Could mouth rinses be an adjuvant in the treatment of SARS-CoV-2 patients? An appraisal with a systematic review

Antiseptics: An expeditious third force in the prevention and management of coronavirus diseases

Notably, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19) have all had significant negative impact on global health and economy. COVID-19 alone, has resulted to millions of deaths with new cases and mortality still being reported in its various waves. The development and use of vaccines have not stopped the transmission of SARS coronavirus 2 (SARS-CoV-2), the etiological agent of COVID-19, even among vaccinated individuals. The use of vaccines and curative drugs should be supplemented with adoption of simple hygiene preventive measures in the fight against the spread of the virus, especially for healthcare workers. Several virucidal topical antiseptics, such as povidone-iodine (PVP-I), citrox, cyclodextrins among others, have been demonstrated to be efficacious in the inactivation of SARS-CoV-2 and other coronaviruses in both in vitro and in vivo studies. The strategic application of these virucidal formulations could provide the additional impetus needed to effectively control the spread of the virus. We have here presented a simple dimension towards curtailing the dissemination of COVID-19, and other coronaviruses, through the application of effective oral, nasal and eye antiseptics among patients and medical personnel. We have further discussed the mechanism of action of some of these commonly available virucidal solutions while also highlighting some essential controversies in their use.

Efficacy of three antimicrobial mouthwashes in reducing SARS-CoV-2 viral load in the saliva of hospitalized patients: a randomized controlled pilot study

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.

Are COVID-19 patients given adequate instructions about toothbrush hygiene? A cross-sectional study

OBJECTIVE

The aim of this study was to evaluate toothbrush hygienic practices, whether subjects with a positive COVID-19 test received instructions about toothbrush hygiene, and to determine if carriers of SARS CoV-2 were assigned separate bathrooms during home isolation.

METHODS

Data were collected by an anonymous online questionnaire. Variables of interest included toothbrush hygiene practices, receiving instructions on toothbrush handling if tested positive for COVID-19, and being assigned separate bathrooms during home isolation.

RESULTS

From November 2020 through April 2021; 755 responded (472 [62.5%] females, 269 [35.6%] males, 14 [1.85%] did not specify their gender). 14 (4.1%) of 341 respondents who reported a positive result of a COVID-19 test received instructions about how to maintain their toothbrush during home isolation. The majority of subjects (74.4%) reported the use of water to wet their toothbrush before brushing, this practice was significantly more common among young subjects (p < 0.001). 58.6% wash all parts of the toothbrush after use while 38.8% wash the head of the toothbrush, and 1.6% place the toothbrush in an antiseptic. 53% used separate bathrooms during isolation, this was significantly associated with age group (p = 0.006) and higher monthly income (p = 0.02).

CONCLUSIONS

The majority of participants with a positive result of the COVID-19 test were not given explicit instructions about toothbrush handling. Less than half reported good toothbrush hygienic practices. Higher monthly income was significantly associated with using a separate bathroom during home isolation. Providing explicit instructions about toothbrush hygiene is recommended to reduce the spread of contagious diseases such as COVID-19.

Efficacy of Cetylpyridinium Chloride mouthwash against SARS-CoV-2: A systematic review of randomized controlled trials

INTRODUCTION

COVID-19 is a transmissible respiratory and multisystem disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Viral transmission occurs mainly through the spread of salivary droplets or aerosol from an infected subject. Studies suggest that salivary viral load is correlated with disease severity and probability of transmission. Cetylpyridinium chloride mouthwash has been found to be effective in reducing salivary viral load. The aim of this systematic review of randomized controlled trials is to evaluate the efficacy of the mouthwash ingredient cetylpyridinium chloride on salivary viral load in SARS-CoV-2 infection.

METHODS

Randomized controlled trials comparing cetylpyridinium chloride mouthwash with placebo and other mouthwash ingredients in SARS-CoV-2 positive individuals were identified and evaluated.

RESULTS

Six studies with a total of 301 patients that met the inclusion criteria were included. The studies reported the efficacy of cetylpyridinium chloride mouthwashes in reduction on SARS-CoV-2 salivary viral load compared to placebo and other mouthwash ingredients.

CONCLUSION

Mouthwashes containing cetylpyridinium chloride are effective against salivary viral load of SARS-CoV-2 in vivo. There is also the possibility that the use of mouthwash containing cetylpyridinium chloride in SARS-CoV-2 positive subjects could reduce transmissibility and severity of COVID-19.

In vivo effect of mouthwashes on viable viral load of SARS-CoV-2 in saliva: a pilot study

Current data on the efficacy of antiseptic mouthwashes to reduce viral load are contradictory. Firstly, in vitro data indicate very strong virucidal effects that are not replicated in clinical studies. Secondly, most clinical studies identify a limited effect, do not include a control/placebo group, or do not evaluate viral viability in an infection model. In the current manuscript, we perform a double-blind, randomized clinical trial where salivary viral load was measured before and after the mouthwash, and where saliva samples were also cultured in an in vitro infection model of SARS-CoV-2 to evaluate the effect of mouthwashes on viral viability. Our data show a 90-99% reduction in SARS-CoV-2 salivary copies with one of the tested mouthwashes, although we show that the remaining viruses are mostly viable. In addition, our data suggest that the active ingredient concentration and the overall excipients' formulation can play an important role; and most importantly, they indicate that the effect is not immediate, being significant at 15 min and having maximum effectiveness after 1 h. Thus, we show that some oral mouthwashes can be useful in reducing viral transmission, although their efficacy must be improved through refined formulations or revised protocols.

