Mouthrinses differentially rewire salivary virus-microbiome interaction dynamics in COVID-19 patients: A randomized controlled trial
et al., Archives of Oral Biology, doi:10.1016/j.archoralbio.2026.106524, Apr 2026
58th treatment shown to reduce risk in
September 2025, now with p = 0.0035 from 4 studies.
Lower risk for recovery and viral clearance.
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RCT 40 COVID-19 outpatients showing lower salivary SARS-CoV-2 viral load with cetylpyridinium chloride (CPC), povidone-iodine (PVP-I), and sodium chlorite (NaClO2) mouthrinses, without statistical significance. CPC and PVP-I selectively altered specific oral bacterial taxa (e.g., Leptotrichia sp., Lautropia mirabilis) while preserving overall microbiome diversity, and disrupted virus-microbiome interaction networks involving SARS-CoV-2 N and ORF1ab genes. The study is underpowered with only 10 patients per group, which likely explains the lack of statistical significance despite observed trends. Clinical outcomes are not reported.
Study covers cetylpyridinium chloride and povidone-iodine.
Widyarman et al., 30 Apr 2026, Randomized Controlled Trial, peer-reviewed, 9 authors.
Abstract:
[Archives of Oral Biology](https://www.sciencedirect.com/journal/archives-of-oral-biology)
Volume 184, April 2026, 106524
Mouthrinses differentially rewire salivary virus-microbiome interaction dynamics in COVID-19 patients: A randomized controlled trial
Armelia Sari Widyarman , Rika Bur , Nadeeka S. Udawatte , Prika Maulina Agaristi , Intan Razari , Syukrini Bahri , Mario Richi a b c d e f g h i
, Tri Erri Astoeti , Chaminda Jayampath Seneviratne d
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Cite https://doi.org/10.1016/j.archoralbio.2026.106524
Highlights
- The first COVID-19 RCT to examine mouth rinses effects on both viral load and oral microbes during active infection.
- CPC & PVP-I selectively reduced pathogenic oral bacteria ( Leptotrichia , Prevotella , Veillonella ) while preserving overall diversity.
- CPC & PVP-I reshaped complex virus-microbiome networks, suggesting oral cavity as active niche for SARS-CoV-2-bacteria interactions.
Abstract
Objective
In this randomized clinical trial (RCT) we evaluated the efficacy of mouthrinses containing sodium chlorite (NaClO ), povidone iodine (PVP-I), cetylpyridinium chloride (CPC) compared to sterile water control in modulating salivary SARS-CoV-2 viral load and the oral microbiome in COVID-19 patients. 2
Methods
Forty PCR-confirmed COVID-19 patients were randomly allocated to four groups (n = 10 each) and rinsed with 10 ml of their assigned solution for 30 s. Saliva was collected pre-rinse and at 5-min, 3-hour, and 6-hour post-rinse. Viral load was quantified via RT-qPCR targeting N and ORF1ab genes, and oral microbiome was analyzed using 16S rRNA sequencing.
Results
CPC reduced viral load by 1.5-fold (P = 0.12), PVP-I by 1.2-fold (P = 0.18), and NaClO by 1.1-fold (P = 0.34) at 6-hour, though not statistically significant. Overall oral microbiome diversity and composition remained stable (P = 0.67), although CPC and PVP-I significantly altered specific taxa such as Leptotrichia sp. and Lautropia mirabilis . Moreover, CPC and PVP-I disrupted the salivary microbiome network with SARS-CoV-2 genes, namely N and ORF1ab genes. 2
Conclusion
This study to provide new insight into the modulation dynamics of mouthrinses on salivary SARS CoV-2 and oral microbiome, suggesting that CPC and PVP-I may provide potential health benefits by reducing viral load and modulating microbiome-virus networks.
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