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

{ '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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