Next Article in Journal
Older Patients on Hemodiafiltration: Behavior of Uremic Toxins, Inflammation, Endothelium, and Bone Mineral Disorder
Previous Article in Journal
Cell Responses to Simulated Microgravity and Hydrodynamic Stress Can Be Distinguished by Comparative Transcriptomics
Previous Article in Special Issue
Exploring the Role of Serology Testing to Strengthen Vaccination Initiatives and Policies for COVID-19 in Asia Pacific Countries and Territories: A Discussion Paper
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

The In Vitro Virucidal Effects of Mouthwashes on SARS-CoV-2

1
Think Dental Learning Institute, Paoli, PA 19301, USA
2
Department of Graduate Periodontics, University of Maryland, Baltimore, MD 20742, USA
3
Department of Graduate Prosthodontics, University of Washington, Seattle, WA 98195, USA
4
Department of Graduate Periodontics, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
5
Department of Microbiology and Immunology (Medicine), Temple University, Philadelphia, PA 19140, USA
6
Department of Periodontology and Oral Implantology (Dentistry), Temple University, Philadelphia, PA 19140, USA
*
Author to whom correspondence should be addressed.
Int. J. Transl. Med. 2022, 2(3), 387-397; https://doi.org/10.3390/ijtm2030030
Submission received: 15 May 2022 / Revised: 11 July 2022 / Accepted: 25 July 2022 / Published: 31 July 2022
(This article belongs to the Special Issue Translational Medicine Approach against the COVID-19 Pandemic)

Abstract

:
Oral antiseptic mouthwashes have been widely used for their antibacterial activity. As a result of the SARS-CoV-2 pandemic, the antiviral properties of these oral antiseptics have been aggressively studied. To demonstrate the direct antiviral activity of mouthwashes against SARS-CoV-2, this review will focus on the in vitro virucidal effects of these mouthwashes. Knowledge of the type, concentration, and exposure time of available mouthwashes can provide insights into effective protocols for their clinical use. With an understanding of the characteristics of each oral antiseptic mouthwash, proper mouthwash selection against SARS-CoV-2 may become a useful adjunct to personal protective equipment.

1. Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic. SARS-CoV-2 is a single stranded enveloped RNA virus [1]. It’s exponential spread, resulting in significant morbidity and mortality [2]. The SARS-CoV-2 viral load is highest in the oropharynx, nasopharynx, and nasal cavity [3]. This is due to the high angiotensin-converting enzyme 2 (ACE2) receptors in the respiratory epithelium. The ACE2 receptors are used by the virus on first entry into the body [4]. Since the mouth is part of the oropharynx, contaminated saliva can contribute to the spread of SARS-CoV-2 [5,6]. SARS-CoV-2 can spread via respiratory droplets, saliva, dental procedures that produce aerosolized viral particles [7], and physical contact. Dental providers are at risk of exposure to high levels of contamination with SARS-CoV-2 while performing aerosol-producing dental procedures [8].
SARS-CoV-2 shedding is the highest during the initial stages of disease and occurs in the upper respiratory tract [9,10]. SARS-CoV-2-infected symptomatic patients, as well as asymptomatic and pre-symptomatic SARS-CoV-2-infected individuals can spread the virus [11]. Social distancing and preventative measures, including personal hygiene and frequent disinfection of high-touch surfaces, are some important interventions to reduce person-to-person transmission. Cross-infection control guidelines need to stay abreast of the constantly mutating SARS-CoV-2 [12] and, likewise, new vaccines need to constantly evolve to continue to be effective [13]. Thus, strategies to curb the spread may involve proper hand washing and oral disinfection with mouthwashes [7].

2. Oral Antiseptic Mouthwashes

Oral antiseptic mouthwashes have been used widely for their antibacterial activity. Due to the COVID-19 pandemic, the antiviral properties of these oral antiseptics have been further investigated for infection control (Table 1). Commercially available mouthwashes contain active ingredients such as povidone iodine or polyvinylpyrrolidone iodine (PVP-I), cetylpyridinium chloride (CPC), chlorohexidine gluconate (CHX), dipotassium oxalate, stabilized hypochlorous acid, hydrogen peroxide (H2O2), eucalyptol, thymol, menthol, sodium fluoride, and zinc fluoride [14].

3. In vitro Studies assessing Virucidal Activity

To evaluate the disinfecting activity of mouthwashes, the EN14476 standard methods were utilized for the virus time–kill assay [30]. Against SARS-CoV-2, the evaluated mouthwashes were tested undiluted and 50% diluted, at contact times of 15, 30 and 60 s, and under clean (0.3 g/L bovine serum albumin (BSA)) or dirty (0.3 g/L BSA + 3 mL/L human erythrocytes) conditions. Viral activity was immediately neutralized at the specific contact times to ensure that there were no sequelae. The 10-fold serial dilutions were incubated with Vero E6 cells for 72 h until cytopathic effects were observed. The Spearman–Kärber method [31,32] was used to determine the viral titers. Based on the European Chemicals Agency (ECHA) guidelines [33], virucidal activity is calculated as the reduction in viral titer compared to control. The log reduction value (LRV) of each mouthwash (Table 1) was compared to the negative control (water).

