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Ghoneim A, Proaño D, Kaur H, Singhal S. Aerosol-generating procedures and associated control/mitigation measures: Position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2024; 58:48-63. [PMID: 38505316 PMCID: PMC10946320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 03/21/2024]
Abstract
Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols. Discussion and Conclusion Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care.
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Affiliation(s)
| | - Diego Proaño
- Faculty of Dentistry, University of Toronto, Toronto, ON Canada
| | - Harpinder Kaur
- Faculty of Dentistry, University of Toronto, Toronto, ON Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, ON Canada
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McGrath C, Clarkson J, Glenny AM, Walsh LJ, Hua F. Effectiveness of Mouthwashes in Managing Oral Diseases and Conditions: Do They Have a Role? Int Dent J 2023; 73 Suppl 2:S69-S73. [PMID: 37867064 PMCID: PMC10690548 DOI: 10.1016/j.identj.2023.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 10/24/2023] Open
Abstract
Antimicrobial mouthwashes are considered to reduce dental plaque biofilm and thus the potential to prevent plaque-induced oral diseases, particularly periodontal diseases. The effectiveness of mouthwashes relates to this antiplaque role, as well as, their tooth-whitening potential and ability to mask/mange malodour (halitosis). There is also a growing interest in the use of mouthwashes as an adjunctive measure in post surgical and post-dental care, while the COVID-19 pandemic has given a new lease of life to mouthwashes as an oral antispetic that may be useful in reducing the oral viral load. The mode of action of mouthwashes varies, depending on their active ingredients, concentrations, and mode and frequency of use, as does their potential effectiveness. This article aims to provide a narrative overview of the evidence of the effectiveness of the most widely used mouthwashes in managing oral diseases, oral conditions, and adjunctive care roles.
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Affiliation(s)
- Colman McGrath
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | | | - Ann-Marie Glenny
- Division of Dentistry, School of Medical Sciences, University of Manchester, UK
| | | | - Fang Hua
- School & Hospital of Stomatology, Wuhan University, China
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Perussolo J, Teh MT, Gkranias N, Tiberi S, Petrie A, Cutino-Moguel MT, Donos N. Efficacy of three antimicrobial mouthwashes in reducing SARS-CoV-2 viral load in the saliva of hospitalized patients: a randomized controlled pilot study. Sci Rep 2023; 13:12647. [PMID: 37542087 PMCID: PMC10403620 DOI: 10.1038/s41598-023-39308-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/23/2023] [Indexed: 08/06/2023] Open
Abstract
This study aimed to evaluate the efficacy of 3 mouthwashes in reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in the saliva of coronavirus disease 2019 (COVID-19) patients at 30 min, 1, 2 and 3 h after rinsing. This pilot study included 40 admitted COVID-19 positive patients (10 in each group). Saliva samples were collected before rinsing and at 30 min, 1, 2 and 3 h after rinsing with: Group 1-0.2% Chlorhexidine digluconate (CHX); Group 2-1.5% Hydrogen peroxide (H2O2); Group 3-Cetylpyridinium chloride (CPC) or Group 4 (control group)-No rinsing. Viral load analysis of saliva samples was assessed by Reverse Transcription quantitative PCR. Mean log10 viral load at different time points was compared to that at baseline in all groups using a random effects linear regression analysis while for comparison between groups linear regression analysis was used. The results showed that all groups had a significantly reduced mean log10 viral load both at 2 (p = 0.036) and 3 (p = 0.041) hours compared to baseline. However, there was no difference in mean log10 viral load between any of the investigated mouthwashes and the control group (non-rinsing) at the evaluated time points. Although a reduction in the SARS-CoV-2 viral load in the saliva of COVID-19 patients was observed after rinsing with mouthwashes containing 0.2% CHX, 1.5% H2O2, or CPC, the reduction detected was similar to that achieved by the control group at the investigated time points. The findings of this study may suggest that the mechanical action of rinsing/spitting results in reduction of SARS-CoV-2 salivary load.
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Affiliation(s)
- Jeniffer Perussolo
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Muy-Teck Teh
- Centre for Oral Immunobiology and Regenerative Medicine, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nikolaos Gkranias
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Simon Tiberi
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
- Division of Infection, Newham and The Royal London Hospitals, Barts Health NHS Trust, London, UK
| | - Aviva Petrie
- Biostatistics Unit, Eastman Dental Institute, University College London, London, UK
| | | | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK.
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Shayegh M, Sorenson C, Downey J, Lin S, Jiang Y, Sodhi P, Sullivan V, Howard KM, Kingsley K. Assessment of SARS-CoV-2 (COVID-19) Clinical Mouthwash Protocol and Prevalence of the Oral Pathogen Scardovia wiggsiae: A Pilot Study of Antibacterial Effects. Methods Protoc 2023; 6:65. [PMID: 37489432 PMCID: PMC10366884 DOI: 10.3390/mps6040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
One protocol in healthcare facilities and dental offices due to the COVID-19 pandemic for reducing the amount of detectable oral SARS-CoV-2 has been gargling with mouthwash for 60 s. This protocol lasts longer than the daily routine for most patients and may have unexpected benefits in reducing oral microbes as a result. This project evaluated the prevalence of the newly identified oral pathogen Scardovia wiggsiae before and after this procedure to determine any measurable effects. Using an approved protocol, n = 36 pre-mouthwash patient samples, n = 36 matched post-mouthwash samples, and n = 36 matched recall samples were identified (total sample number n = 108). DNA was isolated from each sample (pre-, post-mouthwash, and recall). Screening using qPCR and validated primers revealed n = 10/36 or 27.8% tested positive for Scardovia among the pre-mouthwash (Sample A) isolates with n = 3/36 or 8.3% testing positive among the post-mouthwash (Sample B) isolates. Screening of the recall (Sample C) samples has revealed n = 10/36, or 27.8% once again tested positive for Scardovia, demonstrating that this pathogen was found among a significant proportion of pediatric patient samples. Moreover, the COVID-19-related procedure of requiring sustained mouth washing prior to clinical treatment appears to reduce the levels of detectable Scardovia, at least initially. However, this study found no long-term effects using this isolated protocol.
