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Efficacy of mouthwash on reducing salivary SARS-CoV-2 viral load and clinical symptoms: a systematic review and meta-analysis

Zhang et al., BMC Infectious Diseases, doi:10.1186/s12879-023-08669-z, PROSPERO CRD42023401961
Oct 2023  
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*, now with p = 0.000000004 from 21 studies.
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No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19early.org
Systematic review and meta-analysis of 13 randomized controlled trials with a total of 832 participants analyzing the efficacy of mouthwash on reducing salivary SARS-CoV-2 viral load and clinical symptoms in COVID-19 patients. Authors found that mouthwash had a significant positive effect on the CT values of SARS-CoV-2 compared to control, indicating lower viral loads. Subgroup analyses showed mouthwashes containing chlorhexidine, povidone-iodine, and hydrogen peroxide were associated with higher CT values. However, there was no significant difference in direct viral load measurements between mouthwash and control groups overall. Authors conclude that mouthwash, especially containing povidone-iodine, may help reduce SARS-CoV-2 viral load, but more research is needed on dosing and frequency of use.
Study covers povidone-iodine, cetylpyridinium chloride, chlorhexidine, and hydrogen peroxide.
Zhang et al., 11 Oct 2023, peer-reviewed, 6 authors, trial PROSPERO CRD42023401961. Contact: dongqing@ncst.edu.cn, gujq829@163.com.
This PaperPovidone-Iod..All
Efficacy of mouthwash on reducing salivary SARS-CoV-2 viral load and clinical symptoms: a systematic review and meta-analysis
Mingrui Zhang, Nan Meng, Hong Duo, Yuanbo Yang, Qing Dong, Jianqi Gu
BMC Infectious Diseases, doi:10.1186/s12879-023-08669-z
Background COVID-19 has been a public health emergency of international concern (PHEIC) for a lengthy period of time. The novel coronavirus is primarily spread via aerosols at a short distance, with infected individuals releasing large amounts of aerosols when speaking and coughing. However, there is an open question regarding whether mouthwash could effectively reduce virus transmission during the COVID-19 pandemic and support the prevention of infection among medical workers. Methods Cochrane Library, PubMed, Web of Science, and Embase databases were systematically searched from the inception of each database to January 12, 2023 for currently available randomized clinical trials (RCTs) on the effect of mouthwash on novel coronavirus load in the oral cavity in COVID-19 patients. The treatment group received mouthwash for rinsing the mouth, while the control group received a placebo or distilled water for COVID-19 patients. The primary outcomes were CT value and viral load. Odds ratios (ORs) were estimated using a random-effects model. Subgroup and sensitivity analyses were performed to minimize the bias and the impact of heterogeneity. Results Thirteen RCTs were included. Seven studies reported the intervention effect of mouthwash on the CT value of novel coronavirus. The analysis results showed that the mouthwash group had a positive impact on the CT value of novel coronavirus [ SMD = 0.35, 95% CI (0.21, 0.50)] compared with the control group. In addition, subgroup analysis showed a significant positive effect of mouthwash on CT values in the treatment group compared with the control group, with chlorhexidine (CHX) [SMD = 0.33, 95% CI (0.10, 0.56)], povidone-iodine (PVP-I) [SMD = 0.61, 95% CI (0.23, 0.99)], or hydrogen peroxide (HP) [SMD = 1.04, 95% CI (0.30, 1.78)] as an ingredient of the mouthwash. Six studies reported the intervention effect of mouthwash on the viral load, 263 cases in the treatment group and 164 cases in the control group. The analysis results showed that there was no statistical difference between the mouthwash group and the control group in the viral load of novel coronavirus [SMD = -0.06, 95% CI (-0.18, 0.05)]. In the subgroup analysis by measurement time, there were statistically significant differences between the mouthwash and control groups for CT values [SMD = 0.52, 95% CI (0.31, 0.72)] and viral load [SMD = -0.32, 95% CI (-0.56, -0.07)] within 30 min of gargling.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s12879-023-08669-z. Additional file 6: Table S1 . Search strategy. Authors' contributions Conceptualization: Qing Dong, Jianqi Gu; Methodology: Nan Meng, Mingrui Zhang, Hong Duo; Formal analysis and investigation: Nan Meng, Mingrui Zhang, Hong Duo, Yuanbo Yang; Writing-original draft preparation: Mingrui Zhang, Nan Meng; Writing-review and editing: Qing Dong, Jianqi Gu; Funding acquisition: Qing Dong, Yuanbo Yang; Resources: Qing Dong, Yuanbo Yang; Supervision: Qing Dong, Jianqi Gu. And all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Declarations Ethics approval and consent to participate All analyses were based on previous published studies, thus no ethical approval and patient consent are required. Consent for publication Not applicable. Competing interests The authors declare no competing interests. • fast, convenient online submission • thorough peer review by experienced researchers in your field • rapid publication on acceptance • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year • At BMC, research is always in progress. Learn more biomedcentral.com/submissions Ready to submit your research Ready to submit your..
