The short-term effect of different chlorhexidine forms versus povidone iodine mouth rinse in minimizing the oral SARS-CoV-2 viral load: An open label randomized controlled clinical trial study
Natto et al.
, The short-term effect of different chlorhexidine forms versus povidone iodine mouth rinse in minimizing the..
, Medicine, doi:10.1097/MD.0000000000028925
60 patient RCT comparing chlorhexidine, PVP-I, and saline in Saudi Arabia with a single mouth rinse treatment and PCR testing 5 minutes later, showing statistically significant improvement in Ct value for PVP-I. PVP-I showed greater improvement than saline, without statistical significance.
risk of viral load, 74.0% lower, RR 0.26, p = 0.27, treatment 12, control 12, relative improvement in Ct value, both genes combined.
risk of viral load, 96.2% lower, RR 0.04, p = 0.12, treatment mean 4.43 (±4.78) n=12, control mean 0.17 (±7.67) n=12, relative improvement in Ct value, E gene.
risk of viral load, 44.4% lower, RR 0.56, p = 0.60, treatment mean 3.33 (±5.6) n=12, control mean 1.85 (±7.68) n=12, relative improvement in Ct value, S gene.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Natto et al., 29 Jul 2022, Randomized Controlled Trial, Saudi Arabia, peer-reviewed, 7 authors, this trial compares with another treatment - results may be better when compared to placebo.
Clinical Trial/Experimental Study
The short-term effect of different chlorhexidine
forms versus povidone iodine mouth rinse in
minimizing the oral SARS-CoV-2 viral load
An open label randomized controlled clinical trial study
Zuhair S. Natto, DrPHa,* , Muhammed A. Bakhrebah, PhDb, Marwah Afeef, MScc, Samiah Al-Harbi, BAd,
Majed S. Nassar, PhDb, Abdulkarim F. Alhetheel, PhDe,f, Heba Ashi, PhDa
Several investigations evaluated the possibility of different types of mouth wash rinse in minimizing the SARS-CoV-2 load.
However, results still controversial. The study aim is to assess the short-term efficiency of several over-the-counter mouth rinses
and lozenges in minimizing the salivary viral load for SARS-CoV-2 in patients with confirmed COVID-19 in comparison to saline.
This is a randomized controlled clinical trial with 4 arms. The recruited cases were randomized using a simple randomization
technique and were assigned to chlorhexidine digluconate mouth rinse (CHX mouth rinse), 2 mg of chlorhexidine digluconate
lozenges (CHX lozenges), povidone iodine mouth rinse (PVP-I mouth rinse) or saline as a control group. Saliva were collected from
all study subjects by passive drool technique at two time points. First, prior to intervention with mouth rinse or the lozenges, the
baseline saliva sample was collected. Second saliva samples were collected immediately after the mouth rinse. Real time PCR
was conducted and the value threshold cycle (Ct) for each sample was recorded.
Majority of the participants had an education level of high school or less (60%), were married (68.3), males (58.3%), and nonsmokers (58.5%). No statistically significant differences between groups at the two times test (P > .05). However, a significant
decrease of salivary viral load in all four groups combined (P-value for E genes = .027, and for S genes = .006), and in PVP-I mouth
rinse specifically (P = .003 and P = .045, respectively). Povidone iodine mouth rinse showed a potential influence on the reduction
of the viral load on a short-term basis. However, longer-term studies of the effect of these products should be conducted.
Abbreviations: CHX mouth rinse = digluconate mouth rinse, CHX lozenges = chlorhexidine digluconate lozenges, PVP-I mouth
rinse = povidone iodine mouth rinse, Ct = threshold cycle, SARS-CoV-2 = Severe Acute Respiratory Syndrome Coronavirus
2, KFGH = King Fahad General Hospital, RT-PCR = Real-time polymerase chain reaction.
Keywords: COVID-19, SARS-CoV-2, mouth rinse, chlorhexidine digluconate, povidone iodine
especially given the new variants, and the chances of its transmission with asymptomatic patients is still very high. The
SARS-CoV-2 incubation period has been reported to range
between 1 and 14 days, with most evidence suggested it to be 3
to 7 days. Therefore, there is evidence indicating the possibility
of infection spreading when patients were unaware about their
infection status and asymptomatic.[8,9]
Current evidence proved saliva can act as a SARS-CoV-2
reservoir. Several reports found that the virus is transmitted through aerosols, which pose a significant possibility for
transmission risk of the infection in dental clinics.[5,7] So, it
is required to decrease this potential risk in dental offices,
by minimizing the salivary SARS-CoV-2 load, if possible,
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