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Affiliation(s)
- Melika Shayegh
- Department of Advanced Education in Pediatric Dentistry, School of Dental Medicine, University of Nevada, Las Vegas, 1700 W Charleston Boulevard, Las Vegas, NV 89106, USA
| | - Chase Sorenson
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1700 W Charleston Boulevard, Las Vegas, NV 89106, USA
| | - Jackson Downey
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1700 W Charleston Boulevard, Las Vegas, NV 89106, USA
| | - Summer Lin
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1700 W Charleston Boulevard, Las Vegas, NV 89106, USA
| | - Yuxin Jiang
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1700 W Charleston Boulevard, Las Vegas, NV 89106, USA
| | - Praneeti Sodhi
- Department of Advanced Education in Pediatric Dentistry, School of Dental Medicine, University of Nevada, Las Vegas, 1700 W Charleston Boulevard, Las Vegas, NV 89106, USA
| | - Victoria Sullivan
- Department of Advanced Education in Pediatric Dentistry, School of Dental Medicine, University of Nevada, Las Vegas, 1700 W Charleston Boulevard, Las Vegas, NV 89106, USA
| | - Katherine M Howard
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1001 Shadow Lane Boulevard, Las Vegas, NV 89106, USA
| | - Karl Kingsley
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1001 Shadow Lane Boulevard, Las Vegas, NV 89106, USA
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Hasan F, Chiu HY, Salamanca E, Ridwan ES, Wiratama BS, Budi HS. Effects of Chlorhexidine and Povidone-Iodine on the SARS-CoV-2 Load: A Systematic Review and Meta-analysis. Eur J Dent 2023; 17:587-601. [PMID: 36075270 PMCID: PMC10569867 DOI: 10.1055/s-0042-1753470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The efficacy of mouthwash for reducing the viral load in patients with the novel coronavirus disease 2019 (COVID-19) remains unclear. This systematic review and meta-analysis comprehensively examined the effects of chlorhexidine (CHX) and povidone-iodine (PVP-I) on the viral load in patients with COVID-19. We performed methodological analysis, systematic review, and meta-analysis of included studies using the Comprehensive Meta-analysis Software. PubMed, EMBASE, Cochrane Library, and ProQuest were searched from December 1, 2019, to December 2, 2021. In total, we included 10 studies of 1,339 patients with COVID-19. Compared with the control group, both CHX and PVP-I significantly reduced the number of negative reverse-transcription polymerase chain reaction (RT-PCR) results (p<0.001) among COVID-19 patients. The CHX and PVP-I were effective on reducing the number of negative RT-PCR results in COVID-19 patients. Additional studies using adequate randomization methods and larger samples are warned.
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Affiliation(s)
- Faizul Hasan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Eisner Salamanca
- School of Dentistry, College of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Edi S. Ridwan
- School of Nursing, Faculty of Health Sciences, Alma Ata University, Yogyakarta, Indonesia
| | - Bayu S. Wiratama
- Department of Epidemiology, Biostatistics and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
| | - Hendrik S. Budi
- Department of Oral Biology, Dental Pharmacology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
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Van der Weijden F. Aerosol in the oral health-care setting: a misty topic. Clin Oral Investig 2023:10.1007/s00784-023-05034-x. [PMID: 37162570 PMCID: PMC10170433 DOI: 10.1007/s00784-023-05034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
Studies have shown that mouth and respiratory tract microorganisms can be transported in aerosol and spatter. Due to aerosol-generating procedures, there are potentially various infection risks for patients and those working in health care, especially in oral health care. Dental aerosol can contaminate not only the mucous membranes of the oral health-care professional's mouth, respiratory passages, and eyes but also exposed surfaces and materials in the environment. As such, preventing disease transmission within oral health-care offices is important issue. Since the start of the COVID-19 pandemic, an innumerable amount of (mis)information and advice on how to stay safe and prevent the spread of coronavirus has been published. What preventive measures can and have been taken to counteract this, and what have we learned during the pandemic? This review summarizes relevant literature that has addressed the presence and dispersal of aerosol and spatter as a concern in health care. It includes the sources of dental aerosol, their potential health threats, and strategies for controlling and mitigating their impact. It shows that further research is needed to better understand the potential health risks of dental aerosol and to develop effective strategies for mitigating them. CLINICAL RELEVANCE: Using personal protective equipment, high-volume evacuation systems and pre-procedural antimicrobial agents can help to reduce the potential for infection in oral health-care settings and protect the well-being of oral health-care workers and their patients.