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{ 'indexed': { 'date-parts': [[2023, 10, 12]], 'date-time': '2023-10-12T05:22:46Z', 'timestamp': 1697088166135}, 'reference-count': 43, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2023, 10, 11]], 'date-time': '2023-10-11T00:00:00Z', 'timestamp': 1696982400000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2023, 10, 11]], 'date-time': '2023-10-11T00:00:00Z', 'timestamp': 1696982400000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'funder': [ { 'name': 'Key Research and Development Program in Hebei Province of China', 'award': ['22377741D', '22377741D', '22377741D', '22377741D', '22377741D', '22377741D']}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>COVID-19 has been a public health emergency of international concern ' '(PHEIC) for a lengthy period of time. The novel coronavirus is primarily spread via aerosols ' 'at a short distance, with infected individuals releasing large amounts of aerosols when ' 'speaking and coughing. However, there is an open question regarding whether mouthwash could ' 'effectively reduce virus transmission during the COVID-19 pandemic and support the prevention ' 'of infection among medical workers.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>Cochrane Library, PubMed, Web of Science, and Embase databases were ' 'systematically searched from the inception of each database to January 12, 2023 for currently ' 'available randomized clinical trials (RCTs) on the effect of mouthwash on novel coronavirus ' 'load in the oral cavity in COVID-19 patients. The treatment group received mouthwash for ' 'rinsing the mouth, while the control group received a placebo or distilled water for COVID-19 ' 'patients. The primary outcomes were CT value and viral load. Odds ratios (ORs) were estimated ' 'using a random-effects model. Subgroup and sensitivity analyses were performed to minimize ' 'the bias and the impact of heterogeneity.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Thirteen RCTs were included. Seven studies reported the intervention ' 'effect of mouthwash on the CT value of novel coronavirus. The analysis results showed that ' 'the mouthwash group had a positive impact on the CT value of novel coronavirus [ SMD\u2009' '=\u20090.35, 95% CI (0.21, 0.50)] compared with the control group. In addition, subgroup ' 'analysis showed a significant positive effect of mouthwash on CT values in the treatment ' 'group compared with the control group, with chlorhexidine (CHX) [SMD\u2009=\u20090.33, 95% CI ' '(0.10, 0.56)], povidone-iodine (PVP-I) [SMD\u2009=\u20090.61, 95% CI (0.23, 0.99)], or ' 'hydrogen peroxide (HP) [SMD\u2009=\u20091.04, 95% CI (0.30, 1.78)] as an ingredient of the ' 'mouthwash. Six studies reported the intervention effect of mouthwash on the viral load, 263 ' 'cases in the treatment group and 164 cases in the control group. The analysis results showed ' 'that there was no statistical difference between the mouthwash group and the control group in ' 'the viral load of novel coronavirus [SMD\u2009=\u2009-0.06, 95% CI (-0.18, 0.05)]. In the ' 'subgroup analysis by measurement time, there were statistically significant differences ' 'between the mouthwash and control groups for CT values [SMD\u2009=\u20090.52, 95% CI (0.31, ' '0.72)] and viral load [SMD\u2009=\u2009\u2009−\u20090.32, 95% CI (−\u20090.56,\u2009−\u2009' '0.07)] within 30\xa0min of gargling.