Effect of oral antiseptics on the viral load of SARS-CoV-2: A randomized controlled trial

Sevinç Gül et al., Dental and Medical Problems, doi:10.17219/dmp/150831, NCT05214196

Jul 2022

Source PDF All Studies Meta AnalysisMeta

RCT with 21 PVP-I and 20 saline patients gargling for 30 seconds and testing PCR Ct after 30 minutes, showing greater improvement with PVP-I, without statistical significance.

Ct values differ across testing platforms, however the reported Ct value difference can represent a large difference in viral load. For example, using the calibration included with the ct2vl converter, the reported difference in mean Ct values corresponds to a reduction in viral load of over 3x for PVP-I.

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.

1. Alemany et al., Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial, Journal of Dental Research, doi:10.1177/00220345221102310.sagepub.com, doi.org.

2. Tarragó‐Gil et al., Randomized clinical trial to assess the impact of oral intervention with cetylpyridinium chloride to reduce salivary SARS‐CoV‐2 viral load, Journal of Clinical Periodontology, doi:10.1111/jcpe.13746.wiley.com, doi.org.

Important missing comments or errors? Let us know.

risk of viral load, 99.5% lower, RR 0.005, p = 0.37, treatment mean 1.85 (±7.06) n=21, control mean 0.01 (±5.89) n=20, relative improvement in Ct value.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Sevinç Gül et al., 29 Jul 2022, Randomized Controlled Trial, Turkey, peer-reviewed, 4 authors, study period 1 September, 2021 - 1 December, 2021, this trial compares with another treatment - results may be better when compared to placebo, trial NCT05214196 (history).

Contact: semanursevinc@gmail.com.

All Studies Meta Analysis Submit Updates or Corrections

This Paper Povidone-Iod..All

Effect of oral antiseptics on the viral load of SARS-CoV-2: A randomized controlled trial

Sema Sevinç Gül, A,B,D,F Alparslan Dilsiz, İmran Sağlık, C,E Nurten Nur Aydın

Dental and Medical Problems, doi:10.17219/dmp/150831

Background. In the oral cavity, which plays an important role in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is possible to reduce the viral load of SARS-CoV-2 with antiseptics, thereby minimizing the transmission of the virus during dental procedures. Objectives. The aim of this study was to clinically evaluate the effect of the hypochlorous acid (HClO) and povidone-iodine (PVP-I) solutions on the oral viral load of SARS-CoV-2. Material and methods. This randomized controlled trial was conducted on 75 patients hospitalized in the COVID-19 ward of a local hospital. All the patients included in the study were within the first 24 h of hospitalization and the first 5 days of coronavirus disease 2019 (COVID-19) symptoms. The viral load of mouthwash samples was measured with the cycle threshold (Ct) value of SARS-CoV-2 through a realtime reverse transcription polymerase chain reaction (RT-PCR). The patients were divided into 3 groups. The effect on the patient's SARS-CoV-2 viral load was investigated after gargling the mouths and throats for 30 s with HClO, PVP-I and isotonic saline. First, a sample was taken after gargling with isotonic saline, then another sample was taken after gargling for 30 s with a particular antiseptic to determine the viral load of SARS-CoV-2. Results. Comparing the before and after mouthwash samples from all 3 groups, there were no statistically significant differences in the Ct values before and after gargling (p > 0.05). However, there were statistically significant differences in the number of negative samples after the use of HClO and PVP-I, which were positive before gargling (p < 0.05). Conclusions. In the light of the data obtained in this study, there is insufficient evidence that gargling with HClO or PVP-I reduces viral load. Taken together, these findings imply no role for antiseptics in the transmission of SARS-CoV-2 by the aerosol generated during dental procedures, or more generally, SARS-CoV-2 infection control.

Conflict of interest None declared Consent for publication Not applicable. ORCID iDs Sema Nur Sevinç Gül  https://orcid.org/0000-0003-0699-917X Alparslan Dilsiz  https://orcid.org/0000-0001-8462-1725 İmran Sağlık  https://orcid.org/0000-0003-0864-4989 Nurten Nur Aydın  https://orcid.org/0000-0003-4138-2490

References

Abubakr, Salem, Kamel, Oral manifestations in mild-tomoderate cases of COVID-19 viral infection in the adult population, Dent Med Probl, doi:10.17219/dmp/130814

Ait-Ou-Amar, Berrazzouk, Ennibi, Handwashing revisited in dental practice during the COVID-19 outbreak, Dent Med Probl, doi:10.17219/dmp/132901

Anderson, Sivalingam, Kang, Povidone-iodine demon strates rapid in vitro virucidal activity against SARS-CoV-2, the virus causing COVID-19 disease, Infect Dis Ther, doi:10.1007/s40121-020-00316-3

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 Prosthodont, doi:10.1111/jopr.13220

Block, Rowan, Hypochlorous acid: A review, J Oral Maxillofac Surg, doi:10.1016/j.joms.2020.06.029

Chaudhary, Melkonyan, Meethil, Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load: A randomized controlled trial, J Am Dent Assoc, doi:10.1016/j.adaj.2021.05.021

Congrave-Wilson, Lee, Jumarang, Change in saliva RT-PCR sensitivity over the course of SARS-CoV-2 infection, JAMA, doi:10.1001/jama.2021.13967

Davies, Buczkowski, Welch, Effective in vitro inactivation of SARS-CoV-2 by commercially available mouthwashes, J Gen Virol, doi:10.1099/jgv.0.001578

Dilsiz, Parlak, Gül, Oral and ocular manifestations in a patient with coronavirus disease-2019: Clinical presentation and management, Rev Soc Bras Med Trop, doi:10.1590/0037-8682-0699-2021