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Affiliation(s)
- Fridus Van der Weijden
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
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Pablo-Marcos D, Abascal B, Lloret L, Gutiérrez Cuadra M, Velasco N, Valero C. Utility of mouth rinses with povidone-iodine and hydrogen peroxide in patients with COVID-19. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:173-175. [PMID: 36058840 PMCID: PMC9434324 DOI: 10.1016/j.eimce.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/02/2021] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Povidone-iodine and hydrogen peroxide could be effective in against SARS-CoV-2. METHODS A "non-interventional trial" in 88 patients (43±17 yrs., 55% men) with SARS-CoV-2 in nasopharyngeal swabs (RT-PCR). 31 received mouth rinses/gargling with povidone-iodine (every 8h, two consecutive days), 17 with mouth rinses/gargling of hydrogen peroxide, and 40 controls. Were repeated PCR in 3, 11 and 17 days. RESULTS After intervention the viral load (Log10 copies/ml) remained similar in povidone-iodine (4.3±2.7 copies/ml), hydrogen peroxide (4.6±2.9 copies/ml; p=0.40) and controls (4.4±3.0 copies/ml). The percentage of patients with a negative result in the second PCR was 27% in povidone-iodine group, 23% in hydrogen peroxide and 32% in controls; in the third PCR, 62%, 54% y 58% respectively; and in the fourth PCR, 81%, 75% y 81%. CONCLUSION Our results do not support the clinical usefulness of mouth rinses/gargling with povidone-iodine or hydrogen peroxide in patients with COVID-19.
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Affiliation(s)
- Daniel Pablo-Marcos
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Beatriz Abascal
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Lara Lloret
- Instituto de Física de Cantabria, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Manuel Gutiérrez Cuadra
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Nieves Velasco
- Servicio de Farmacia Hospitalaria, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Carmen Valero
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain.
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Pablo-Marcos D, Abascal B, Lloret L, Gutiérrez Cuadra M, Velasco N, Valero C. [Utility of mouth rinses with povidone-iodine and hydrogen peroxide in patients with COVID-19]. Enferm Infecc Microbiol Clin 2023; 41:173-175. [PMID: 34720312 PMCID: PMC8542440 DOI: 10.1016/j.eimc.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022]
Abstract
Introduction Povidone-iodine and hydrogen peroxide could be effective in against SARS-CoV-2. Methods A "non-interventional trial" in 88 patients (43 ± 17 yrs, 55% men) with SARS-CoV-2 in nasopharyngeal swabs (RT-PCR). 31 received mouth rinses/gargling with povidone-iodine (every 8 h, two consecutive days), 17 with mouth rinses/gargling of hydrogen peroxide, and 40 controls. PCR were repeated at 3, 11 and 17 days. Results After intervention the viral load (Log 10 copies/ml) remained similar in povidone-iodine (4.3 ± 2.7 copies/ml), hydrogen peroxide (4.6 ± 2.9 copies/ml; p = 0.40) and controls (4.4 ± 3.0 copies/ml). The percentage of patients with a negative result in the second PCR was 27% in povidone-iodine group, 23% in hydrogen peroxide and 32% in controls; in the third PCR, 62%, 54% and 58% respectively; and in the fourth PCR, 81%, 75% and 81%. Conclusion Our results do not support the clinical usefulness of mouth rinses/gargling with povidone-iodine or hydrogen peroxide in patients with COVID-19.
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Affiliation(s)
- Daniel Pablo-Marcos
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, España
| | - Beatriz Abascal
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, España
| | - Lara Lloret
- Instituto de Física de Cantabria, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, España
| | - Manuel Gutiérrez Cuadra
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, España
| | - Nieves Velasco
- Servicio de Farmacia Hospitalaria, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, España
| | - Carmen Valero
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, España
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Chumpitaz-Cerrate V, Chávez-Rimache L, Ruiz-Ramirez E, Franco-Quino C, Erazo-Paredes C. Evaluation of Current Evidence on the Use of Oral Antiseptics Against SARS-CoV-2: A Narrative Review. J Int Soc Prev Community Dent 2022; 12:488-499. [PMID: 36532329 PMCID: PMC9753926 DOI: 10.4103/jispcd.jispcd_65_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/29/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS AND OBJECTIVES The detection of SARS-COV-2 in the oral cavity has generated endless claims about the efficacy of using oral mouthwashes to reduce viral load. This review aims to assess the current evidence on the use of oral antiseptics against SARS-CoV-2 and to assess the certainty of the evidence according to the GRADE system. The question this study focussed on was what is the efficacy of oral antiseptics against SARS-CoV-2? MATERIALS AND METHODS A bibliographic search was performed in Medline databases through PubMed, Science Direct, and Google Scholar (until February 2022), using search terms related to COVID-19 and oral antiseptics. Two independent researchers extracted the information from the articles included in an excel form. The identification and selection of the studies was carried out from August 2021 to February 2022. RESULTS It was found that oral antiseptics can have a potential beneficial effect on COVID-19, mainly in reducing viral load. However, these potential benefits are mainly based on in-vitro studies or clinical studies with various methodological limitations. At present, the certainty of the evidence is very low due to inconsistency (heterogeneity), moderate-to-high risk of bias, and imprecision of the results. CONCLUSION The certainty of the current evidence on the efficacy of oral antiseptics against SARS-CoV-2 is very low, mainly due to the methodological limitations of the studies. Therefore, for evidence-based decision-making about this intervention, clinical studies with greater methodological rigor are required. Oral antiseptics could present potential benefits in patients with COVID-19 mainly by reducing viral load. However, a careful and conscious evaluation of the evidence is required for decision-making in clinical practice.