4. Safety of Antiseptic Mouthwashes

For an antiseptic to be used safely as a mouthwash in the oral cavity, cytotoxicity assays were performed to evaluate the lowest concentration at which the mouthwash was non-cytotoxic to human cells. Mouthwash dilutions were added to confluent monolayers of Vero E6 cell culture and incubated for 72 h before measuring the cell viability to determine the concentration at which no cytotoxic effects were observed on human cells. This also needs to be taken into consideration when assessing virucidal activity via the time–kill assay [30]. The Vero E6 cell lines are commonly used to isolate, propagate, and study SARS-CoV-2. The Vero lineage was extracted and isolated from African green monkey kidney epithelial cells [34]. The Vero E6 is a clone derived from Vero 76. The advantages of the Vero E6 cells are that they support high titres of viral replication [35,36,37,38,39], due their high ACE2 receptor expression [40] and the lack of interferon-producing activity [41].
PVP-I at a 5% concentration has proven safe for oral use [42,43,44]. With 6 months of 5% PVP-I use, the thyroid-stimulating hormone was shown to slightly increase with no indication of thyroid disease [45]. Mouthwash absorption at concentrations of 0.2% to 0.5% iodine is minimal and below the daily 150 μg iodine intake for a healthy adult. Furthermore, no taste change or teeth discoloration were reported in the studies [46]. Importantly, PVP-I substantivity has been reported to be as long as 4 h [47]. Contraindications for PVP-I include anaphylactic allergy to iodine, active thyroid disease, pregnancy, and radioactive iodine therapy [48,49,50,51]. There was some cytotoxicity reported for H2O2 and CHX [23].

5. Effectiveness of Oral Antiseptic Mouthwashes

Virucidal activity of a mouthwash (Table 1) can be reported as the log reduction value (LRV), which compares the reduction in viral titers to viral control. A ≥4 log10 reduction in viral titers corresponds to a ≥99.99% kill, which indicates rapid virucidal activity. The exposure time was tested at 15 or 30 s; the 30 s exposure time was mandated by the European Chemicals Agency (ECHA) guidelines [33]. The Centers for Disease Control and Prevention (CDC) has suggested the use of PVP-I, chlorhexidine gluconate, cetylpyridinium chloride, or essential oils as possible options for an antiviral mouth rinse [52].
SARS-CoV-2 can be effectively inactivated in 30 s by most commercially available mouthwashes [22]. The most effective active ingredients were povidone–iodine [18], cetylpyridinium chloride, hexetidine, benzalkonium chloride, and essential oils [22].
PVP-I is a complex of povidone and iodine. It has been used for over 60 years in healthcare because of its broad-spectrum antimicrobial properties and safety profile [30,53]. SARS-CoV-2 can be completely inactivated by PVP-I in-vitro at concentrations of 0.5%, 1.25%, or 1.5%, in as little as 15 s [16]. It can completely inactivate SARS-CoV-2 at a concentration as minimal as 0.5% and a contact time of as minimal as 15 s [17]. Other in vitro studies reported PVP-I solutions of 0.23% inactivated SARS-CoV-2 in as little as 15 s [19,30]. In Japan, PVP-I at a 0.23% concentration has been recommended by the Japanese Ministry of Health, Labor and Welfare and is routinely used for daily gargling to prevent upper respiratory tract infections and COVID-19 [19,30,54]. Commercial mouthwashes containing 0.01–0.02% hypochlorous acid or 0.58% PVP-I effectively inactivated SARS-CoV-2 [14]. Iotech International formula 100-S displayed the highest virucidal activity compared to other mouthwashes; it inactivated SARS-CoV-2 completely. The 100 ppm molecular iodine mouthwash is unique in iodine chemistry [55].
CPC is a quaternary ammonium compound with broad antiseptic and antimicrobial activity. It has been used in many oral mouthwashes and breath sprays. CPC is virucidal against enveloped viruses, including influenza and several coronaviruses [56,57]. CPC mouthwashes can effectively decrease the viral load of SARS-CoV-2-infected individuals regardless of the viral variant [58]. The CPC mouthwashes can retain their effectiveness in the presence or absence of saliva [58]. CPC and CPC-containing mouthwashes disrupt the viral membrane integrity and inhibit SARS-CoV-2 entry into human cells. This decreases the infectivity of SARS-CoV-2 and is effective against the viral variants [58]. Previous studies have also shown that CPC has substantivity, lasting 3–5 h in saliva [59]. Another study reported a 6 log reduction in virucidal activity in a solution containing CPC and D-limonene 0.2% [60].
Some mouthwash formulations containing CHX were reported to have limited effectiveness against SARS-CoV-2 [28]. One study reported that the virucidal activity of CHX-containing mouthwash against SARS-CoV-2 was slightly less than those of CPC and hexetidine. This is incongruent with another study, which showed log reduction factors ranging from 0.33 to 0.78 [22]. Other in vitro and in vivo studies reported that CHX at a concentration of 0.12–2% was effective against SARS-CoV-2 [61,62]. CHX may temporarily reduce SARS-CoV-2 viral load in COVID-19 patients [63].
H2O2 is low cost and easily accessible [64,65]. However, it has the potential for toxicity under routine use [64], which includes gastric and colon symptoms [66]. H2O2 can be inactivated by the catalase in the saliva [67], and there is a lack of clinical or in vitro data for its virucidal effects on SARS-CoV-2. H2O2 at 3.0% and 1.5% had minimal antiviral activity after 15 s or 30 s [16]. PVP-I has more viricidal activity than H2O2. [16]. Some studies reported that H2O2 and CHX alone had no virucidal effect against SARS-CoV-2 [20]. Commercial H2O2 oral rinses may have additional components that improve the virucidal activity.
Mouthwashes containing dequalinium chloride and benzalkonium chloride had virucidal activity against SARS-CoV-2 [22]. Delmopinol hydrochloride is a known cationic surfactant [22]. Thus, cationic surfactants may also be effective against SARS-CoV-2.
Mouthwashes with an anionic phthalocyanine derivative (APD) can adhere to the cellular components of microoganisms [68]. APD mouthwashes can produce an in vitro intense antiviral reaction resulting in 90% viral inactivation [25].
Stabilized chlorine dioxide is antiviral, antibacterial, anti-biofilm, antifungal, and oxidative on oral malodor compounds [69,70,71]. Diluted toothpaste slurry with stabilized 0.04% chloride dioxide, compared to 0.1% chloride dioxide in mouthwashes, showed comparable viral load reduction [27]. The amino acids and organic acids present in saliva quickly liberate the chloride dioxide from its stabilized form in the oral cavity [70]. The released chlorine dioxide exhibits antiviral and antimicrobial activity [69].
Ethanol at 70% (positive control) did not completely inactivate SARS-CoV-2 at 15 s of contact; 30 s of contact was required to inactivate the virus [20].
Salt water and thymol was not effective against SARS-CoV-2, even though a high concentration of NaCl (0.34 M) was used [29]. Salt water gargling has been a common home remedy to alleviate the symptoms of a cold and sore throat. Mucin in buffers with a high salt concentration (0.3 M) increased the mucin barrier function, blocking viral infection in vitro [29]. Increasing the concentration of sodium chloride (NaCl) can enhance the antiviral activity of epithelial cells via inhibition of RNA and DNA viral replications [72]. More elaborate studies are needed to evaluate the virucidal effect of different NaCl concentrations on SARS-CoV-2.