A Cross-Sectional, Questionnaire-Based Survey on Air Infection Control among Romanian People

(1) Background: Infection control should be one of the main objectives in the comprehensive medical approach. (2) Methods: A cross-sectional study was conducted from June-July 2022. A questionnaire including 22 questions with multiple answers was applied online to 202 subjects selected at random. The questionnaire collected data on the subjects' knowledge about protective measures against airborne infections. For this study, a descriptive statistic was performed. Pearson's Chi-square test was used for data comparison. (3) Results: Only 61.39% (124) of the subjects consider that protective equipment is mandatory for the dental team, 40.10% (81) know to a very large extent and 44.06% (89) to a large extent that when talking, a respiratory infection can be transmitted. A rather large percentage of the subjects take into account the cost of the protective mask to a very large extent 39.60% (80). Only 30.20% (61) of the subjects would vaccinate to a very large extent and 24.75% (50) to a large extent against micro-organisms transmitted by air p > 0.05. (4) Conclusions: Most people know the aspects related to air decontamination, the priority being the promotion of control methods of airborne infections, and it is necessary to improve the level of knowledge on a large scale within the population.

Transparency of COVID-19-Related Research in Dental Journals

Objective

We aimed to assess the adherence to transparency practices (data availability, code availability, statements of protocol registration and conflicts of interest and funding disclosures) and FAIRness (Findable, Accessible, Interoperable, and Reusable) of shared data from open access COVID-19-related articles published in dental journals available from the Europe PubMed Central (PMC) database.

Methods

We searched and exported all COVID-19-related open-access articles from PubMed-indexed dental journals available in the Europe PMC database in 2020 and 2021. We detected transparency indicators with a validated and automated tool developed to extract the indicators from the downloaded articles. Basic journal- and article-related information was retrieved from the PMC database. Then, from those which had shared data, we assessed their accordance with FAIR data principles using the F-UJI online tool (f-uji.net).

Results

Of 650 available articles published in 59 dental journals, 74% provided conflicts of interest disclosure and 40% funding disclosure and 4% were preregistered. One study shared raw data (0.15%) and no study shared code. Transparent practices were more common in articles published in journals with higher impact factors, and in 2020 than in 2021. Adherence to the FAIR principles in the only paper that shared data was moderate.

Conclusion

While the majority of the papers had a COI disclosure, the prevalence of the other transparency practices was far from the acceptable level. A much stronger commitment to open science practices, particularly to preregistration, data and code sharing, is needed from all stakeholders.

Relationship between Recovery from COVID-19-Induced Smell Loss and General and Oral Health Factors

Background and Objectives: Loss of smell is one of the strongest predictors of coronavirus disease 2019 (COVID-19) and can persist long after other symptoms have resolved. “Long” cases (>28 days) of smell dysfunction present future challenges to medical and dental professionals, as there is a lack of evidence on the causes and any exacerbating or relieving factors. This study aimed to explore the persistence of COVID-19-induced smell loss and association with physical, lifestyle and oral health factors. Materials and Methods: This study was a cross-sectional survey of 235 participants. Recovery of smell was explored, comparing rapid recovery (≤28 days) with prolonged recovery (>28 days). Associative factors included age, sex, illness severity, diet, BMI, vitamin D supplementation, antidepressants, alcohol use, smoking, brushing frequency, flossing, missing teeth, appliances and number of dental restorations. Results: Smell loss showed 87% resolution within 30 days. Prolonged smell loss was significantly associated with older age (mean ± 95%, CI = 31.53 ± 1.36 years for rapid recovery vs. mean ± 95%, CI = 36.0 ± 3 years for prolonged recovery, p = 0.003) and increased self-reported illness severity (mean ± 95%, CI = 4.39 ± 0.27 for rapid recovery vs. 5.01 ± 0.54 for prolonged recovery, p = 0.016). Fisher’s exact test revealed flossing was associated with rapid recovery, with flossers comprising 75% of the rapid-recovery group, compared to 56% in the prolonged-recovery group (odds ratio ± 95%, CI = 2.26 (1.23–4.15), p = 0.01). All other factors were not significantly associated (p > 0.05). Conclusions: Increased age and illness severity were associated with prolonged smell recovery. Use of floss was the only modifiable factor associated with rapid recovery of smell loss. As 87% of cases resolve within 30 days, future studies may benefit from targeted recruitment of individuals experiencing prolonged sense loss. This would increase statistical confidence when declaring no association with the other factors assessed, avoiding type II errors.