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Affiliation(s)
- Victor Chumpitaz-Cerrate
- Group “Investigación en Ciencias Básicas Estomatológicas ICBEST,” Universidad Nacional Mayor de San Marcos, Lima, Perú,Address for correspondence: Dr. Victor Chumpitaz-Cerrate, Germán Amézaga Nro. 375, Lima, Perú. E-mail:
| | - Lesly Chávez-Rimache
- Group “Investigación en Ciencias Básicas Estomatológicas ICBEST,” Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Eliberto Ruiz-Ramirez
- Group “Investigación en Ciencias Básicas Estomatológicas ICBEST,” Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - César Franco-Quino
- Group “Investigación en Ciencias Básicas Estomatológicas ICBEST,” Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Carlos Erazo-Paredes
- Group “Investigación en Ciencias Básicas Estomatológicas ICBEST,” Universidad Nacional Mayor de San Marcos, Lima, Perú
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Kumbargere Nagraj S, Eachempati P, Paisi M, Nasser M, Sivaramakrishnan G, Francis T, Verbeek JH. Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare providers. Cochrane Database Syst Rev 2022; 8:CD013826. [PMID: 35994295 PMCID: PMC9394685 DOI: 10.1002/14651858.cd013826.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aerosols and spatter are generated in a dental clinic during aerosol-generating procedures (AGPs) that use high-speed hand pieces. Dental healthcare providers can be at increased risk of transmission of diseases such as tuberculosis, measles and severe acute respiratory syndrome (SARS) through droplets on mucosae, inhalation of aerosols or through fomites on mucosae, which harbour micro-organisms. There are ways to mitigate and contain spatter and aerosols that may, in turn, reduce any risk of disease transmission. In addition to personal protective equipment (PPE) and aerosol-reducing devices such as high-volume suction, it has been hypothesised that the use of mouth rinse by patients before dental procedures could reduce the microbial load of aerosols that are generated during dental AGPs. OBJECTIVES To assess the effects of preprocedural mouth rinses used in dental clinics to minimise incidence of infection in dental healthcare providers and reduce or neutralise contamination in aerosols. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 4 February 2022. SELECTION CRITERIA We included randomised controlled trials and excluded laboratory-based studies. Study participants were dental patients undergoing AGPs. Studies compared any preprocedural mouth rinse used to reduce contaminated aerosols versus placebo, no mouth rinse or another mouth rinse. Our primary outcome was incidence of infection of dental healthcare providers and secondary outcomes were reduction in the level of contamination of the dental operatory environment, cost, change in mouth microbiota, adverse events, and acceptability and feasibility of the intervention. DATA COLLECTION AND ANALYSIS Two review authors screened search results, extracted data from included studies, assessed the risk of bias in the studies and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data MAIN RESULTS: We included 17 studies with 830 participants aged 18 to 70 years. We judged three trials at high risk of bias, two at low risk and 12 at unclear risk of bias. None of the studies measured our primary outcome of the incidence of infection in dental healthcare providers. The primary outcome in the studies was reduction in the level of bacterial contamination measured in colony-forming units (CFUs) at distances of less than 2 m (intended to capture larger droplets) and 2 m or more (to capture droplet nuclei from aerosols arising from the participant's oral cavity). It is unclear what size of CFU reduction represents a clinically significant amount. There is low- to very low-certainty evidence that chlorhexidine (CHX) may reduce bacterial contamination, as measured by CFUs, compared with no rinsing or rinsing with water. There were similar results when comparing cetylpyridinium chloride (CPC) with no rinsing and when comparing CPC, essential oils/herbal mouthwashes or boric acid with water. There is very low-certainty evidence that tempered mouth rinses may provide a greater reduction in CFUs than cold mouth rinses. There is low-certainty evidence that CHX may reduce CFUs more than essential oils/herbal mouthwashes. The evidence for other head-to-head comparisons was limited and inconsistent. The studies did not provide any information on costs, change in micro-organisms in the patient's mouth or adverse events such as temporary discolouration, altered taste, allergic reaction or hypersensitivity. The studies did not assess acceptability of the intervention to patients or feasibility of implementation for dentists. AUTHORS' CONCLUSIONS: None of the included studies measured the incidence of infection among dental healthcare providers. The studies measured only reduction in level of bacterial contamination in aerosols. None of the studies evaluated viral or fungal contamination. We have only low to very low certainty for all findings. We are unable to draw conclusions regarding whether there is a role for preprocedural mouth rinses in reducing infection risk or the possible superiority of one preprocedural rinse over another. Studies are needed that measure the effect of rinses on infectious disease risk among dental healthcare providers and on contaminated aerosols at larger distances with standardised outcome measurement.
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Affiliation(s)
- Sumanth Kumbargere Nagraj
- Professor and Head, Department of Oral Medicine and Oral Radiology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
- Honorary Research Fellow, Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London, London, UK
| | - Prashanti Eachempati
- Professor and Head, Department of Prosthodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
| | - Martha Paisi
- Peninsula Dental Social Enterprise, Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Mona Nasser
- Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Tony Francis
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
| | - Jos H Verbeek
- Cochrane Work, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Cieplik F, Jakubovics NS. Preprocedural Mouthwashes for Reduction of SARS-CoV-2 Viral Load and Infectivity. J Dent Res 2022; 101:1421-1423. [PMID: 35897159 PMCID: PMC9597161 DOI: 10.1177/00220345221110444] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- F Cieplik
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - N S Jakubovics
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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12
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Oral Antiseptics against SARS-CoV-2: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148768. [PMID: 35886619 PMCID: PMC9316971 DOI: 10.3390/ijerph19148768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022]
Abstract
Dentists are health care workers with the highest risk of exposure to COVID-19, because the oral cavity is considered to be a reservoir for SARS-CoV-2 transmission. The identification of SARS-CoV-2 in saliva, the generation of aerosols, and the proximity to patients during dental procedures are conditions that have led to these health care workers implementing additional disinfection strategies for their protection. Oral antiseptics are widely used chemical substances due to their ability to reduce the number of microorganisms. Although there is still no evidence that they can prevent the transmission of SARS-CoV-2, some preoperative oral antiseptics have been recommended as control measures, by different health institutions worldwide, to reduce the number of microorganisms in aerosols and droplets during dental procedures. Therefore, this review presents the current recommendations for the use of oral antiseptics against SARS-CoV-2 and analyzes the different oral antiseptic options used in dentistry.