6. Other Effects of Mouthwashes on SARS-CoV-2

In addition to the virucidal effects, the previously described mouthwashes may have inhibitory effects on the viral spike protein–ACE2 interaction, as well as transmembrane protease serine 2 (TMPRSS2) activity [73]. Disruption to the viral spike protein–ACE2 interaction and the TMPRSS2 activity can limit the entry of SAR-CoV-2 into the host cells and help prevent the spread of SARS-CoV-2 [74,75]. TMPRSS2 cleaves the viral spike protein and facilitates SARS-CoV-2 fusion to the host cell membrane [76].
Some active ingredients present in commercially available mouthwashes and toothpastes include sodium dodecyl sulfate (SDS), sodium N-lauroyl-N-methyltaurine (LMT), sodium tetradecene sulfonate (TDS), sodium N-lauroylsarcosinate (LSS), and copper gluconate (GCU). These active ingredients are reported to be effective against ACE2 and TMPRSS2, resulting in a highly preventive effect [73]. In addition, tranexamic acid (TXA) has inhibitory effects on TMPRSS2 protease activity [73].

7. Biocide Resistance of Mouthwashes

Long-term use of a sublethal dose of mouthwash may increase the bacterial minimum inhibitory concentration (MIC) and biocide resistance [77,78,79,80,81]. The MICs are lower for Gram-positive bacteria compared to Gram-negative bacteria; CHX has a greater affinity for the Gram-positive bacterial cell wall. Thus, prolonged use may increase risk of Gram-negative bacterial overgrowth.
The development of biocide resistance may lead to concomitant antibiotic cross-resistance [82]. Bacterial drug resistance was reported after frequent use of CPC [83]. Likewise, there is evidence of the development of bacterial resistance in response to low-level exposure to CHX [84]. Some mechanisms for bacterial resistance involve dysfunctional efflux pumps and cell membrane mutation [84].
However, studies reported that biocide resistance was to non-oral bacteria. There are limited reports on the long-term effects of low-concentration mouthwashes on oral bacteria. One study reported that the short-term use of CPC did not result in non-native bacterial colonization nor increased Gram-negative microorganisms [85].
The widespread use of mouthwashes may pose a potential risk of bacterial phenotypic adaptation, biocide resistance, and antibiotic cross-resistance. Further studies needed to investigate this potential risk and the underlying molecular mechanisms.

8. Limitations of In Vitro Studies

The effects of mouthwashes in vitro may not perform the same way in vivo; the human oral microenvironment is more complex. Substances such as saliva or teeth can act as viral carriers [86]. The presence of saliva may interfere with the effectiveness of the mouthwash in vivo. Saliva in the mouth with a flow rate of 5mL/min [87] can dilute the concentration of the mouthwash. In addition, bacteria in biofilms may exhibit a higher tolerance to antimicrobial mouthwashes [88]. In addition, the oral cavity maintains a mean temperature of 36.6 °C [89], while in vitro studies occur at ambient temperature. SARS-CoV-2 may be more stable at ambient temperature than at body temperature [90]. The temperature difference in the mouth and in vitro may contribute to some errors in outcomes. Furthermore, in vitro studies use standardized validated virucidal efficacy tests that are not representative of the in vivo antiviral effects in the oral cavity. The substantivity of the mouthwashes may also be different in the oral cavity compared to in vitro.

9. Conclusions

The broad-spectrum antibacterial and rapid virucidal activities against SARS-CoV-2, of the antiseptic mouthwashes discussed above suggests an important application in infection control. Randomized clinical trials comparing mouthwashes in COVID-19-positive patients are the next step in determining the ideal mouthwash and pre-procedural strategies to inactivate SARS-CoV-2 in the oral cavity in a clinical setting. PVP-I at 0.5–1.5% or CPC should be preferred over H2O2 or CHX. These virucidal mouthwashes with adequate substantivity can help reduce disease transmission and can be easily integrated into existing infection control protocols. The use of these mouthwashes can complement hygiene measures and curb the transmission of COVID-19 in the community.

Author Contributions

M.T. participated in the design of the review, literature search and article selection, drafting and revising of manuscript and table, and final approval of submitted version. J.B.S. participated in the design of the review, article selection, drafting and revising of manuscript and table, and final approval of submitted version. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest in the writing of this manuscript. J.B.S. is a U.S. Government Special Government Employee with the US Food and Drug Administration, Silver Spring, MD, USA.

