Is hydrogen peroxide an effective mouthwash for reducing the viral load of SARS-CoV-2 in dental clinics?
The Saudi Dental Journal, doi:10.1016/j.sdentj.2022.01.005
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 aerosolgenerating procedures, and poor air ventilation. Objectives: The aim of this study was to investigate the effects of a 1% hydrogen peroxide (H 2 O 2 ) 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 CO 2 is coexhaled with aerosols containing SARS-CoV-2 by COVID-19 infected people, we also measured CO 2 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.
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Author Statement D.R (email@example.com) and I.R.U (itziar.rodriguez@ uclm.es) created the project, measured the CO 2 concentration, and collected the HEPA filters. E.B-R. (emma.burgos@uclm. es) did the analyses. All authors drafted the manuscript and contributed to the discussion of the results.
Ethical Statement This article requires no human or animal in research.
Askarian, Mirraei, Honarvar, Etminan, Araujo, Knowledge, attitude and practice towards droplet and airborne isolation precautions among dental health care professionals in Shiraz, Iran. J. Public Health Dentistry, doi:10.1111/j.1752-7325.2005.tb02785.x
Benzian, Beltra´n-Aguilar, Mathur, Niederman, Pandemic considerations on essential oral health care, J. Dent. Res, doi:10.1177/0022034520979830
Bidra, Pelletier, Westover, Frank, Brown et al., Comparison of in vitro inactivation of SARS CoV-2 with hydrogen peroxide and povidone-iodine oral antiseptic rinses, J. Prosthodontics, doi:10.1111/jopr.13220
Burgos-Ramos, Canelles, Perianes-Cachero, Arilla-Ferreiro, Argente et al., Adipose tissue promotes a serum cytokine profile related to lower insulin sensitivity after chronic central leptin infusion, PLoS ONE, doi:10.1371/journal.pone.0046893
Cai, Sun, Huang, Gamber, Wu et al., Indirect Virus Transmission in Cluster of COVID-19 Cases, Infect. Dis, doi:10.3201/eid2606.200412
Cdc, Interim infection prevention and control guidance for dental settings during the COVID-19 response
Chopra, Sivaraman, Radhakrishnan, Balakrishnan, Narayana, Can povidone iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence-based update, Jpn. Dent. Sci. Rev, doi:10.1016/j.jdsr.2021.03.001
Dominiak, Shuleva, Silvestros, Alcoforado, A prospective observational study on perioperative use of antibacterial agents in implant surgery, Adv. Clin. Exp. Med, doi:10.17219/acem/115087
Elzein, Abdel-Sater, Fakhreddine, Abi Hanna, Feghali et al., In vivo evaluation of the virucidal efficacy of Chlorhexidine and Povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial, J. Evid. Based Dent, doi:10.1016/j.jebdp.2021.101584
Guo, Wang, Zhang, Li, Li et al., Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Infect. Dis, doi:10.3201/eid2607.200885
Gusberti, Sampathkumar, Siegrist, Lang, Microbiological and clinical effects of Chlorhexidine diguconate and hydrogen peroxide mouthrinses on developing plaque and gingivitis, J. Clin. Periodontol, doi:10.1111/j.1600-051x.1988.tb01556.x
Hammond, Khalid, Thornton, Woodall, Hay, Should homes and workplaces purchase portable air filters to reduce the transmission of SARS-CoV-2 and other respiratory infections? A systematic review, PLoS One, doi:10.1371/journal.pone.0251049
Harrel, Molinari, Aerosols and splatter in dentistry: a brief review of the literature and infection control implications, J. Am. Dent. Assoc, doi:10.14219/jada.archive.2004.0207