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13
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Thurzo A, Urbanová W, Waczulíková I, Kurilová V, Mriňáková B, Kosnáčová H, Gális B, Varga I, Matajs M, Novák B. Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7693. [PMID: 35805347 PMCID: PMC9266032 DOI: 10.3390/ijerph19137693] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 12/19/2022]
Abstract
With the arrival of the highly transmissible Omicron variants (BA.4 and BA.5), dentistry faces another seasonal challenge to preserve the biosafety of dental care and education. With the aim of protecting patients, students, teachers and healthcare professionals, this paper introduces a prospective sustainable biosafety setting for everyday dental care and education. The setting developed by dental clinicians, epidemiologists, and teachers of dentistry consists of a combination of modern technologies focused on the air-borne part of the viral pathway. The introduced biosafety setting has been clinically evaluated after 18 months of application in the real clinical environment. The protocol has three fundamental pillars: (1) UVC air disinfection; (2) air saturation with certified virucidal essences with nebulizing diffusers; (3) complementary solutions including telehealth and 3D printing. A pseudonymous online smart form was used as the evaluation method. The protocol operates on the premise that everybody is a hypothetical asymptomatic carrier. The results of a clinical evaluation of 115 patient feedbacks imply that no virus transmission from patient to patient or from doctor to nurse was observed or reported using this protocol, and vice versa, although nine patients retrospectively admitted that the clinic visit is likely to be infectious. Despite these promising results, a larger clinical sample and exposition to the current mutated strains are needed for reliable conclusions about protocol virucidal efficiency in current dental environments.
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Affiliation(s)
- Andrej Thurzo
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia;
| | - Wanda Urbanová
- Department of Orthodontics and Cleft Anomalies, Dental Clinic 3rd Medical Faculty Charles University, Faculty Hospital Kralovske Vinohrady, 10034 Prague, Czech Republic;
| | - Iveta Waczulíková
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, Mlynska dolina F1, 84248 Bratislava, Slovakia;
| | - Veronika Kurilová
- Faculty of Electrical Engineering and Information Technology, Slovak University of Technology, Ilkovicova 3, 81219 Bratislava, Slovakia;
| | - Bela Mriňáková
- 1st Department of Oncology, Medical Faculty, Comenius University, St. Elisabeth Cancer Institute, 81250 Bratislava, Slovakia;
| | - Helena Kosnáčová
- Department of Simulation and Virtual Medical Education, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 81272 Bratislava, Slovakia;
- Department of Genetics, Cancer Research Institute, Biomedical Research Center, Slovak Academy Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia
| | - Branislav Gális
- Department of Oral and Maxillofacial Surgery, Medical Faculty, Comenius University, University Hospital Bratislava, 81499 Bratislava, Slovakia;
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 81372 Bratislava, Slovakia;
| | - Marek Matajs
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia;
| | - Bohuslav Novák
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia;
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14
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Evaluation of the Effect of Anti-COVID-19 Mouthwashes on Shear Bond Strength of Composite Resin Restorations to Dentin and Enamel: An “In Vitro Study”. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3824796. [PMID: 35535042 PMCID: PMC9077449 DOI: 10.1155/2022/3824796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/18/2022] [Indexed: 11/23/2022]
Abstract
Objectives Given the high prevalence of the coronavirus and the high risk of virus transfer to dentists, the use of mouthwashes, which can potentially eliminate this virus, is suggested before dental procedures. Since these mouthwashes may affect the bond strength of composite resin restorations to teeth, this study was conducted to investigate the effect of recommended mouthwashes on the shear bond strength of composite resin restorations to dentin and enamel in selective etch and rinse and two-step self-etch bonding systems. Methods Five groups of posterior teeth (n = 15) were selected for five groups of cetylpyridinium chloride 0.07%, povidone-iodine 1%, hydrogen peroxide 1%, and chlorhexidine 0.2% as mouthwash and distilled water as the control group. The buccal enamel and lingual dentin of each tooth were rinsed after immersion in a mouthwash. After 20 seconds of enamel acid-etching and 15 seconds of dentin priming, they were impregnated with an adhesive, and composite cylinders were placed on the dentin and enamel surfaces of the tooth. The shear bond strength test was performed after 24 hours, and results were analyzed by ANOVA and paired t-test (α = 0.05). Results The mean shear bond strength of enamel to composite was significantly (p < 0.05) higher than that of dentin to composite in each study group, but no significant difference was found between the mean shear bond strength of composite to enamel (p = 0.199) and to dentin (p = 0.335) after the use of mouthwashes and that of the control group. Conclusion The use of mouthwashes used in this study did not have negative effects on the shear bond strength of composite to enamel and dentin.