References

  1. Ting, M.; Suzuki, J.B. SARS-CoV-2: Overview and Its Impact on Oral Health. Biomedicines 2021, 9, 1690. [Google Scholar] [CrossRef] [PubMed]
  2. Zhao, S.; Lin, Q.; Ran, J.; Musa, S.S.; Yang, G.; Wang, W.; Lou, Y.; Gao, D.; Yang, L.; He, D.; et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Int. J. Infect. Dis 2020, 92, 214–217. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  3. Zou, L.; Ruan, F.; Huang, M.; Liang, L.; Huang, H.; Hong, Z.; Yu, J.; Kang, M.; Song, Y.; Xia, J.; et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N. Engl. J. Med. 2020, 382, 1177–1179. [Google Scholar] [CrossRef] [PubMed]
  4. Sungnak, W.; Huang, N.; Becavin, C.; Berg, M.; Queen, R.; Litvinukova, M.; Talavera-Lopez, C.; Maatz, H.; Reichart, D.; Sampaziotis, F.; et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat. Med. 2020, 26, 681–687. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  5. Harrel, S.K.; Molinari, J. Aerosols and splatter in dentistry: A brief review of the literature and infection control implications. J. Am. Dent. Assoc. 2004, 135, 429–437. [Google Scholar] [CrossRef] [PubMed]
  6. Micik, R.E.; Miller, R.L.; Mazzarella, M.A.; Ryge, G. Studies on dental aerobiology. I. Bacterial aerosols generated during dental procedures. J. Dent. Res. 1969, 48, 49–56.e11. [Google Scholar] [CrossRef] [PubMed]
  7. Enciso, R.; Keaton, J.; Saleh, N.; Ahmadieh, A.; Clark, G.T.; Sedghizadeh, P.P. Assessing the utility of serum C-telopeptide cross-link of type 1 collagen as a predictor of bisphosphonate-related osteonecrosis of the jaw: A systematic review and meta-analysis. J. Am. Dent. Assoc. 2016, 147, 551–560. [Google Scholar] [CrossRef] [PubMed]
  8. Bordea, I.R.; Xhajanka, E.; Candrea, S.; Bran, S.; Onisor, F.; Inchingolo, A.D.; Malcangi, G.; Pham, V.H.; Inchingolo, A.M.; Scarano, A.; et al. Coronavirus (SARS-CoV-2) Pandemic: Future Challenges for Dental Practitioners. Microorganisms 2020, 8, 1704. [Google Scholar] [CrossRef] [PubMed]
  9. Wolfel, R.; Corman, V.M.; Guggemos, W.; Seilmaier, M.; Zange, S.; Muller, M.A.; Niemeyer, D.; Jones, T.C.; Vollmar, P.; Rothe, C.; et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020, 581, 465–469. [Google Scholar] [CrossRef] [Green Version]
  10. To, K.K.; Tsang, O.T.; Leung, W.S.; Tam, A.R.; Wu, T.C.; Lung, D.C.; Yip, C.C.; Cai, J.P.; Chan, J.M.; Chik, T.S.; et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: An observational cohort study. Lancet Infect. Dis 2020, 20, 565–574. [Google Scholar] [CrossRef] [Green Version]
  11. Bai, Y.; Yao, L.; Wei, T.; Tian, F.; Jin, D.Y.; Chen, L.; Wang, M. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020, 323, 1406–1407. [Google Scholar] [CrossRef] [Green Version]
  12. Bordea, I.R.; Candrea, S.; Salagean, T.; Pop, I.D.; Lucaciu, O.; Ilea, A.; Manole, M.; Babtan, A.M.; Sirbu, A.; Hanna, R. Impact of COVID-19 Pandemic on Healthcare Professionals and Oral Care Operational Services: A Systemic Review. Risk Manag. Healthc. Policy 2021, 14, 453–463. [Google Scholar] [CrossRef]
  13. Inchingolo, A.D.; Inchingolo, A.M.; Bordea, I.R.; Malcangi, G.; Xhajanka, E.; Scarano, A.; Lorusso, F.; Farronato, M.; Tartaglia, G.M.; Isacco, C.G.; et al. SARS-CoV-2 Disease through Viral Genomic and Receptor Implications: An Overview of Diagnostic and Immunology Breakthroughs. Microorganisms 2021, 9, 793. [Google Scholar] [CrossRef] [PubMed]
  14. Davies, K.; Buczkowski, H.; Welch, S.R.; Green, N.; Mawer, D.; Woodford, N.; Roberts, A.D.G.; Nixon, P.J.; Seymour, D.W.; Killip, M.J. Effective in vitro inactivation of SARS-CoV-2 by commercially available mouthwashes. J. Gen. Virol. 2021, 102, 001578. [Google Scholar] [CrossRef] [PubMed]
  15. Anderson, D.E.; Sivalingam, V.; Kang, A.E.Z.; Ananthanarayanan, A.; Arumugam, H.; Jenkins, T.M.; Hadjiat, Y.; Eggers, M. Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease. Infect. Dis. Ther. 2020, 9, 669–675. [Google Scholar] [CrossRef] [PubMed]
  16. Bidra, A.S.; Pelletier, J.S.; Westover, J.B.; Frank, S.; Brown, S.M.; Tessema, B. Comparison of In Vitro Inactivation of SARS CoV-2 with Hydrogen Peroxide and Povidone-Iodine Oral Antiseptic Rinses. J. Prosthodont. 2020, 29, 599–603. [Google Scholar] [CrossRef] [PubMed]
  17. Bidra, A.S.; Pelletier, J.S.; Westover, J.B.; Frank, S.; Brown, S.M.; Tessema, B. Rapid In-Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Using Povidone-Iodine Oral Antiseptic Rinse. J. Prosthodont. 2020, 29, 529–533. [Google Scholar] [CrossRef] [PubMed]
  18. Hassandarvish, P.; Tiong, V.; Mohamed, N.A.; Arumugam, H.; Ananthanarayanan, A.; Qasuri, M.; Hadjiat, Y.; Abubakar, S. In vitro virucidal activity of povidone iodine gargle and mouthwash against SARS-CoV-2: Implications for dental practice. Br. Dent. J. 2020, 1–4. [Google Scholar] [CrossRef] [PubMed]
