Effects of chlorhexidine gluconate and povidone-iodine mouthwash on cycle threshold values in patients infected with SARS-CoV-2
Lilies Dwi Sulistyani, Teuku Zulfahmi Rizki, Budi Haryanto, Vera Julia, Arfan Badeges, Dwi Ariawan, Mohammad Adhitya Latief, Yudy Ardilla Utomo
Dental and Medical Problems, doi:10.17219/dmp/192493
Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants exhibit different phenotypes and clinical manifestations in comparison to non-mutated viruses. Spike gene target failure (SGTF) is a characteristic feature of the gene in a novel variant that is recognized as highly transmissible. Several studies have demonstrated the virucidal effects of mouthwashes on SARS-CoV-2. Moreover, mouthwashes have proven beneficial for patients undergoing oral and maxillofacial surgery. Objectives. The present study aimed to analyze the effects of 2 different types of mouthwash (0.2% chlorhexidine gluconate and 1% povidone-iodine) on the cycle threshold (CT) values in coronavirus disease 2019 (COVID-19) patients with and without SGTF. Material and methods. This single-blind, non-randomized controlled clinical trial comprised 45 patients who were divided into 3 groups based on the intervention method: 0.2% chlorhexidine gluconate mouthwash; 1% povidone-iodine mouthwash; and mineral water (control group). The patients were instructed to gargle with the assigned solution 3 times a day for 5 days. Reverse transcription polymerase chain reaction (RT-PCR) tests were conducted at the time of initial diagnosis and on days 3 and 5. A normality test (Shapiro-Wilk test) was performed. Consequently, the non-parametric Friedman test was used. Results. The analysis revealed that the subjects who utilized mouthwashes exhibited higher CT values in comparison to the control group. Furthermore, 73% of patients who used 0.2% chlorhexidine gluconate presented with increased CT values, as indicated by a negative RT-PCR test on the 3 rd day. Conclusions. Gargling with 0.2% chlorhexidine gluconate or 1% povidone-iodine for 30 s for at least 3 days has been demonstrated to increase CT values in both SGTF and non-SGTF COVID-19 patients. Hence, using the mouthwash may be considered for preoperative use in patients undergoing oral and maxillofacial surgery.
Conflict of interest
None declared
Conclusions Gargling with 0.2% chlorhexidine gluconate or 1% povidone-iodine for 30 s for at least 3 days was shown to reduce the viral load of SARS-CoV-2. An increase in CT values was observed in patients with and without SGTF, indicating that mouthwash is effective against all SARS-CoV-2 variants. Gargling with 0.2% chlorhexidine gluconate or 1% povidone-iodine could be considered as an initial protocol prior to oral and maxillofacial surgical procedures in patients with COVID-19.
Trial registration This study was registered in the International Standard Randomised Controlled Trial Number (ISRCTN) registry under No. ISRCTN13090248.
Ethics approval and consent to participate The study protocol was reviewed and approved by the Health Ethics Committee of Persahabatan Central General Hospital, Jakarta, Indonesia (protocol No. 73/KEPK-RSUPP/08/2022).
Consent for publication Not applicable.
Use of AI and AI-assisted technologies Not applicable.
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doi:10.1016/S0140-6736(22)00017-4DOI record:
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