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15
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Mezarina Mendoza JPI, Trelles Ubillús BP, Salcedo Bolívar GT, Castañeda Palacios RDP, Herrera Lopez PSG, Padilla Rodríguez DA, Uchima Koecklin KH. ANTIVIRAL EFFECT OF MOUTHWASHES AGAINST SARS-COV-2: A SYSTEMATIC REVIEW. Saudi Dent J 2022; 34:167-193. [PMID: 35125835 PMCID: PMC8806023 DOI: 10.1016/j.sdentj.2022.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 01/05/2023] Open
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).
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Affiliation(s)
- Jhon Paul Iakov Mezarina Mendoza
- Faculty of Dentistry, National University of San Marcos, Lima, Perú
- Corresponding author at: Faculty of Dentistry, National University of San Marcos, Av. German Amezaga No. 375 – Ciudad Universitaria, Cercado de Lima, Lima, Peru.
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16
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Shashikumar P, Nisha S, Karmakar S, Das S, Jana D, Ali N. Comparison of chlorhexidine and hydrogen peroxide as preprocedural mouthrinse during ultrasonic scaling: A triple-blinded randomized controlled clinical trial. J Pharm Bioallied Sci 2022; 14:S110-S114. [PMID: 36110637 PMCID: PMC9469440 DOI: 10.4103/jpbs.jpbs_595_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Every year, around 2 million people suffer from hospital-acquired infections worldwide. Aerosols are produced while performing ultrasonic scaling. They are potential source of infection and cross contamination. It can result in spread of several infections including hepatitis, HIV, SARS CoV 2, etc. Preprocedural rinse before scaling is considered an effective measure to reduce the microbial load in aerosols. Materials and Methods: This study was a triple-blinded randomized controlled trial performed on 90 participants diagnosed with chronic periodontitis. Random allocation of participants into three groups, i.e., Group-1, Group-2, and Group-3, was done, wherein 0.12% chlorhexidine (CHX), 1.5% hydrogen peroxide (HP), and distilled water (DW) were used, respectively, as preprocedural mouthrinse. The participants of each group were instructed to perform mouthrinse for 60 s before the start of ultrasonic scaling sessions. Blood agar plates were kept at three locations, i.e., operator's chest area, patient's chest area, and assistant's chest area for aerosol collection after scaling. Colony-forming units (CFUs) were counted for microbiological analysis. Results: Least number of CFUs was found in the CHX group, followed by HP and DW groups. Location wise, the patient's chest area had the highest CFU count and the least was at the assistant's chest area. CFU count between the groups was statistically significant. Conclusion: Preprocedural rinse using HP can effectively be used as a method to reduce dental aerosols generated during ultrasonic scaling.
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Marques-Medeiros AC, Martins RC, Silva MESE, Vilaça ÊL, Souza LND, Martins MAP, Gomez RS, Guimarães de Abreu MHN. Staff Knowledge and Attitudes Towards COVID-19 New Biosafety Practices at a Brazilian Dental School. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Is hydrogen peroxide an effective mouthwash for reducing the viral load of SARS-CoV-2 in dental clinics? Saudi Dent J 2022; 34:237-242. [PMID: 35136326 PMCID: PMC8800492 DOI: 10.1016/j.sdentj.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/24/2021] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
RT-PCR was used to detect SARS-CoV-2 in HEPA filters in a dental clinic. SARS-CoV-2 was detected in the waiting room but not in the treatment rooms. CO2 levels indicated low ventilation and risk of COVID-19 transmission. The virucidal effect of H2O2 mouth rinsing was proven.
Background Previous studies have demonstrated that SARS-CoV-2 is mainly transmitted by inhalation of aerosols and can remain viable in the air for hours. Viruses can spread in dental settings and put professionals and patients at high risk of infection due to proximity and aerosol-generating procedures, and poor air ventilation. Objectives The aim of this study was to investigate the effects of a 1% hydrogen peroxide (H2O2) mouth rinse on reducing the intraoral SARS-CoV-2 load. Methods Portable air cleaners with HEPA filters exposed for 3 months were analysed to test for virus presence in a waiting room (where patients wore a face mask but did not undergo mouth rinsing) and three treatment rooms (where patients wore no mask but carried out mouth rinsing). As CO2 is co-exhaled with aerosols containing SARS-CoV-2 by COVID-19 infected people, we also measured CO2 as a proxy of infection risk indoors. Specific primer and probe RT-PCR were applied to detect viral genomes of the SARS-CoV-2 virus in the filters. Specifically, we amplified the nucleocapsid gene (Nuclv) of SARS-CoV-2. Results CO2 levels ranged from 860 to 907 ppm, thus indicating low ventilation and the risk of COVID-19 transmission. However, we only found viral load in filters from the waiting room and not from the treatment rooms. The results revealed the efficiency of 1-minute mouth rinsing with 1% H2O2 since patients rinsed their mouths immediately after removing their mask in the treatment rooms. Conclusions Our findings suggest that dental clinics would be safer and more COVID-19 free by implementing mouth rinsing 1 min with 1% H2O2 immediately after the patients arrive at the clinic.
