Antiviral effect of mouthwashes against SARS-COV-2: A systematic review

Abstract

Objective This systematic review aimed to evaluate the antiviral effect of mouthwashes against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Material and methods An electronic search was performed on PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ProQuest, and Google Scholar, and was complemented by a manual search. Both clinical and in vitro studies that focused on the antiviral effect of mouthwashes against SARS-CoV-2 were included. Risk of bias assessment was performed only on the clinical studies using the RoB-2 and ROBINS-I tools. Results A total of 907 records were found; after initial selection by title and abstract, 33 full-text articles were selected to be evaluated for eligibility. Finally, a total of 27 studies were included for the qualitative synthesis, including 16 in vitro studies and 11 clinical trials. Antiviral effects were evaluated separately for the in vitro and clinical studies. In vitro studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, essential oils, cetylpyridinium chloride, and other compounds; in vivo studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, essential oils, chlorine dioxide, β-cyclodextrin-citrox, and sorbitol with xylitol. Povidone-iodine, cetylpyridinium chloride, and essential oils were effective in vitro , while hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, β-cyclodextrin-citrox, and sorbitol with xylitol were effective in vivo . Unclear or high risk of bias was found for almost all clinical studies, and only one study presented with a low risk of bias. No further quantitative analysis was performed. Conclusion Although povidone-iodine, cetylpyridinium chloride, and essential oils may be an alternative to reduce the viral load in vitro and in vivo , more studies are needed to determine the real antiviral effect of these different mouthwashes against SARS-CoV-2. This work was not funded. The protocol was registered in PROSPERO (identification number: CRD42021236134).

In vitro virucidal activity of mouthwashes on SARS‐CoV‐2

“…The COVID‐19 pandemic prompted a dramatic closure or limitation of dental services worldwide, thus causing serious health and economic consequences (Marcenes, 2020 ). The increasing risks in SARS‐CoV‐2 transmission via saliva and respiratory secretions during dental procedures has led to the use of pre‐operating mouthwashes (Tadakamadla et al, 2021 ; Mendoza et al, 2022 ; Silva et al, 2021 ) as additional preventive measures together with physical barriers such as facial masks and facial barriers.…”

Mouth rinses efficacy on salivary SARS‐CoV‐2 viral load: A randomized clinical trial

“… 25 Several clinical studies emerged with conflicting results regarding the effectiveness of preprocedural mouth rinses against SARS‐CoV‐2. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Therefore, this study investigated the effect of four commercially available mouth rinses (PVP‐I, H 2 O 2 , CPC, and HOCl) on salivary SARS‐CoV‐2 viral load overtime.…”

“…Consequently, preprocedural rinsing has been recommended as a preventive measure to mitigate SARS‐CoV‐2 transmissions during the COVID‐19 pandemic by ADA and the Centers for Disease Control and Prevention (CDC) 17,18 . However, evidence from in vitro and clinical studies is limited and contradictory regarding the antiviral potential of different mouth rinses against SARS‐CoV2 19–27 . The limited number of clinical studies and the equivocal results mandate conducting more clinical trials to evaluate the effectiveness of mouth rinses against salivary SARS‐CoV‐2.…”

“…17 , 18 However, evidence from in vitro and clinical studies is limited and contradictory regarding the antiviral potential of different mouth rinses against SARS‐CoV2. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 The limited number of clinical studies and the equivocal results mandate conducting more clinical trials to evaluate the effectiveness of mouth rinses against salivary SARS‐CoV‐2.…”

Further observations on hydrogen peroxide antisepsis and COVID-19 cases among healthcare workers and inpatients

“…The search for new strategies to contain the pandemic must, therefore, continue, and include focusing on measures to prevent contracting and spreading SARS-CoV-2. The growing interest in the use of oro- and nasopharyngeal antiseptics to inactivate SARS-CoV-2 to control the pandemic is, therefore, not, surprising [12] , [13] , [14] , [15] .…”