Antiviral Mechanism and Clinical Benefits of Mouthwash Active Against SARS-CoV-2

 Reia, V.C.B., da Fonseca Orcina, B., Vilhena, F.V. et al. Antiviral Mechanism and Clinical Benefits of Mouthwash Active Against SARS-CoV-2. Curr Oral Health Rep (2024). https://doi.org/10.1007/s40496-024-00368-1

Abstract

Purpose of Review

We aim to review the spectrum of biological mechanisms of mouthwashes shown to be active against SARS-CoV-2, evidence for efficacy in reduction of viral load, in vitro and in vivo, and the potential for clinical benefit in use of mouthwashes in the context of COVID-19.

Recent Findings

Numerous studies have now been performed to establish the antiviral efficacy of specific mouthwash ingredients against SARS-CoV-2. A combination of biological in vitro studies and clinical studies which assess reduction of viral load in vivo have been performed. Certain mouthwash ingredients have been shown to have anti-SARS-CoV-2 effect, both in vitro and in vivo, for example, by reducing viral load detectable in saliva during acute COVID-19 infection. In addition, iron phthalocyanine, which has antibacterial, antifungal, and antiviral properties, has been tested using in vitro tests, cross-sectional population studies, and randomized clinical trials to assess clinical benefit of its use in the context of hospitalized patients with COVID-19.

Summary

A non-systematic search of the literature was conducted to find studies which generally investigated the mechanisms of action of specific mouthwash ingredients including chlorhexidine (CHX), cetylpyridinium chloride (CPC), ethyl lauroyl arginate (ELA), hydrogen peroxide (HP), povidone-iodine (PVP-I), and anionic phthalocyanine derivative (APD). The terms “Coronavirus infections,” “Severe Acute Respiratory Syndrome Coronavirus 2,” “In vitro techniques,” “Mouthwash,” and “Dentifrices” were used to search the electronic databases. Included were full-text articles in Portuguese, English, and Spanish that could be read online without limitations on the publication year. In clinical investigations, CPC has been demonstrated to lower SARS-CoV-2 viral load in saliva for up to 6 h, chlorhexidine was shown to reduce viral load for 60 min, and PVP-I 1% showed the ability to decrease SARS-CoV-2 for up to 3 h. Mouthwash containing APD has shown potential for benefit in clinical application as an adjunct to standard care in the setting of acute COVID-19. This mouthwash ingredient has shown evidence for reducing symptoms, length of hospital admission, need for intensive care admission, and mortality.