Duś-Ilnicka, Krala, Cholewińska, Radwan-Oczko, The use of saliva as a biosample in the light of COVID-19, Diagnostics, doi:10.3390/diagnostics11101769

Eggers, Koburger-Janssen, Ward, Newby, Müller, Bactericidal and virucidal activity of povidone-iodine and chlorhexidine gluconate cleansers in an in vivo hand hygiene clinical simulation study, Infect Dis Ther, doi:10.1007/s40121-018-0202-5

Elzein, Sater, Fakhreddine, In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomizedcontrolled clinical trial, J Evid Based Dent Pract, doi:10.1016/j.jebdp.2021.101584

Emodi-Perlman, Eli, Smardz, Temporomandibular disorders and bruxism outbreak as a possible factor of orofacial pain worsening during the COVID-19 pandemic -concomitant research in two countries, J Clin Med, doi:10.3390/jcm9103250

Goldfarb, Tilley, Gn, Self-collected saline gargle samples as an alternative to health care worker-collected nasopharyngeal swabs for COVID-19 diagnosis in outpatients, J Clin Microbiol, doi:10.1128/jcm.02427-20

Hassandarvish, Tiong, Mohamed, In vitro virucidal activity of povidone iodine gargle and mouthwash against SARS-CoV-2: Implications for dental practice, Br Dent J, doi:10.1038/s41415-020-2402-0

Huang, Perez, Kato, SARS-CoV-2 infection of the oral cavity and saliva, Nat Med, doi:10.1038/s41591-021-01296-8

Izzetti, Nisi, Gabriele, Graziani, COVID-19 transmission in dental practice: Brief review of preventive measures in Italy, J Dent Res, doi:10.1177/0022034520920580

Kawana, Kitamura, Nakagomi, Inactivation of human viruses by povidone-iodine in comparison with other antiseptics, Dermatology, doi:10.1159/000246027

Lu, These are the occupations with the highest COVID-19 risk, World Economic Forum

Meselson, Droplets and aerosols in the transmission of SARS-CoV-2, N Engl J Med, doi:10.1056/NEJMc2009324

Mueller, Winter, Renner, A concept for the reduction of mucosal SARS-CoV-2 load using hypochloric acid solutions, Drug Res (Stuttg), doi:10.1055/a-1467-5956

O'donnell, Thomas, Stanton, Potential role of oral rinses targeting the viral lipid envelope in SARS-CoV-2 infection, Function, doi:10.1093/function/zqaa002

Pan, Zhang, Yang, Poon, Wang, Viral load of SARS-CoV-2 in clinical samples, Lancet Infect Dis, doi:10.1016/S1473-3099(20)30113-4

Pelletier, Tessema, Frank, Westover, Brown et al., Efficacy of povidone-iodine nasal and oral antiseptic preparations against severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), Ear Nose Throat J, doi:10.1177/0145561320957237

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

Saito, Adachi, Yamayoshi, Gargle lavage as a safe and sensitive alternative to swab samples to diagnose COVID-19: A case report in Japan, Clin Infect Dis, doi:10.1093/cid/ciaa377

Sakarya, Gunay, Karakulak, Ozturk, Ertugrul, Hypochlorous acid: An ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency, Wounds

Sarinoglu, Guneser, Sengel, Korten, Yagci, Evaluation of different respiratory samples and saliva for the detection of SARS-CoV-2 RNA, Marmara Med J, doi:10.5472/marumj.866658

Seneviratne, Balan, Ko, Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: Randomized control trial in Singapore, Infection, doi:10.1007/s15010-020-01563-9

Takeda, Matsuda, Jamsransuren, Ogawa, Comparison of the SARS-CoV-2-inactivating activities of the differently manufactured hypochlorous acid water products with various pH, J Water Health, doi:10.2166/wh.2021.260

Torul, Omezli, Is saliva a reliable biofluid for the detection of COVID-19?, Dent Med Probl, doi:10.17219/dmp/132515

Wang, Xu, Gao, Detection of SARS-CoV-2 in different types of clinical specimens, JAMA, doi:10.1001/jama.2020.3786

Wieckiewicz, Danel, Pondel, Identification of risk groups for mental disorders, headache and oral behaviors in adults during the COVID-19 pandemic, Sci Rep, doi:10.1038/s41598-021-90566-z

Winter, Ilbert, Graf, Ozcelik, Bleach activates a redox-regulated chaperone by oxidative protein unfolding, Cell, doi:10.1016/j.cell.2008.09.024

Wutzler, Sauerbrei, Klöcking, Brögmann, Reimer, Virucidal activity and cytotoxicity of the liposomal formulation of povidone-iodine, Antiviral Res, doi:10.1016/s0166-3542(01)00213-3

Wölfel, Corman, Guggemos, Virological assessment of hospitalized patients with COVID-2019, Nature, doi:10.1038/s41586-020-2196-x

Xu, Wang, Hoskin, Differential effects of antiseptic mouth rinses on SARS-CoV-2 infectivity in vitro, Pathogens, doi:10.3390/pathogens10030272

Zhang, Li, Zhang, Wang, Molina, Identifying airborne transmission as the dominant route for the spread of COVID-19, Proc Natl Acad Sci U S A, doi:10.1073/pnas.2009637117

Zou, Ruan, Huang, SARS-CoV-2 viral load in upper respiratory specimens of infected patients, N Engl J Med, doi:10.1056/NEJMc2001737

Download Image

Please send us corrections, updates, or comments. Vaccines and treatments are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.

Submit

@CovidAnalysis

FAQ

Public domain CC0 1.0