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>In summary, mouthwash has some efficacy in reducing the viral load of ' 'novel coronavirus, especially within 30\xa0min after rinsing the mouth. Mouthwash containing ' 'CHX, PVP-I and HP all had significant positive effects on CT values, and PVP-I-containing ' 'mouthwash may be a promising option to control novel coronavirus infections and relieve ' 'virus-related symptoms. However, studies on the dose and frequency of use of mouthwash for ' 'infection control are still lacking, which may limit the clinical application of ' 'mouthwash.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Trial registration</jats:title>\n' ' <jats:p>Protocol registration: The protocol was registered at PROSPERO ' '(CRD42023401961).</jats:p>\n' ' </jats:sec>', 'DOI': '10.1186/s12879-023-08669-z', 'type': 'journal-article', 'created': { 'date-parts': [[2023, 10, 11]], 'date-time': '2023-10-11T12:02:50Z', 'timestamp': 1697025770000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Efficacy of mouthwash on reducing salivary SARS-CoV-2 viral load and clinical symptoms: a ' 'systematic review and meta-analysis', 'prefix': '10.1186', 'volume': '23', 'author': [ {'given': 'Mingrui', 'family': 'Zhang', 'sequence': 'first', 'affiliation': []}, {'given': 'Nan', 'family': 'Meng', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hong', 'family': 'Duo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Yuanbo', 'family': 'Yang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Qing', 'family': 'Dong', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jianqi', 'family': 'Gu', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2023, 10, 11]]}, 'reference': [ { 'issue': '10225', 'key': '8669_CR1', 'doi-asserted-by': 'publisher', 'first-page': '689', 'DOI': '10.1016/S0140-6736(20)30260-9', 'volume': '395', 'author': 'JT Wu', 'year': '2020', 'unstructured': 'Wu JT, Leung K, Leung GM. 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' 'Cetylpyridinium chloride mouthwash to reduce shedding of infectious ' 'SARS-CoV-2: a double-blind randomized clinical trial. J Dent Res. ' '2022;101(12):1450–6.', 'journal-title': 'J Dent Res'}, { 'issue': '1', 'key': '8669_CR14', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/jmv.28412', 'volume': '95', 'author': 'MM Alzahrani', 'year': '2023', 'unstructured': 'Alzahrani MM, Bamashmous S, Alkharobi H, Alghamdi A, Alharbi RH, Hassan ' 'AM, Darwish M, Bukhari A, Mahmoud AB, Alfaleh MA, et al. Mouth rinses ' 'efficacy on salivary SARS-CoV-2 viral load: a randomized clinical trial. ' 'J Med Virol. 2023;95(1): e28412.', 'journal-title': 'J Med Virol'}, { 'issue': '10', 'key': '8669_CR15', 'doi-asserted-by': 'publisher', 'first-page': '1494', 'DOI': '10.1016/j.cmi.2021.05.028', 'volume': '27', 'author': 'F Carrouel', 'year': '2021', 'unstructured': 'Carrouel F, Valette M, Gadea E, Esparcieux A, Illes G, Langlois ME, ' 'Perrier H, Dussart C, Tramini P, Ribaud M, et al. Use of an antiviral ' 'mouthwash as a barrier measure in the SARS-CoV-2 transmission in adults ' 'with asymptomatic to mild COVID-19: a multicentre, randomized, ' 'double-blind controlled trial. Clin Microbiol Infect. ' '2021;27(10):1494–501.', 'journal-title': 'Clin Microbiol Infect'}, { 'issue': 'Suppl 2', 'key': '8669_CR16', 'doi-asserted-by': 'publisher', 'first-page': '2500', 'DOI': '10.1111/odi.14086', 'volume': '28', 'author': 'DD Costa', 'year': '2022', 'unstructured': 'Costa DD, Brites C, Vaz SN, de Santana DS, Dos Santos JN, Cury