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19
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Smith J, Kim J, Spilchuk V, Tran V, Singhal S. Letter to the Editor, "Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols". J Dent Res 2021; 101:237. [PMID: 34928740 DOI: 10.1177/00220345211037659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- J Smith
- Research Coordinator, Infection Prevention and Control, Public Health Ontario, Santé Publique Ontario, Ottawa, ON, Canada
| | - J Kim
- Public Health Physician, Environmental and Occupational Health, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
| | - V Spilchuk
- Occupational Medicine Physician, Environmental and Occupational Health, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
| | - V Tran
- Clinical Microbiologist, Public Health Laboratories, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
| | - S Singhal
- Public Health Dentist, Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
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20
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Ortega KL, Braz-Silva PH. Letter to the Editor: "Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols". J Dent Res 2021; 101:235. [PMID: 34928741 DOI: 10.1177/00220345211039484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K L Ortega
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - P H Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.,Laboratory of Virology, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
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21
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Silva A, Azevedo M, Sampaio-Maia B, Sousa-Pinto B. The effect of mouthwashes on SARS-CoV-2 viral load: a systematic review. J Am Dent Assoc 2021; 153:635-648.e16. [PMID: 35287944 PMCID: PMC8716175 DOI: 10.1016/j.adaj.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/17/2021] [Accepted: 12/26/2021] [Indexed: 11/30/2022]
Abstract
Background Considering that the oral cavity is a major entryway and reservoir for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the aim of the authors was to perform a systematic review of in vivo and in vitro studies to assess the effectiveness of mouthrinses on SARS-CoV-2 viral load. Types of Studies Reviewed The authors searched PubMed, Web of Science, Scopus, MedRxiv, and bioRxiv databases, including in vitro and in vivo studies assessing the virucidal effect of mouthrinses on SARS-CoV-2 or surrogates. From a total of 1,622 articles retrieved, the authors included 39 in this systematic review. Results Povidone-iodine was the most studied mouthrinse (14 in vitro and 9 in vivo studies), frequently showing significant reductions in viral load in in vitro assays. Similarly, cetylpyridinium chloride also showed good results, although it was evaluated in fewer studies. Chlorhexidine gluconate and hydrogen peroxide showed conflicting results on SARS-CoV-2 load reduction in both in vitro and in vivo studies. Practical Implications Povidone-iodine–based mouthrinses appear to be the best option as an oral prerinse in the dental context for SARS-CoV-2 viral load reduction. Although the results of primary studies are relevant, there is a need for more in vivo studies on mouthrinses, in particular, randomized controlled clinical trials, to better understand their effect on SARS-CoV-2 viral load and infection prevention.
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22
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Gandhi G, Thimmappa L, Upadhya N, Carnelio S. Could mouth rinses be an adjuvant in the treatment of SARS-CoV-2 patients? An appraisal with a systematic review. Int J Dent Hyg 2021; 20:136-144. [PMID: 34628705 PMCID: PMC8653299 DOI: 10.1111/idh.12555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/21/2021] [Accepted: 10/07/2021] [Indexed: 01/21/2023]
Abstract
Objective A wide variety of mouth rinses are available to combat micro‐organisms in the oral cavity. At the present global pandemic, the need of the hour is to control the viral infection due to the novel corona virus SARS‐COV‐2, as its port of entry is through the receptors located in the oral and pharyngeal mucosa. This systematic literature review focuses on the in vivo studies [randomized control trials (RCTs)] done on the efficacy of existing mouth rinses which have been used in reducing the viral loads. Methods The electronic database which includes PubMed‐MEDLINE, Google scholar, Scopus, Web of Science, EMBASE, ProQuest and CINAHL was searched from December 2019 to June 2021 with appropriate Medical Subject Headings (MeSH) terms and Boolean operators. Two reviewers independently reviewed the abstracts. Results Of the 2438 retrieved titles, 905 remained after removing duplicates. Twelve articles were eligible to be included in this review of which seven were randomized with adequate sample size. Conclusions Mouth washes containing povidone iodine and chlorhexidine decrease the viral load transiently. Large amount of in vivo studies are of paramount importance, especially RCTs, to prove the efficacy of these mouth rinses.
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Affiliation(s)
- Gargi Gandhi
- Department of Oral and Maxillofacial Pathology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Latha Thimmappa
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Nagaraja Upadhya
- Department of Dental Materials, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Sunitha Carnelio
- Department of Oral and Maxillofacial Pathology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
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Cagna DR, Donovan TE, McKee JR, Eichmiller F, Metz JE, Albouy JP, Marzola R, Murphy KG, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2021; 126:276-359. [PMID: 34489050 DOI: 10.1016/j.prosdent.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.
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Affiliation(s)
- David R Cagna
- Professor, Associate Dean, Chair and Residency Director, Department of Prosthodontics, University of Tennessee Health Sciences Center College of Dentistry, Memphis, Tenn.
| | - Terence E Donovan
- Professor, Department of Comprehensive Oral Health, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Frederick Eichmiller
- Vice President and Science Officer, Delta Dental of Wisconsin, Stevens Point, Wis
| | | | - Jean-Pierre Albouy
- Assistant Professor of Prosthodontics, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Kevin G Murphy
- Associate Clinical Professor, Department of Periodontics, University of Maryland College of Dentistry, Baltimore, Md; Private practice, Baltimore, Md
| | - Matthias Troeltzsch
- Associate Professor, Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University of Munich, Munich, Germany; Private practice, Ansbach, Germany
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Eggmann F, Haschemi AA, Doukoudis D, Filippi A, Verna C, Walter C, Weiger R, Zitzmann NU, Bornstein MM. Impact of the COVID-19 pandemic on urgent dental care delivery in a Swiss university center for dental medicine. Clin Oral Investig 2021; 25:5711-5721. [PMID: 33710460 PMCID: PMC7952257 DOI: 10.1007/s00784-021-03872-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022]
Abstract
Objectives This study aimed to assess whether the emergency service of a major Swiss dental institution faced different demands (patient volume, treatment needs, dental care characteristics) during a lockdown, issued to mitigate the COVID-19 pandemic, compared with the weeks before and after. Materials and methods Data of patients receiving urgent care at a university center for dental medicine (Basel, Switzerland) during the 6-week lockdown, pre-lockdown, and post-lockdown periods were retrospectively evaluated. Statistical analysis involved tests for equal proportions and logistic regression models. The level of significance was set at α=0.05. Results The study comprised 3109 dental emergency visits in the period from February 2 to June 5, 2020. Daily caseloads increased during lockdown. Abscesses, orthodontic emergencies, and surgical follow-ups were more common during lockdown, whereas the number of dento-alveolar injuries declined (≤0.048). Urgent dental care provision involved intraoral radiographs more frequently in the pre-lockdown period compared with the following weeks (p<0.001). Among all treatments, aerosol-generating procedures dropped from 56.1% (pre-lockdown) to 21.3% during lockdown (p<0.001), while teledentistry follow-ups became more frequent (p<0.001). Patients with comorbidities sought urgent dental care less frequently during the post-lockdown period (p=0.004). Conclusions The lockdown significantly impacted the dental emergency service in terms of patients’ diagnoses, treatment needs, and the characteristics of the urgent care that was delivered. Clinical relevance Access to essential dental care must be monitored and safeguarded throughout the COVID-19 pandemic and beyond as deferred care entails risks for serious sequelae and persons with comorbidities may change their dental care-seeking behavior.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland.
