Oral antiseptics against coronavirus: in-vitro and clinical evidence

Abstract

Background Angiotensin converting enzyme II (ACE2) is the cellular receptor for SARS-CoV-2, so ACE2-expressing cells can act as target cells and are susceptible to infection. ACE2 receptors are highly expressed in the oral cavity so this may be a potential high-risk route for SARS-CoV-2 infection. Furthermore, the virus can be detected in saliva, even before COVID-19 symptoms appear, with the consequent high risk of virus transmission in asymptomatic/pre-symptomatic patients. Reducing oral viral load could lead to a lower risk of transmission via salivary droplets or aerosols and therefore contribute to the control of the pandemic. Aim To evaluate the available evidence testing the in vitro and in vivo effects of oral antiseptics to inactivate or eradicate coronaviruses. Methods The criteria used were those described in the PRISMA® Declaration for performing systematic reviews. An electronic search in MEDLINE (via PubMed) and in Web of Sciences, using the terms MeSH: “mouthwash” OR “oral rinse” OR “mouth rinse” OR “povidone iodine” OR “hydrogen peroxide” OR “cetylpyridinium chloride” AND “COVID-19” OR “SARS-CoV-2” OR “coronavirus” OR “SARS” OR “MERS”. Findings The initial search strategy identified 619 articles on two electronic databases. A total of 17 articles were included assessing the virucidal efficacy of oral antiseptics against coronaviruses. Conclusions There is sufficient in vitro evidence to support the use of antiseptics to potentially reduce the viral load of SARS-CoV-2 and other coronaviruses. However, in vivo evidence for most oral antiseptics is limited. Randomized clinical trials with a control group are needed to demonstrate its clinical efficacy.

Oral Microbiome Dysbiosis Is Associated With Symptoms Severity and Local Immune/Inflammatory Response in COVID-19 Patients: A Cross-Sectional Study

“…On the other hand, connections between oral dysbiosis and post-viral complications have been reported, suggesting that improving oral health may reduce the risk of complications from COVID-19 (Sampson et al, 2020), thus supporting the hypothesis of a role of dysbiosis in the virus-induced disease. Toward this direction, recent studies reported that SARS-CoV-2 load can be reduced by the use of chlorhexidine mouthwashes (Yoon et al, 2020), supporting the use of antiseptics against coronavirus infection (Koch-Heier et al, 2021;Mateos Moreno et al, 2021), and clinical studies are developing accordingly (Carrouel et al, 2020) and hopefully will help to clarify this aspect.…”

The use of antiviral Phthalocyanine mouthwash as a preventive measure against COVID-19

“…It was demonstrated that the use of antiviral oral antiseptics (mouthrinses) had the potential to reduce the in vitro viral load of SARS-CoV-2, but the in vivo effectiveness was still inconclusive [ 5 ]. Only in April 2021 was it suggested that there was sufficient in vitro and in vivo evidence of the effectiveness of some oral antiseptics in inactivating SARS-CoV-2 and other coronaviruses [ 6 ] (Figure 1 (Fig. 1) ).…”

Cetylpyridinium chloride mouthwashes: Potential role in COVID-19 control

“…Other authors [ 3 , 7 ] have suggested the use of mouthwashes before any procedure that generates aerosols, such as dental care; however, official recommendations on the use of mouthwashes that contribute to the prevention or attenuation of COVID-19 in the population have not yet been published.…”

“…Mouthwashes with CPC are low-cost, clinically safe and easily accessible products for the general public, with an in vitro antiviral effect superior to chlorhexidine [ 1 , 7 ]; similarly, CPC could be added to body disinfectants to decrease the amount of virus spread [ 9 ]. On the other hand, the recommendations made by governments and healthcare providers need to be based on complete and conclusive evidence, so that the use of this type of product can be massively communicated.…”