  19. Kariwa, H.; Fujii, N.; Takashima, I. Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions and chemical reagents. Dermatology 2006, 212 (Suppl. 1), 119–123. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  20. Koch-Heier, J.; Hoffmann, H.; Schindler, M.; Lussi, A.; Planz, O. Inactivation of SARS-CoV-2 through Treatment with the Mouth Rinsing Solutions ViruProX((R)) and BacterX((R)) Pro. Microorganisms 2021, 9, 521. [Google Scholar] [CrossRef]
  21. Komine, A.; Yamaguchi, E.; Okamoto, N.; Yamamoto, K. Virucidal activity of oral care products against SARS-CoV-2 in vitro. J. Oral. Maxillofac. Surg. Med. Pathol. 2021, 33, 475–477. [Google Scholar] [CrossRef] [PubMed]
  22. Meister, T.L.; Bruggemann, Y.; Todt, D.; Conzelmann, C.; Muller, J.A.; Gross, R.; Munch, J.; Krawczyk, A.; Steinmann, J.; Steinmann, J.; et al. Virucidal Efficacy of Different Oral Rinses Against Severe Acute Respiratory Syndrome Coronavirus 2. J. Infect. Dis. 2020, 222, 1289–1292. [Google Scholar] [CrossRef] [PubMed]
  23. Moskowitz, H.; Mendenhall, M. Comparative Analysis of Antiviral Efficacy of Four Different Mouthwashes against Severe Acute Respiratory Syndrome Coronavirus 2: An In Vitro Study. Int. J. Exp. Dent. Sci. 2020, 9, 1–3. [Google Scholar] [CrossRef]
  24. Pelletier, J.S.; Tessema, B.; Frank, S.; Westover, J.B.; Brown, S.M.; Capriotti, J.A. Efficacy of Povidone-Iodine Nasal and Oral Antiseptic Preparations Against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). Ear. Nose. Throat. J. 2021, 100, 192S–196S. [Google Scholar] [CrossRef] [PubMed]
  25. Santos, C.; da Fonseca Orcina, B.; Brito Reia, V.C.; Ribeiro, L.G.; Grotto, R.M.T.; Prudenciatti, A.; de Moraes, L.N.; Ragghianti Zangrando, M.; Vilhena, F.V.; da Silva Santos, P.S. Virucidal Activity of the Antiseptic Mouthwash and Dental Gel Containing Anionic Phthalocyanine Derivative: In vitro Study. Clin. Cosmet. Investig. Dent. 2021, 13, 269–274. [Google Scholar] [CrossRef] [PubMed]
  26. Shet, M.; Westover, J.; Hong, R.; Igo, D.; Cataldo, M.; Bhaskar, S. In vitro inactivation of SARS-CoV-2 using a povidone-iodine oral rinse. BMC Oral Health 2022, 22, 47. [Google Scholar] [CrossRef] [PubMed]
  27. Shewale, J.G.; Gelhaus, H.C.; Ratcliff, J.L.; Hernandez-Kapila, Y.L. In vitro antiviral activity of stabilized chlorine dioxide containing oral care products. Oral Dis. 2021, 00, 1–8. [Google Scholar] [CrossRef] [PubMed]
  28. Steinhauer, K.; Meister, T.L.; Todt, D.; Krawczyk, A.; Passvogel, L.; Becker, B.; Paulmann, D.; Bischoff, B.; Pfaender, S.; Brill, F.H.H.; et al. Comparison of the in-vitro efficacy of different mouthwash solutions targeting SARS-CoV-2 based on the European Standard EN 14476. J. Hosp. Infect. 2021, 111, 180–183. [Google Scholar] [CrossRef]
  29. Tiong, V.; Hassandarvish, P.; Bakar, S.A.; Mohamed, N.A.; Wan Sulaiman, W.S.; Baharom, N.; Abdul Samad, F.N.; Isahak, I. The effectiveness of various gargle formulations and salt water against SARS-CoV-2. Sci. Rep. 2021, 11, 20502. [Google Scholar] [CrossRef] [PubMed]
  30. Eggers, M.; Koburger-Janssen, T.; Eickmann, M.; Zorn, J. In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and Oral Tract Pathogens. Infect. Dis. Ther. 2018, 7, 249–259. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  31. Spearman, C. The method of ‘Right and Wrong cases’ (“Constant Stimuli”) without Gauss’s Formulae. Br. J. Psychol. 1908, 2, 227–242. [Google Scholar] [CrossRef]
  32. Kärber, G. Beitrag zur kollektiven Behandlung pharmakologischer Reihenversuche. Naunyn-Schmiedebergs Arch. Für Exp. Pathol. Pharmakol. 1931, 162, 480–483. [Google Scholar] [CrossRef]
  33. Rupel, K.; Ottaviani, G.; Gobbo, M.; Contardo, L.; Tirelli, G.; Vescovi, P.; Di Lenarda, R.; Biasotto, M. A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ). Oral Oncol. 2014, 50, 1049–1057. [Google Scholar] [CrossRef]
  34. Yasumura, Y.; Kawakita, M. The research for the SV40 by means of tissue culture technique. Nippon. Rinsho. 1963, 21, 1201–1219. [Google Scholar]
  35. Banerjee, A.; Nasir, J.A.; Budylowski, P.; Yip, L.; Aftanas, P.; Christie, N.; Ghalami, A.; Baid, K.; Raphenya, A.R.; Hirota, J.A.; et al. Isolation, Sequence, Infectivity, and Replication Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg. Infect. Dis. 2020, 26, 2054–2063. [Google Scholar] [CrossRef] [PubMed]
