- Eggers M, Eickmann M, Zorn J. Rapid and effective virucidal activity of povidone-iodine products against Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Modified Vaccinia Virus Ankara (MVA) Infect. Dis. Ther. 2015;4(4):491–501. doi: 10.1007/s40121-015-0091-9.
- Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J. Hosp. Infect. 2020;104(3):246–251. doi: 10.1016/j.jhin.2020.01.022.
- Meyers C, Robison R, Milici J, Solo K, Yaacoub S, Schünemann HJ. Lowering the transmission and spread of human coronavirus. J. Med. Virol. 2020 doi: 10.1002/jmv.26514.
- Steinhauer K, et al. Comparison of the in vitro-efficacy of different mouthwash solutions targeting SARS-CoV-2 based on the European Standard EN 14476. bioRxiv. 2020 doi: 10.1101/2020.10.25.354571.
- Meister TL, et al. Virucidal efficacy of different oral rinses against severe acute respiratory syndrome coronavirus 2. J. Infect. Dis. 2020;222(8):1289–1292. doi: 10.1093/infdis/jiaa471.
- Anderson DE, et al. Povidone-iodine demonstrates rapid in vitro virucidal activity against SARS-CoV-2, the virus causing COVID-19 disease. Infect. Dis. Ther. 2020;9(3):669–675. doi: 10.1007/s40121-020-00316-3.
- O'Donnell VB, et al. Potential role of oral rinses targeting the viral lipid envelope in SARS-CoV-2 infection. Function (Oxf) 2020;1(1):zqaa002. doi: 10.1093/function/zqaa002.
- Paz S, Mauer C, Ritchie A, Robishaw JD, Caputi M. A simplified SARS-CoV-2 detection protocol for research laboratories. PLoS One. 2020;15(12):e0244271. doi: 10.1371/journal.pone.0244271.PMID:33338082;PMCID:PMC7748277.
- WHO. Molecular assays to diagnose COVID-19: Summary table of available protocols. 24 January 2020.
- Corman VM, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020;25(3):2000045. doi: 10.2807/1560-7917.ES.2020.25.3.2000045.
- R Core Team . R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2020.
- Statkute E, Rubina A, O’Donnell VB, Stanton DWTRJ. The virucidal efficacy of oral rinse components against SARS-CoV-2. In Vitro. 2020 doi: 10.1101/2020.11.13.381079.
- 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. doi: 10.1159/000089211.
- Duke S, Forward G. The conditions occurring in vivo when brushing with toothpastes. Br. Dent. J. 1982;152:52–54. doi: 10.1038/sj.bdj.4804743.
- Sun J, et al. The kinetics of viral load and antibodies to SARS-CoV-2. Clin. Microbiol. Infect. 2020;26(12):1690.e1–1690.e4. doi: 10.1016/j.cmi.2020.08.043.
- Yoon JG, et al. Clinical significance of a high SARS-CoV-2 viral load in the saliva. J. Korean Med. Sci. 2020;35(20):e195. doi: 10.3346/jkms.2020.35.e195.
- Gottsauner MJ, et al. A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2. Clin. Oral Investig. 2020;24(10):3707–3713. doi: 10.1007/s00784-020-03549-1.
- Martínez LL, et al. Is povidone iodine mouthwash effective against SARS-CoV-2? First in vivo tests. Oral Dis. 2020 doi: 10.1111/odi.13526.
- Seneviratne CJ, et al. Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: Randomized control trial in Singapore. Infection. 2020;14:1–7.
- Riva L, et al. Discovery of SARS-CoV-2 antiviral drugs through large-scale compound repurposing. Nature. 2020;586(7827):113–119. doi: 10.1038/s41586-020-2577-1.
- Xu Y, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat. Med. 2020;26(4):502–505. doi: 10.1038/s41591-020-0817-4.
- Herrera D, Serrano J, Roldán S, Sanz M. Is the oral cavity relevant in SARS-CoV-2 pandemic? Clin. Oral Investig. 2020;24(8):2925–2930. doi: 10.1007/s00784-020-03413-2.
Source: PubMed