OTC mouth-rinses and SARS-CoV-2 viral load in saliva: Randomized Control Trial

Chaminda Jayampath Seneviratne, Preethi Balan, Karrie Ko Kwan Ki, Nadeeka S. Udawatte, Deborah Lai, Dorothy Ng Hui Lin, Indumathi Venkatachalam, Jay Lim Kheng Sit, Ling Moi Lin, Lynette Oon, Bee Tin Goh, Jean Sim Xiang Ying

doi: https://doi.org/10.1101/2020.09.14.20186494

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

PDF: https://www.medrxiv.org/content/10.1101/2020.09.14.20186494v1.full.pdf

Abstract

The presence of high SARS-coronavirus 2 (SARS-CoV-2) titres in saliva may result in transmission of the virus and increase the risk of COVID-19 infection. This is particularly important as significant amounts of aerosols are generated during dental procedures, posing risk to dental care personnel and patients. Thus, reducing the titres of SARS-CoV-2 in the saliva of infected patients could be one of the key approaches to reduce the risk of COVID-19 transmission during dental procedures. In this randomised control trial, the efficacy of three commercial mouth-rinse viz. povidone-iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 positive patients were compared with water. A total of 36 COVID-19 positive patients were recruited, of which 16 patients were randomly assigned to four groups: PI group (n=4), CHX group (n=6), CPC group (n=4) and water as control group (n=2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis. The fold change of Ct values were significantly increased in CPC group at 5 minutes and 6 h time points (p<0.05), while it showed significant increase at 6 h timepoint for PI group (p<0.01). Considering Ct values as an indirect method of arbitrarily quantifying the viral load, it can be postulated that CPC mouth-rinse can decrease the salivary SARS-CoV-2 levels within 5 minutes of use, compared to water rinsing. The effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, it can be concluded that use of CPC and PI formulated commercial mouth-rinses, with its sustained effect on reducing salivary SARS-CoV-2 level, may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

ISRCTN95933274

Funding Statement

This study was supported by the NMRC Centre Grant Seed Funding Program, National Dental Centre Singapore (NDCS) Research fund (133/20) and National Dental Research Institute Singapore (NDRIS) fund (11/FY2019/G1/02-A44) to CJS.

https://www.medrxiv.org/content/10.1101/2020.09.14.20186494v1