Virucidal activity of oral care products against SARS-CoV-2 in vitro

Abstract

Objective Coronavirus disease 2019 (COVID-19) caused by infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Since reducing the amount of virus in saliva is considered to prevent broader infection, the Center for Disease Control (CDC) and American Dental Hygienists’ Association (ADHA) have recommended use of CPC- or CHX-containing oral care products before the dental procedure. However, there is no certified evidence. So, we examined inactivation of SARS-CoV-2 by oral care products in several countries in vitro . Methods 0.05% Cetylpyridinium chloride (CPC) mouthwash, 0.05% CPC toothpaste and 0.30% CPC spray in Japan; 0.06% chlorhexidine gluconate (CHX) + 0.05% CPC mouthwash and 0.12% CHX + 0.05% CPC mouthwash in Europe; 0.075% CPC mouthwash, 0.12% CHX mouthwash, and 0.20% delmopinol hydrochloride mouthwash in the USA; and 0.04% CPC mouthwash in China were assessed for their virucidal activity with ASTM E1052. Results The virus was inactivated in vitro by the contact time in directions for use of all oral care products containing CPC or delmopinol hydrochloride as anticeptics. Conclusions These results suggest that these oral care products in each country may reduce the viral load in the mouth.

Virucidal activity of CPC-containing oral rinses against SARS-CoV-2 variants and are active in the presence of human saliva

“…In contrast, within the same experiment, a mouthwash containing CHX (0.2% chlorhexidine gluconate), exhibited poorer virucidal activity against SARS-CoV-2. Our observations are consistent with others, where a number of different CPC mouthwash formulations have been shown to effectively inactivate SARS-CoV-2 in vitro , whereas CHX containing mouthwashes are reported to have modest ability to inactive SARS-CoV-2 [6, 19, 21]. The virucidal action of CPC mouthwash was maintained in the presence of whole human saliva, consistent with human clinical trials which report that rinsing with CPC mouthwash can lower SARS-CoV-2 salivary count for several hours after use [7, 28].…”

“…CPC is widely used in mouthwash formulations displaying substantive action against a range of oral bacteria [12][13][14] and viruses, including SARS-CoV-2 [6,[15][16][17], whilst data on antiviral efficacy of CHX against SARS-CoV-2 has been more varied [18][19][20][21][22]. All mouthwashes, regardless of composition, must function in situ in the oral cavity, and hence must retain efficacy in the presence of human saliva, overcoming any potential deactivation from salivary components [23][24][25].…”

Surfactants – Compounds for inactivation of SARS-CoV-2 and other enveloped viruses

“… soap (Na oleate, laurate) a inactivation of Flu viruses [ 109 ] SDS a reducing the infectivity of tomato bushy stunt and potato X viruses [ 110 ] disinfection [ 106 , 107 ] Triton X-100 n activity of the replication/transcription complex of SARS-CoV was greatly reduced [ 115 ] effectiveness of classical, often surfactant-based, disinfectants [ 116 ] sodium laureth sulfate a inactivate SARS-CoV-2 effectively [ 117 ] quaternary alkyl am-monium salts (QUATs) c Disinfection; most widely employed group of disinfectants for hard surfaces [ [120] , [121] , [122] , [123] ] hand sanitation [ 128 ] benzalkonium chloride inactivates Coronaviruses [ 118 , 119 ] chlorhexidine (typically as salt, e.g. as gluconate or digluconate) c antiviral activity against enveloped viruses, as demonstrated for SARS-CoV-2 [ 138 ] Chlorhexidine together with CPyC c effective against SARS-CoV-2 in a variety of different formulations [ 139 ] different agents in mouthwashes/dentistry [ 140 ] anionic peptide surfactant surfactin a very effective against enveloped viruses but: applicability is limited by cytotoxicity [ 134 , ...…”

“…Here an interesting study by neutron diffraction, using a model membrane of PC, has shown that chlorhexidine positions itself at the head group of the phospholipid, suggesting a mode of action where the molecule is bent in half and inserts wedge-like into the lipid matrix, a mode of action that is very similar to that employed by antimicrobial peptides when they interact with bilayers [ 152 ]. Chlorhexidine is often employed in combination with CPyC, which has been known for a long time to be a very effective microbial for mouthwash formulation, but recently was also shown to be very effective against SARS-CoV-2 in different formulations [ 139 ]. The reduction in virus titer was very high (between approximately 1,000- to 10,000-fold, log 10 : 3.3-4.3), and in this study it was also reported that delmopinol (2-[3-(4-propylheptyl)morpholin-4-yl]ethanol) hydrochloride, another amphiphilic compound, even showed a higher activity (log 10 >5.3).…”

Los enjuagatorios bucales en tiempos de Covid-19

“…El cloruro de cetilpiridinio (CCP), es un compuesto de amonio cuaternario presente en varios enjuagues bucales y aerosoles para el aliento. Posee una probada actividad antiséptica y antimicrobiana, y se ha demostrado in vitro, que reduce mil veces la infectividad del SARS-CoV-2 al inhibir la fusión del virus con las células diana y además tendría un efecto mantenido en la reducción del nivel salival de SARS-CoV-2 en pacientes con COVID-19 (8,9,10,12,13) .…”