PR. ' 'Chlorhexidine mouthwash reduces the salivary viral load of SARS-CoV-2: a ' 'randomized clinical trial. Oral Dis. 2022;28(Suppl 2):2500–8.', 'journal-title': 'Oral Dis'}, { 'issue': '6', 'key': '8669_CR17', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.heliyon.2021.e07346', 'volume': '7', 'author': 'FP Eduardo', 'year': '2021', 'unstructured': 'Eduardo FP, Corrêa L, Heller D, Daep CA, Benitez C, Malheiros Z, Stewart ' 'B, Ryan M, Machado CM, Hamerschlak N, et al. Salivary SARS-CoV-2 load ' 'reduction with mouthwash use: a randomized pilot clinical trial. ' 'Heliyon. 2021;7(6): e07346.', 'journal-title': 'Heliyon'}, { 'issue': '3', 'key': '8669_CR18', 'doi-asserted-by': 'publisher', 'first-page': '101584', 'DOI': '10.1016/j.jebdp.2021.101584', 'volume': '21', 'author': 'R Elzein', 'year': '2021', 'unstructured': 'Elzein R, Abdel-Sater F, Fakhreddine S, Hanna PA, Feghali R, Hamad H, ' 'Ayoub F. In vivo evaluation of the virucidal efficacy of chlorhexidine ' 'and povidone-iodine mouthwashes against salivary SARS-CoV-2. A ' 'randomized-controlled clinical trial. J Evid-Based Dental Pract. ' '2021;21(3):101584.', 'journal-title': 'J Evid-Based Dental Pract'}, { 'issue': '1', 'key': '8669_CR19', 'doi-asserted-by': 'publisher', 'first-page': '24392', 'DOI': '10.1038/s41598-021-03461-y', 'volume': '11', 'author': 'MD Ferrer', 'year': '2021', 'unstructured': 'Ferrer MD, Barrueco ÁS, Martinez-Beneyto Y, Mateos-Moreno MV, ' 'Ausina-Márquez V, García-Vázquez E, Puche-Torres M, Giner MJF, González ' 'AC, Coello JMS, et al. Clinical evaluation of antiseptic mouth rinses to ' 'reduce salivary load of SARS-CoV-2. Sci Rep. 2021;11(1):24392.', 'journal-title': 'Sci Rep'}, { 'key': '8669_CR20', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.virusres.2022.198791', 'volume': '316', 'author': 'TL Meister', 'year': '2022', 'unstructured': 'Meister TL, Gottsauner JM, Schmidt B, Heinen N, Todt D, Audebert F, ' 'Buder F, Lang H, Gessner A, Steinmann E, et al. Mouthrinses against ' 'SARS-CoV-2 - High antiviral effectivity by membrane disruption in vitro ' 'translates to mild effects in a randomized placebo-controlled clinical ' 'trial. Virus Res. 2022;316: 198791.', 'journal-title': 'Virus Res'}, { 'issue': '30', 'key': '8669_CR21', 'doi-asserted-by': 'publisher', 'DOI': '10.1097/MD.0000000000028925', 'volume': '101', 'author': 'ZS Natto', 'year': '2022', 'unstructured': 'Natto ZS, Bakhrebah MA, Afeef M, Al-Harbi S, Nassar MS, Alhetheel AF, ' 'Ashi H. 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. ' 'Medicine. 2022;101(30): e28925.', 'journal-title': 'Medicine'}, { 'issue': '1', 'key': '8669_CR22', 'doi-asserted-by': 'publisher', 'first-page': '1833', 'DOI': '10.1080/22221751.2022.2098059', 'volume': '11', 'author': 'Á Sánchez Barrueco', 'year': '2022', 'unstructured': 'Sánchez Barrueco Á, Mateos-Moreno MV, Martínez-Beneyto Y, García-Vázquez ' 'E, Campos González A, Zapardiel Ferrero J, Bogoya Castaño A, Alcalá ' 'Rueda I, Villacampa Aubá JM, Cenjor Español C, et al. Effect of oral ' 'antiseptics in reducing SARS-CoV-2 infectivity: evidence from a ' 'randomized double-blind clinical trial. Emerg Microbes Infect. ' '2022;11(1):1833–42.', 'journal-title': 'Emerg Microbes Infect'}, { 'issue': '3', 'key': '8669_CR23', 'doi-asserted-by': 'publisher', 'first-page': '357', 'DOI': '10.17219/dmp/150831', 'volume': '59', 'author': 'SN Sevinç Gül', 'year': '2022', 'unstructured': 'Sevinç Gül SN, Dilsiz A, Sağlık İ, Aydın NN. Effect