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All Studies   Meta Analysis    Recent:   

Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load

Chaudhary et al., The Journal of the American Dental Association, doi:10.1016/j.adaj.2021.05.021, NCT04603794
Jun 2021  
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21st treatment shown to reduce risk in May 2021
 
*, now known with p = 0.029 from 7 studies.
Lower risk for viral clearance.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments. c19early.org
Small RCT comparing mouthrinsing with saline, 1% hydrogen peroxide, 0.12% chlorhexidine, and 0.5% povidone-iodine, showing significant reductions in salivary viral load for all 4 mouthrinses at 15 and 45 minutes after rinsing.
Analysis of short-term changes in viral load using PCR may not detect effective treatments because PCR is unable to differentiate between intact infectious virus and non-infectious or destroyed virus particles. For example Alemany, Tarragó‐Gil perform RCTs with cetylpyridinium chloride (CPC) mouthwash that show no difference in PCR viral load, however there was significantly increased detection of SARS-CoV-2 nucleocapsid protein, indicating viral lysis. CPC inactivates SARS-CoV-2 by degrading its membrane, exposing the nucleocapsid of the virus. To better estimate changes in viral load and infectivity, methods like viral culture or antigen detection that can differentiate intact vs. degraded virus are preferred.
This study is excluded in the after exclusion results of meta analysis: study only provides short-term viral load results.
Study covers hydrogen peroxide and povidone-iodine.
Chaudhary et al., 11 Jun 2021, Randomized Controlled Trial, USA, peer-reviewed, 17 authors, trial NCT04603794 (history).
This PaperHydrogen Per..All
Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load
PhD Premprashant Chaudhary, Arsen Melkonyan, Dr Archana Meethil, Dr Shweta Saraswat, David L Hall, Dr James Cottle, Mark Wenzel, Nadine Ayouty, Dr Spenser Bense, Dr Fabiola Casanova, Dr Matthew Chaney, Hannah Chase, Rebecca Hermel, Dr Matthew Mcclement, Dr Claire Sesson, Bryce Woolsey, Purnima Kumar
The Journal of the American Dental Association, doi:10.1016/j.adaj.2021.05.021
Background. Many people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) never develop substantial symptoms. With more than 34 million people in the United States already infected and highly transmissible variants rapidly emerging, it is highly probable that post-and presymptomatic people will form an important fraction of those seeking dental care. Salivary carriage rates in these populations are not known. Moreover, although preventing transmission is critical for controlling spread, the efficacy of mouthrinses in reducing oral viral load is poorly studied. Methods. The authors recruited 201 asymptomatic, presymptomatic, postsymptomatic, and symptomatic people and measured copy numbers of SARS-CoV-2 in unstimulated saliva using realtime reverse transcriptase quantitative polymerase chain reaction. Subsequently, the authors inducted 41 symptomatic people into a randomized, triple-blinded study and instructed them to rinse with saline, 1% hydrogen peroxide, 0.12% chlorhexidine, or 0.5% povidone-iodine for 60 seconds. The authors measured viral load 15 and 45 minutes after rinsing. Results. Salivary SARS-CoV-2 was detected in 23% of asymptomatic, 60% of postsymptomatic, and 28% of presymptomatic participants. Neither carriage rate nor viral load correlated with COVID-19 symptomatology, age, sex, or race or ethnicity. All 4 mouthrinses decreased viral load by 61% through 89% at 15 minutes and by 70% through 97% at 45 minutes. The extent of reduction correlated significantly with initial viral load. Conclusions. Nonsymptomatic people can pose a risk of transmitting the virus, and mouthrinses are simple and efficacious means of reducing this risk, especially when the load is less than 10 4 copies per milliliter. Practical Implications. At a time when resources are stretched, the findings of this study contribute to evidence-based selection of personal protection equipment and simple infectioncontrol practices to reduce contagion at source. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04603794.
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Dr, Woolsey, General Practice Residency Program
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