  36. Matsuyama, S.; Nao, N.; Shirato, K.; Kawase, M.; Saito, S.; Takayama, I.; Nagata, N.; Sekizuka, T.; Katoh, H.; Kato, F.; et al. Enhanced isolation of SARS-CoV-2 by TMPRSS2-expressing cells. Proc. Natl. Acad. Sci. USA 2020, 117, 7001–7003. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  37. Tseng, C.T.; Tseng, J.; Perrone, L.; Worthy, M.; Popov, V.; Peters, C.J. Apical entry and release of severe acute respiratory syndrome-associated coronavirus in polarized Calu-3 lung epithelial cells. J. Virol. 2005, 79, 9470–9479. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  38. Mossel, E.C.; Huang, C.; Narayanan, K.; Makino, S.; Tesh, R.B.; Peters, C.J. Exogenous ACE2 expression allows refractory cell lines to support severe acute respiratory syndrome coronavirus replication. J. Virol. 2005, 79, 3846–3850. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  39. Kaye, M. SARS-associated coronavirus replication in cell lines. Emerg. Infect. Dis. 2006, 12, 128–133. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  40. Gillim-Ross, L.; Taylor, J.; Scholl, D.R.; Ridenour, J.; Masters, P.S.; Wentworth, D.E. Discovery of novel human and animal cells infected by the severe acute respiratory syndrome coronavirus by replication-specific multiplex reverse transcription-PCR. J. Clin. Microbiol. 2004, 42, 3196–3206. [Google Scholar] [CrossRef] [Green Version]
  41. De Clercq, E.; Stewart, W.E., 2nd; De Somer, P. Studies on the mechanism of the priming effect of interferon on interferon production by cell cultures exposed to poly(rI)-poly(rC). Infect. Immun. 1973, 8, 309–316. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  42. Frank, S.; Brown, S.M.; Capriotti, J.A.; Westover, J.B.; Pelletier, J.S.; Tessema, B. In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2. JAMA Otolaryngol. Head Neck Surg. 2020, 146, 1054–1058. [Google Scholar] [CrossRef] [PubMed]
  43. Reimer, K.; Wichelhaus, T.A.; Schafer, V.; Rudolph, P.; Kramer, A.; Wutzler, P.; Ganzer, D.; Fleischer, W. Antimicrobial effectiveness of povidone-iodine and consequences for new application areas. Dermatology 2002, 204 (Suppl. 1), 114–120. [Google Scholar] [CrossRef] [PubMed]
  44. Madan, P.D.; Sequeira, P.S.; Shenoy, K.; Shetty, J. The effect of three mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies: A randomized control trial. J. Cancer Res. 2008, 4, 3–8. [Google Scholar] [CrossRef] [PubMed]
  45. Ader, A.W.; Paul, T.L.; Reinhardt, W.; Safran, M.; Pino, S.; McArthur, W.; Braverman, L.E. Effect of mouth rinsing with two polyvinylpyrrolidone-iodine mixtures on iodine absorption and thyroid function. J. Clin. Endocrinol. Metab. 1988, 66, 632–635. [Google Scholar] [CrossRef] [PubMed]
  46. Kovesi, G. [The use of Betadine antiseptic in the treatment of oral surgical, parodontological and oral mucosal diseases]. Fogorv. Szle. 1999, 92, 243–250. [Google Scholar] [PubMed]
  47. Domingo, M.A.; Farrales, M.S.; Loya, R.M.; Pura, M.A.; Uy, H. The effect of 1% povidone iodine as a pre-procedural mouthrinse in 20 patients with varying degrees of oral hygiene. J. Philipp. Dent. Assoc. 1996, 48, 31–38. [Google Scholar] [PubMed]
  48. Foley, T.P., Jr. The relationship between autoimmune thyroid disease and iodine intake: A review. Endokrynol. Pol. 1992, 43 (Suppl. 1), 53–69. [Google Scholar]
  49. Furudate, S.; Nishimaki, T.; Muto, T. 125I uptake competing with iodine absorption by the thyroid gland following povidone-iodine skin application. Exp. Anim. 1997, 46, 197–202. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  50. Gray, P.E.; Katelaris, C.H.; Lipson, D. Recurrent anaphylaxis caused by topical povidone-iodine (Betadine). J. Paediatr Child. Health 2013, 49, 506–507. [Google Scholar] [CrossRef] [PubMed]
  51. Kampf, G.; Todt, D.; Pfaender, S.; Steinmann, E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J. Hosp. Infect. 2020, 104, 246–251. [Google Scholar] [CrossRef] [Green Version]
  52. The Centers for Disease Control and Prevention (CDC). Interim Infection Prevention and Control Guidance for Dental Settings during the COVID-19 Response. Available online: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html (accessed on 28 May 2020).
  53. Vogt, P.M.; Hauser, J.; Mueller, S.; Bosse, B.; Hopp, M. Efficacy of Conventional and Liposomal Povidone-Iodine in Infected Mesh Skin Grafts: An Exploratory Study. Infect. Dis. Ther. 2017, 6, 545–555. [Google Scholar] [CrossRef]
  54. O’Donnell, V.B.; Thomas, D.; Stanton, R.; Maillard, J.Y.; Murphy, R.C.; Jones, S.A.; Humphreys, I.; Wakelam, M.J.O.; Fegan, C.; Wise, M.P.; et al. Potential Role of Oral Rinses Targeting the Viral Lipid Envelope in SARS-CoV-2 Infection. Function 2020, 1, zqaa002. [Google Scholar] [CrossRef] [PubMed]
  55. Elliot, K.R.; Herbert, M.; Jack, K. Stable Compositions of Uncomplexed Iodine and Methods of Use. U.S. Patent No. 11,297,839, 9 October 2018. [Google Scholar]