| | - Asin Ahmad Haschemi
- Department of General Pediatric and Adolescent Dentistry, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Dimitrios Doukoudis
- Department of General Dentistry, University Center for Dental Medicine UZB, University of Basel UZB, Basel, Switzerland
| | - Andreas Filippi
- Department of Oral Surgery, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Nicola U Zitzmann
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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Povidone-iodine preprocedural rinse-An evidence-based, second-line defense against severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in dental healthcare. Infect Control Hosp Epidemiol 2021; 43:822-824. [PMID: 33706836 PMCID: PMC7985894 DOI: 10.1017/ice.2021.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bahador M, Alfirdous RA, Alquria TA, Griffin IL, Tordik PA, Martinho FC. Aerosols Generated during Endodontic Treatment: A Special Concern during the Coronavirus Disease 2019 Pandemic. J Endod 2021; 47:732-739. [PMID: 33548332 PMCID: PMC7857011 DOI: 10.1016/j.joen.2021.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aims of this study were to investigate aerosolized microorganisms generated during endodontic emergencies and nonsurgical root canal therapy (NSRCT), to assess the spread of airborne microbes, and to verify the spatial distribution of airborne microbial spread. METHODS A total of 45 endodontic procedures were sampled, including full pulpotomy (n = 15), pulpectomy (n = 15), and NSRCT (n = 15). Samples were collected during room resting and after treatment. The passive air sampling technique using settle plates was applied. Agar plates were set at different locations in the operatory. The colony-forming unit (CFU) was counted in brain-heart infusion blood agar plates. A set of agar plates containing selective chromogenic culture media was used for the isolation and presumptive identification of target microorganisms. Fungi were investigated using Sabouraud dextrose agar. RESULTS Pulpotomy generated the lowest mean CFU count (P < .05). There was no difference between the mean CFU counts found in pulpectomy and NSRCT (P > .05). A higher mean CFU count was found close to the patient's mouth (0.5 m) than at a 2-m distance in pulpectomy and NSRCT (P < .05). There was no difference between the mean CFU count found in front of the patient's mouth versus diagonal in pulpectomy and NSRCT (P > .05). Staphylococcus aureus (22/45, 48.8%) was the most frequent bacteria species. Longer treatment times were associated with higher CFU counts. CONCLUSIONS Our findings indicated that pulpotomy generates less aerosolized microorganisms than pulpectomy and NSRCT. The proximity to the patient's mouth and the treatment duration were implicated in the level of contamination.
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Affiliation(s)
- Mason Bahador
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Rayyan A Alfirdous
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Prince Abdulrahman Advanced Dental Institute, Riyadh, Kingdom of Saudi Arabia
| | - Theeb A Alquria
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Department of Restorative Dental Science, Imam Abdulrahman Bin Faisal University, College of Dentistry, Dammam, Saudi Arabia
| | - Ina L Griffin
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Patricia A Tordik
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Frederico C Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland.
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Hsue VB, Itamura K, Wu AW, Illing EA, Sokoloski KJ, Weaver BA, Anthony BP, Hughes N, Ting JY, Higgins TS. Topical Oral and Intranasal Antiviral Agents for Coronavirus Disease 2019 (COVID-19). ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1327:169-189. [PMID: 34279838 DOI: 10.1007/978-3-030-71697-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
With the largest viral loads in both symptomatic and asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) present in the oral and nasal cavities, agents that act on these two areas have the potential for large therapeutic and prophylactic benefit. A literature review was conducted to elucidate the possible agents useful in treatment of SARS-CoV-2. These agents were evaluated for their current applications, adverse reactions, their current state of study, and any future considerations in their management of coronavirus disease 2019 (COVID-2019). Our review has found that, while there are many promising agents with proven efficacy in their in-vitro efficacy against SARS-CoV-2, more clinical trials and in-vivo studies, as well as safety trials, must be conducted before these agents can be effectively implemented.
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Affiliation(s)
- Victor B Hsue
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Kyohei Itamura
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Kevin J Sokoloski
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA
| | - Bree A Weaver
- Division of Infectious Diseases, Departments of Internal Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin P Anthony
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Nathan Hughes
- Pharmacy Operations, Kindred Healthcare Support Center, Louisville, KY, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, USA. .,Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, KY, USA.
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