of oral antiseptics ' 'on the viral load of SARS-CoV-2: a randomized controlled trial. Dental ' 'Med Prob. 2022;59(3):357–63.', 'journal-title': 'Dental Med Prob'}, { 'issue': '3', 'key': '8669_CR24', 'doi-asserted-by': 'publisher', 'first-page': '288', 'DOI': '10.1111/jcpe.13746', 'volume': '50', 'author': 'R Tarragó-Gil', 'year': '2023', 'unstructured': 'Tarragó-Gil R, Gil-Mosteo MJ, Aza-Pascual-Salcedo M, Alvarez MJL, Ainaga ' 'RR, Gimeno NL, Viñuales RF, Fernández YM, Marco JM, Bolsa EA, et al. ' 'Randomized clinical trial to assess the impact of oral intervention with ' 'cetylpyridinium chloride to reduce salivary SARS-CoV-2 viral load. J ' 'Clin Periodontol. 2023;50(3):288–94.', 'journal-title': 'J Clin Periodontol'}, { 'issue': '1', 'key': '8669_CR25', 'doi-asserted-by': 'publisher', 'first-page': '8', 'DOI': '10.1038/s41368-020-0074-x', 'volume': '12', 'author': 'H Xu', 'year': '2020', 'unstructured': 'Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, Li T, Chen Q. High ' 'expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral ' 'mucosa. Int J Oral Sci. 2020;12(1):8.', 'journal-title': 'Int J Oral Sci'}, { 'issue': '5', 'key': '8669_CR26', 'doi-asserted-by': 'publisher', 'first-page': '892', 'DOI': '10.1038/s41591-021-01296-8', 'volume': '27', 'author': 'N Huang', 'year': '2021', 'unstructured': 'Huang N, Pérez P, Kato T, Mikami Y, Okuda K, Gilmore RC, Conde CD, Gasmi ' 'B, Stein S, Beach M, et al. SARS-CoV-2 infection of the oral cavity and ' 'saliva. Nat Med. 2021;27(5):892–903.', 'journal-title': 'Nat Med'}, { 'issue': '1', 'key': '8669_CR27', 'doi-asserted-by': 'publisher', 'first-page': '19937', 'DOI': '10.1038/s41598-021-99013-5', 'volume': '11', 'author': 'PS da Silva Santos', 'year': '2021', 'unstructured': 'da Silva Santos PS, da Fonseca OB, Machado RRG, Vilhena FV, da Costa ' 'Alves LM, Zangrando MSR, de Oliveira RC, Soares MQS, Simão ANC, Pietro ' 'E, et al. Beneficial effects of a mouthwash containing an antiviral ' 'phthalocyanine derivative on the length of hospital stay for COVID-19: ' 'randomised trial. Sci Rep. 2021;11(1):19937.', 'journal-title': 'Sci Rep'}, { 'issue': 'Rr-17', 'key': '8669_CR28', 'first-page': '1', 'volume': '52', 'author': 'WG Kohn', 'year': '2003', 'unstructured': 'Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM. ' 'Guidelines for infection control in dental health-care settings–2003. ' 'MMWR Recommend Rep. 2003;52(Rr-17):1–61.', 'journal-title': 'MMWR Recommend Rep'}, { 'key': '8669_CR29', 'doi-asserted-by': 'publisher', 'first-page': '47', 'DOI': '10.2147/CCIDE.S295423', 'volume': '13', 'author': 'B da Fonseca Orcina', 'year': '2021', 'unstructured': 'da Fonseca Orcina B, Vilhena FV, de Cardoso Oliveira R, da Costa Marques ' 'Alves L, Araki K, Toma SH, Ragghianti Zangrando MS, da Silva Santos PS. ' 'A Phthalocyanine derivate mouthwash to gargling/rinsing as an option to ' 'reduce clinical symptoms of COVID-19: case series. Clin Cosmetic Invest ' 'Dentistry. 2021;13:47–50.', 'journal-title': 'Clin Cosmetic Invest Dentistry'}, { 'issue': '4', 'key': '8669_CR30', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jebdp.2022.101777', 'volume': '22', 'author': 'ML Poleti', 'year': '2022', 'unstructured': 'Poleti ML, Gregório D, Bistaffa AGI, Fernandes KBP, Vilhena FV, Santos ' 'P, Simão ANC, Lozovoy MAB, Tatibana BT, Fernandes TMF. use of mouthwash ' 'and dentifrice containing an antimicrobial phthalocyanine derivative for ' 'the reduction of clinical symptoms of covid-19: a randomized ' 'triple-blind clinical trial. J Evid Based Dent Pract. 