  56. Popkin, D.L.; Zilka, S.; Dimaano, M.; Fujioka, H.; Rackley, C.; Salata, R.; Griffith, A.; Mukherjee, P.K.; Ghannoum, M.A.; Esper, F. Cetylpyridinium Chloride (CPC) Exhibits Potent, Rapid Activity Against Influenza Viruses in vitro and in vivo. Pathog. Immun. 2017, 2, 252–269. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  57. Shen, L.; Niu, J.; Wang, C.; Huang, B.; Wang, W.; Zhu, N.; Deng, Y.; Wang, H.; Ye, F.; Cen, S.; et al. High-Throughput Screening and Identification of Potent Broad-Spectrum Inhibitors.s of Coronaviruses. J. Virol. 2019, 93, e00023-19. [Google Scholar] [CrossRef] [Green Version]
  58. Munoz-Basagoiti, J.; Perez-Zsolt, D.; Leon, R.; Blanc, V.; Raich-Regue, D.; Cano-Sarabia, M.; Trinite, B.; Pradenas, E.; Blanco, J.; Gispert, J.; et al. Mouthwashes with CPC Reduce the Infectivity of SARS-CoV-2 Variants In Vitro. J. Dent. Res. 2021, 100, 1265–1272. [Google Scholar] [CrossRef] [PubMed]
  59. Elworthy, A.; Greenman, J.; Doherty, F.M.; Newcombe, R.G.; Addy, M. The substantivity of a number of oral hygiene products determined by the duration of effects on salivary bacteria. J. Periodontol. 1996, 67, 572–576. [Google Scholar] [CrossRef]
  60. Rodríguez-Casanovas, H.J.; la Rosa, M.D.; Bello-Lemus, Y.; Rasperini, G.; Acosta-Hoyos, A.J. Virucidal Activity of Different Mouthwashes Using a Novel Biochemical Assay. Healthcare 2022, 10, 63. [Google Scholar] [CrossRef]
  61. Huang, Y.H.; Huang, J.T. Use of chlorhexidine to eradicate oropharyngeal SARS-CoV-2 in COVID-19 patients. J. Med. Virol. 2021, 93, 4370–4373. [Google Scholar] [CrossRef] [PubMed]
  62. Jain, S.; Bhat, N.; Asawa, K.; Tak, M.; Singh, A.; Shinde, K.; Gandhi, N.; Doshi, A. Effect of Training School Teachers on Oral Hygiene Status of 8-10 Years Old Government School Children of Udaipur City, India. J. Clin. Diagn. Res. JCDR 2016, 10, Zc95–Zc99. [Google Scholar] [CrossRef] [PubMed]
  63. Fernandez, M.D.S.; Guedes, M.I.F.; Langa, G.P.J.; Rosing, C.K.; Cavagni, J.; Muniz, F. Virucidal efficacy of chlorhexidine: A systematic review. Odontology 2022, 110, 376–392. [Google Scholar] [CrossRef] [PubMed]
  64. Walsh, L.J. Safety issues relating to the use of hydrogen peroxide in dentistry. Aust Dent. J. 2000, 45, 257–269. [Google Scholar] [CrossRef] [Green Version]
  65. Caruso, A.A.; Del Prete, A.; Lazzarino, A.I. Hydrogen peroxide and viral infections: A literature review with research hypothesis definition in relation to the current covid-19 pandemic. Med. Hypotheses. 2020, 144, 109910. [Google Scholar] [CrossRef] [PubMed]
  66. Zanelli, M.; Ragazzi, M.; De Marco, L. Chemical gastritis and colitis related to hydrogen peroxide mouthwash. Br. J. Clin. Pharmacol. 2017, 83, 427–428. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  67. Kraus, F.W.; Perry, W.I.; Nickerson, J.F. Salivary catalase and peroxidase values in normal subjects and in persons with periodontal disease. Oral Surg. Oral Med. Oral Pathol. 1958, 11, 95–102. [Google Scholar] [CrossRef]
  68. Santos, C.; Teodoro, G.; Sibelino, S.; Novaes, P.; Farias, M.; Vilhena, F. Antibiofilm action of PHTALOX®-containing oral care formulations. J. Dent. Res. 2020, 99, 3326. [Google Scholar]
  69. Drake, D.; Villhauer, A.L. An in vitro comparative study determining bactericidal activity of stabilized chlorine dioxide and other oral rinses. J. Clin. Dent. 2011, 22, 1–5. [Google Scholar] [PubMed]
  70. Grootveld, M.; Silwood, C.; Gill, D.; Lynch, E. Evidence for the microbicidal activity of a chlorine dioxide-containing oral rinse formulation in vivo. J. Clin. Dent. 2001, 12, 67–70. [Google Scholar]
  71. Lee, S.S.; Suprono, M.S.; Stephens, J.; Withers, S.A.; Li, Y. Efficacy of stabilized chlorine dioxide-based unflavored mouthwash in reducing oral malodor: An 8-week randomized controlled study. Am. J. Dent. 2018, 31, 309–312. [Google Scholar] [PubMed]
  72. Ramalingam, S.; Cai, B.; Wong, J.; Twomey, M.; Chen, R.; Fu, R.; Boote, T.; McCaughan, H.; Griffiths, S.; Haas, J. Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Sci. Rep. 2018, 8, 13630. [Google Scholar] [CrossRef]
  73. Tateyama-Makino, R.; Abe-Yutori, M.; Iwamoto, T.; Tsutsumi, K.; Tsuji, M.; Morishita, S.; Kurita, K.; Yamamoto, Y.; Nishinaga, E.; Tsukinoki, K. The inhibitory effects of toothpaste and mouthwash ingredients on the interaction between the SARS-CoV-2 spike protein and ACE2, and the protease activity of TMPRSS2 in vitro. PLoS ONE 2021, 16, e0257705. [Google Scholar] [CrossRef] [PubMed]
  74. Abdel-Moneim, A.S.; Abdelwhab, E.M.; Memish, Z.A. Insights into SARS-CoV-2 evolution, potential antivirals, and vaccines. Virology 2021, 558, 1–12. [Google Scholar] [CrossRef] [PubMed]
  75. Kabir, M.A.; Ahmed, R.; Chowdhury, R.; Iqbal, S.M.A.; Paulmurugan, R.; Demirci, U.; Asghar, W. Management of COVID-19: Current status and future prospects. Microbes. Infect. 2021, 23, 104832. [Google Scholar] [CrossRef] [PubMed]
