Objectives Recent scientific evidences suggest a relevant role of the oral cavity in the transmission and pathogenicity of SARS-CoV-2. Methods A literature search was performed in PubMed, up to April 30, 2020, focusing on SARS-CoV-2, COVID-19, oral cavity, and antimicrobial agents. Results Oral viral load of SARS-CoV-2 has been associated with the severity of COVID-19, and thus, a reduction in the oral viral load could be associated with a decrease in the severity of the condition. Similarly, a decrease in the oral viral load would diminish the amount of virus expelled and reduce the risk of transmission, since (i) during the first 10 days, the virus mainly accumulates at the nasal, oral, and pharyngeal area; (ii) the number of angiotensin-converting enzyme (ACE2) receptor is greater in the salivary glands as compared with the lungs; and (iii) salivary droplets represent the most relevant transmission route. To reduce the oral viral load, antiseptic agents may be used, although the evidence on its efficacy is indirect and weak. Conclusions Antiseptic mouth rinses, such as those containing cetylpyridinium chloride or povidone-iodine, may be able to decrease the severity of COVID-19 by reducing oral viral load in infected subjects and decreasing the risk of transmission by limiting viral load in droplets, generated in normal life, or in aerosols, produced during dental procedures. Well-designed clinical and preclinical research must be conducted to support these hypotheses. Clinical relevance Antiseptic mouth rinses may help in decreasing the severity of COVID-19 and in reducing the risk of transmission.

of adjunctive antiplaque chemical agents in managing gingivitis: a systematic review and meta-analysis. J Clin Periodontol 2015; 42 (Suppl. 16): S106-S138. doi: 10.1111/jcpe.12331. AbstractAim: The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials (RCTs). Material and Methods: A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences (WMD) and 95% confidence intervals. Results: After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of L€ oe & Silness gingival index (46 comparisons, WMD À0.217), modified gingival index (n = 23, À0.415), gingivitis severity index (n = 26, À14.939%) or bleeding index (n = 23, À7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD À0.475), Silness & L€ oe (n = 26, À0.109), and plaque severity (n = 12, À23.4%) indices, with significant heterogeneity. (Beals et al. 2000); limited use of interdental cleaning (Lang et al. 1995, Stewart et al. 1997, MacGregor et al. 1998); tendency to return to baseline plaque levels in patients instructed in oral hygiene procedures (Stewart et al. 1997) or in patients enrolled in oral hygiene studies (Emilson & Fornell 1976, Lie & Enersen 1986, Yates et al. 1993, Claydon et al. 1996, Rosling et al. 1997; lack of mechanical control of other oral biofilms different from dental plaque (Quirynen et al. 1995, Greenstein 2002, 2004.The adjunctive use of chemical plaque control may be required in those subjects who are not able to effectively remove supragingival biofilms by the sole use of mechanical procedures which, in addition, reduce the amount of biofilm and disrupt its structure. There is a general consensus that plaque inhibitory and antiplaque activities of a given formulation must be proven in long-term (at least 6 months), home-use, randomised clinical trials (RCT), together with the evidence of its safety, primarily shown by the lack of relevant side effects. In these studies, the use of the tested formulations should be adjunctive to mechanical plaque control. The characteristics of this type of trial, in order to obtain valid conclusions, has been approved (Council of Dental Therapeutics 1986), and include double blindness, presence of a control group, a minimum duration of 6 months, a microbiological evaluation, and the selection of a representative population.Based on the previous information, the present systematic review was focused on those studies providing ...

Within the limitations of this study (including the severe imbalance in the amount of evidence), dentifrices containing triclosan-copolymer or chlorhexidine and mouthrinses containing essential oils or chlorhexidine showed the greatest effect on PlI scores as assessed with NMA.

Aim:The aim of this network meta-analysis (NMA) was to compare the efficacy of different oral hygiene products for chemical biofilm control, in 6-month home-use, randomized clinical trials (RCTs), in terms of changes in gingival index (GI). Material and Methods:Six-month RCTs assessing GI were identified and screened for inclusion. Relevant information was extracted, and quality and potential risk of bias were estimated. Mean differences between baseline and end were calculated to obtain standardized mean differences (SMDs). NMA protocols were applied to assess direct and indirect comparisons among products using Löe & Silness GI, modified GI and gingival severity index.Results: Fifty-three papers were included, 19 studies for mouth rinses, 32 for dentifrices, comprising data from 5,775 and 2,682 subjects, respectively. When ranking treatments, similar results were observed for all tested dentifrices, with the lowest effect observed for sanguinarine and baking soda. For mouth rinses, essential oils, triclosan-copolymer, chlorhexidine (at concentrations ≥ 0.10%) and cetylpyridinium chloride (>0.05%) demonstrated the greatest effect. Conclusion:Although NMA revealed significant differences when comparing placebo versus some active agents, when comparing among active agents, no differences were found for dentifrices, while mouth rinses containing essential oils showed the greatest effect on GI scores. K E Y W O R D S antiseptic, chemical biofilm control, dentifrice, gingival bleeding, gingival index, gingivitis, mouth rinse, network meta-analyses, systematic review S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Figuero E, Herrera D, Tobías A, et al. Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: A systematic review and network meta-analyses. J Clin Periodontol. 2019;46:723-739. https ://doi.

Dentifrices are a general term used to describe preparations that are used together with a toothbrush with the purpose to clean and/or polish the teeth. Active toothpastes were first formulated in the 1950s and included ingredients such as urea, enzymes, ammonium phosphate, sodium lauryl sarcosinate and stannous fluoride. Later, therapeutic agents were included. Today's toothpastes have two objectives: to help the toothbrush in cleaning the tooth surface and to provide a therapeutic effect. The therapeutic effect may have an antiplaque or anti-inflammatory basis when the nature of the agents is antimicrobial. Plaque inhibitory and antiplaque activity of toothpastes used for chemical plaque control is evaluated in distinct consecutive stages, the last being home use randomized clinical trials of at least 6 months' duration. In this chapter, the scientific evidence supporting the use of the most common antiplaque agents, included in toothpaste formulations, is reviewed, with a special emphasis on 6-month clinical trials, and systematic reviews with meta-analyses of the mentioned studies. Among the active agents, the following have been included in toothpastes: enzymes, amine alcohols, herbal or natural products, triclosan, bisbiguanides (chlorhexidine), quaternary ammonium compounds (cetylpyridinium chloride) and different metal salts (zinc salts, stannous fluoride, stannous fluoride with amine fluoride). Dentifrices are the ideal vehicles for any active ingredient used as an oral health preventive measure since they are used in combination with toothbrushing, which is the most frequently employed oral hygiene method. The most important indications of dentifrices with active ingredients are associated with long-term use to prevent bacterial biofilm formation, mostly in gingivitis patients or in patients on supportive periodontal therapy.