2022;22(4): ' '101777.', 'journal-title': 'J Evid Based Dent Pract'}, { 'issue': '2', 'key': '8669_CR31', 'doi-asserted-by': 'publisher', 'first-page': 'e179', 'DOI': '10.4317/jced.57406', 'volume': '13', 'author': 'BL Cavalcante-Leão', 'year': '2021', 'unstructured': 'Cavalcante-Leão BL, de Araujo CM, Basso IB, Schroder AG, Guariza-Filho ' 'O, Ravazzi GC, Gonçalves FM, Zeigelboim BS, Santos RS, Stechman-Neto J. ' 'Is there scientific evidence of the mouthwashes effectiveness in ' 'reducing viral load in Covid-19? A systematic review. J Clin Exp Dent. ' '2021;13(2):e179–89.', 'journal-title': 'J Clin Exp Dent'}, { 'key': '8669_CR32', 'doi-asserted-by': 'publisher', 'unstructured': 'Hernández-Vásquez A, Barrenechea-Pulache A, Comandé D, Azañedo D. ' 'Mouthrinses and SARS-CoV-2 viral load in saliva: a living systematic ' 'review. Evid Based Dent. 2022:1–7. ' 'https://doi.org/10.1038/s41432-022-0253-z.', 'DOI': '10.1038/s41432-022-0253-z'}, { 'issue': '19', 'key': '8669_CR33', 'doi-asserted-by': 'publisher', 'first-page': '12148', 'DOI': '10.3390/ijerph191912148', 'volume': '19', 'author': 'M Idrees', 'year': '2022', 'unstructured': 'Idrees M, McGowan B, Fawzy A, Abuderman AA, Balasubramaniam R, Kujan O. ' 'Efficacy of Mouth Rinses and Nasal Spray in the Inactivation of ' 'SARS-CoV-2: A Systematic Review and Meta-Analysis of In Vitro and In ' 'Vivo Studies. Int J Environ Res Public Health. 2022;19(19):12148.', 'journal-title': 'Int J Environ Res Public Health'}, { 'issue': '6', 'key': '8669_CR34', 'doi-asserted-by': 'publisher', 'first-page': 'e00512', 'DOI': '10.1128/JCM.00512-20', 'volume': '58', 'author': 'YW Tang', 'year': '2020', 'unstructured': 'Tang YW, Schmitz JE, Persing DH, Stratton CW. Laboratory diagnosis of ' 'COVID-19: current issues and challenges. J Clin Microbiol. ' '2020;58(6):e00512.', 'journal-title': 'J Clin Microbiol'}, { 'issue': '7809', 'key': '8669_CR35', 'doi-asserted-by': 'publisher', 'first-page': '465', 'DOI': '10.1038/s41586-020-2196-x', 'volume': '581', 'author': 'R Wölfel', 'year': '2020', 'unstructured': 'Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, ' 'Niemeyer D, Jones TC, Vollmar P, Rothe C, et al. Virological assessment ' 'of hospitalized patients with COVID-2019. Nature. 2020;581(7809):465–9.', 'journal-title': 'Nature'}, { 'issue': '6', 'key': '8669_CR36', 'doi-asserted-by': 'publisher', 'first-page': '635', 'DOI': '10.1016/S1473-3099(20)30237-1', 'volume': '20', 'author': 'GM Joynt', 'year': '2020', 'unstructured': 'Joynt GM, Wu WK. Understanding COVID-19: what does viral RNA load really ' 'mean? Lancet Infect Dis. 2020;20(6):635–6.', 'journal-title': 'Lancet Infect Dis'}, { 'issue': '7', 'key': '8669_CR37', 'doi-asserted-by': 'publisher', 'first-page': '599', 'DOI': '10.1111/jopr.13220', 'volume': '29', 'author': 'AS Bidra', 'year': '2020', 'unstructured': 'Bidra AS, Pelletier JS, Westover JB, Frank S, Brown SM, Tessema B. ' 'Comparison of In Vitro Inactivation of SARS CoV-2 with Hydrogen Peroxide ' 'and Povidone-Iodine Oral Antiseptic Rinses. J Prosthodontics. ' '2020;29(7):599–603.', 'journal-title': 'J Prosthodontics'}, { 'issue': '3', 'key': '8669_CR38', 'doi-asserted-by': 'publisher', 'first-page': '752', 'DOI': '10.1111/odi.13378', 'volume': '27', 'author': 'S Pattanshetty', 'year': '2021', 'unstructured': 'Pattanshetty S, Narayana A, Radhakrishnan R. Povidone-iodine gargle as a ' 'prophylactic intervention to interrupt the transmission of SARS-CoV-2. ' 'Oral Dis. 2021;27(3):752–3.', 'journal-title': 'Oral Dis'}, { 'issue': '4', 'key': '8669_CR39', 'doi-asserted-by': 'publisher', 'DOI': '10.1371/journal.pone.0195592', 'volume': '13', 'author': 'I Arteagoitia', 'year': '2018', 'unstructured': 'Arteagoitia I, Rodriguez Andrés C, Ramos E. Does chlorhexidine reduce ' 'bacteremia following tooth extraction? A systematic review and ' 'meta-analysis. PLoS ONE. 2018;13(4): e0195592.', 'journal-title': 'PLoS ONE'}, { 'issue': '7', 'key': '8669_CR40', 'doi-asserted-by': 'publisher', 'first-page': '4370', 'DOI': '10.1002/jmv.26954', 'volume': '93', 'author': 'YH Huang', 'year': '2021', 'unstructured': 'Huang YH, Huang JT. Use of chlorhexidine to eradicate oropharyngeal ' 'SARS-CoV-2 in COVID-19 patients. J Med Virol. 2021;93(7):4370–3.', 'journal-title': 'J Med Virol'}, { 'issue': '2', 'key': '8669_CR41', 'doi-asserted-by': 'publisher', 'first-page': '376', 'DOI': '10.1007/s10266-021-00660-x', 'volume': '110', 'author': 'MDS Fernandez', 'year': '2022', 'unstructured': 'Fernandez MDS, Guedes MIF, Langa GPJ, Rösing CK, Cavagni J, Muniz F. ' 'Virucidal efficacy of chlorhexidine: a systematic review. Odontology. ' '2022;110(2):376–92.', 'journal-title': 'Odontology'}, { 'key': '8669_CR42', 'doi-asserted-by': 'publisher', 'first-page': '1351', 'DOI': '10.3389/fmicb.2020.01351', 'volume': '11', 'author': 'G Dev Kumar', 'year': '2020', 'unstructured': 'Dev Kumar G, Mishra A, Dunn L, Townsend A, Oguadinma IC, Bright KR, ' 'Gerba CP. Biocides and novel antimicrobial agents for the mitigation of ' 'coronaviruses. Front Microbiol. 2020;11:1351.', 'journal-title': 'Front Microbiol'}, { 'issue': '6', 'key': '8669_CR43', 'doi-asserted-by': 'publisher', 'first-page': '506', 'DOI': '10.1111/jpc.12232', 'volume': '49', 'author': 'PE Gray', 'year': '2013', 'unstructured': 'Gray PE, Katelaris CH, Lipson D. Recurrent anaphylaxis caused by topical ' 'povidone-iodine (Betadine). J Paediatr Child Health. 2013;49(6):506–7.', 'journal-title': 'J Paediatr Child Health'}], 'container-title': 'BMC Infectious Diseases', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12879-023-08669-z.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s12879-023-08669-z/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12879-023-08669-z.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 10, 11]], 'date-time': '2023-10-11T13:03:29Z', 'timestamp': 1697029409000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08669-z'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 10, 11]]}, 'references-count': 43, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2023, 12]]}}, 'alternative-id': ['8669'], 'URL': 'http://dx.doi.org/10.1186/s12879-023-08669-z', 'relation': {}, 'ISSN': ['1471-2334'], 'subject': ['Infectious Diseases'], 'container-title-short': 'BMC Infect Dis', 'published': {'date-parts': [[2023, 10, 11]]}, 'assertion': [ { 'value': '8 June 2023', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '4 October 2023', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '11 October 2023', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'All analyses were based on previous published studies, thus no ethical approval ' 'and patient consent are required.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'Not applicable.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '678'}
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