Huang, Marzouk, Cirligeanu, Malmstrom, Eliav et al., Ventilation rate assessment by carbon dioxide levels in dental treatment rooms, J. Dental Res, doi:10.1177/00220345211014441
Koch-Heier, Hoffmann, Schindler, Lussi, Planz, Inactivation of SARS-CoV-2 through Treatment with the Mouth Rinsing Solutions ViruProXÒ and BacterXÒ Pro, Microorganisms, doi:10.3390/microorganisms9030521
Kosutic, Uglesic, Perkovic, Persic, Solman et al., Preoperative antiseptics in clean/contaminated maxillofacial and oral surgery: prospective randomized study, Int. J. Oral Maxillofac. Surg, doi:10.1016/j.ijom.2008.11.023
Marui, Souto, Rovai, Romito, Chambrone et al., Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: a systematic review, J. Am. Dent. Assoc, doi:10.1016/j.adaj.2019.06.024
Meister, Bru¨ggemann, Todt, Conzelmann, Mu¨ller et al., Virucidal efficacy of different oral rinses against Severe Acute Respiratory Syndrome Coronavirus 2, J. Infect. Dis, doi:10.1093/infdis/jiaa471
Mondelli, Colaneri, Seminari, Baldanti, Bruni, Low risk of SARS-CoV-2 transmission by fomites in real-life conditions, Lancet Infect. Diss, doi:10.1016/S1473-3099(20)30678-2
Moosavi, Aminishakib, Ansari, Antiviral mouthwashes: possible benefit for COVID-19 with evidence-based approach, J. Oral Microbiol, doi:10.1080/20002297.2020.1794363
Ortega, Rech, El Haje, Gallo, Pe´rez -Sayans et al., Do hydrogen peroxide mouthwashes have a virucidal effect? A systematic review, J. Hosp. Infect, doi:10.1016/j.jhin.2020.10.003
Peng, Jimenez, Exhaled CO 2 as COVID-19 infection risk proxy for different indoor environments and activities, Environ. Sci. Technol. Lett, doi:10.1021/acs.estlett.1c00183
Peng, Xu, Li, Cheng, Zhou et al., Transmission routes of 2019-nCoV and controls in dental practice, Int. J. Oral Sci, doi:10.1038/s41368-020-0075-9
Ren, Huang, Marzouk, Richard, Pembroke et al., Effects of mechanical ventilation and portable air cleaner on aerosol removal from dental treatment rooms, J. Dent, doi:10.1016/j.jdent.2020.103576
Rodrı´guez, Palop, Sesen˜a, Rodrı´guez, Are the Portable Air Cleaners (PAC) really effective to terminate airborne SARS-CoV-2?, Sci. Tot. Environ, doi:10.1016/j.scitotenv.2021.147300
Rowen, Robins, A Plausible, ''Penny" Costing Effective Treatment for Corona Virus -Ozone Therapy, J. Infect. Dis. Epidemiol, doi:10.23937/2474-3658/1510113
Shamsoddin, Detora, Tovani-Palone, Bierer, Dental care in times of the COVID-19 pandemic: a review, Med. Sci, doi:10.3390/medsci9010013
Tovani-Palone, Shamsoddin, Franchi, Recommendations for safe paediatric dental practices during the COVID-19 pandemic: an update, Eur. J. Paediatr. Dent
Tovani-Palone, Shamsoddin, Use of mouthwashes in the management of COVID-19 patients in intensive care units: recommendations and current evidence, Einstein (Sa˜o Paulo), doi:10.31744/einstein_journal/2021CE6419
Van Doremalen, Bushmaker, Morris, Holbrook, Gamble et al., Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1, N. Engl. J. Med, doi:10.1056/NEJMc2004973
Wiersinga, Rhodes, Cheng, Peacock, Prescott, Pathophysiology, transmission, diagnosis, and treatment of Coronavirus Disease 2019 (COVID-19), JAMA, doi:10.1001/jama.2020.12839
Zemouri, Awad, Volgenant, Crielaard, Laheij et al., Modeling of the Transmission of Coronaviruses, Measles Virus, Influenza Virus, Mycobacterium tuberculosis, and Legionella pneumophila in Dental Clinics, J. Dent. Res, doi:10.1177/0022034520940288