  76. Hoffmann, M.; Kleine-Weber, H.; Schroeder, S.; Kruger, N.; Herrler, T.; Erichsen, S.; Schiergens, T.S.; Herrler, G.; Wu, N.H.; Nitsche, A.; et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020, 181, 271–280.e8. [Google Scholar] [CrossRef]
  77. Loe, H.; Schiott, C.R. The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man. J. Periodontal Res. 1970, 5, 79–83. [Google Scholar] [CrossRef] [PubMed]
  78. Emilson, C.G.; Fornell, J. Effect of toothbrushing with chlorhexidine gel on salivary microflora, oral hygiene, and caries. Scand. J. Dent. Res. 1976, 84, 308–319. [Google Scholar] [CrossRef] [PubMed]
  79. Maynard, J.H.; Jenkins, S.M.; Moran, J.; Addy, M.; Newcombe, R.G.; Wade, W.G. A 6-month home usage trial of a 1% chlorhexidine toothpaste (II). Effects on the oral microflora. J. Clin. Periodontol. 1993, 20, 207–211. [Google Scholar] [CrossRef] [PubMed]
  80. Kampf, G. Acquired resistance to chlorhexidine-is it time to establish an ‘antiseptic stewardship’ initiative? J. Hosp. Infect. 2016, 94, 213–227. [Google Scholar] [CrossRef] [PubMed]
  81. Kampf, G. Biocidal Agents Used for Disinfection Can Enhance Antibiotic Resistance in Gram-Negative Species. Antibiotics 2018, 7, 110. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  82. Kampf, G. Antibiotic Resistance Can Be Enhanced in Gram-Positive Species by Some Biocidal Agents Used for Disinfection. Antibiotics 2019, 8, 13. [Google Scholar] [CrossRef] [Green Version]
  83. Russell, A.D. Biocide use and antibiotic resistance: The relevance of laboratory findings to clinical and environmental situations. Lancet Infect. Dis. 2003, 3, 794–803. [Google Scholar] [CrossRef]
  84. Cieplik, F.; Jakubovics, N.S.; Buchalla, W.; Maisch, T.; Hellwig, E.; Al-Ahmad, A. Resistance Toward Chlorhexidine in Oral Bacteria-Is There Cause for Concern? Front. Microbiol. 2019, 10, 587. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  85. Radford, J.R.; Beighton, D.; Nugent, Z.; Jackson, R.J. Effect of use of 0.05% cetylpyridinium chloride mouthwash on normal oral flora. J. Dent. 1997, 25, 35–40. [Google Scholar] [CrossRef]
  86. Walsh, K.A.; Jordan, K.; Clyne, B.; Rohde, D.; Drummond, L.; Byrne, P.; Ahern, S.; Carty, P.G.; O’Brien, K.K.; O’Murchu, E.; et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection. J. Infect. 2020, 81, 357–371. [Google Scholar] [CrossRef] [PubMed]
  87. Iorgulescu, G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J. Med. Life 2009, 2, 303–307. [Google Scholar] [PubMed]
  88. Ceri, H.; Olson, M.E.; Stremick, C.; Read, R.R.; Morck, D.; Buret, A. The Calgary Biofilm Device: New technology for rapid determination of antibiotic susceptibilities of bacterial biofilms. J. Clin. Microbiol. 1999, 37, 1771–1776. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  89. Geneva, I.I.; Cuzzo, B.; Fazili, T.; Javaid, W. Normal Body Temperature: A Systematic Review. Open Forum Infect. Dis. 2019, 6, ofz032. [Google Scholar] [CrossRef] [PubMed]
  90. Chin, A.W.H.; Chu, J.T.S.; Perera, M.R.A.; Hui, K.P.Y.; Yen, H.L.; Chan, M.C.W.; Peiris, M.; Poon, L.L.M. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe 2020, 1, e10. [Google Scholar] [CrossRef]
Table 1. In-vitro studies on the virucidal effects of mouthwash on SARS-CoV-2.
Table 1. In-vitro studies on the virucidal effects of mouthwash on SARS-CoV-2.
StudyControlContact TimeActive IngredientViral Titer
(Median)
% Viral KillLRV
Compared to Control
Anderson et al., 2020 [15]700 μL phosphate-buffered saline (PBS)30 sPVP-I 1.0%NR≥99.99≥4
30 sPVP-I 1.0%, ≥99.99≥4
1:2 dilution
Bidra et al., 2020 [16]Water
(negative control)
Ethanol 70%
(positive control)
15 sPVP-I 0.5%<0.67NR≥4.33
15 sPVP-I 1.25%<0.67≥4.33
15 sPVP-I 1.5%<0.67≥4.33
30 sPVP-I 0.5%<0.67≥3.63
30 sPVP-I 1.25%<0.67≥3.63
30 sPVP-I 1.5%<0.67≥3.63
15 sH2O2 1.5%≤3.671.33
15 sH2O2 3%≤4.01.0
30 sH2O2 1.5%≤3.631.0
30 sH2O2 3%≤2.51.8
Control
15 sEthanol<0.67≥4.33
30 sEthanol<0.67≥3.63
15 sWater5.0N/A
30 sWater4.3N/A
Bidra et al., 2020 [17]Water
(negative control)
Ethanol 70%
(positive control)
15 sPVP-I 0.5%<0.67NR3.0
15 sPVP-I 0.75%<0.673.0
15 sPVP-I 1.5%<0.673.0
30 sPVP-I 0.5%<0.673.33
30 sPVP-I 0.75%<0.673.33
30 sPVP-I 1.5%<0.673.33
Control
15 sEthanol1.52.17
30 sEthanol<0.673.33
15 sWater3.67N/A
30 sWater4.0N/A
Davies et al., 2021 [14]PBS60 s


60 s


60 s



60 s



60 s


60 s
60 s
0.2% CHX (formulation contains ethanol)
0.2% CHX
(alcohol-free
formulation)
1.4% dipotassium oxalate
(alcohol-free
formulation)
Eucalyptol, thymol, menthol,
sodium fluoride, zinc fluoride
0.01–0.02% stabilised
hypochlorous acid
1.5% H2O2
0.58% PVP-I
(surfactant-free)
NRNR0.5


0.2


≥3.5



≥4.1



≥5.5


0.2
≥4.1
Hassandarvish et al., 2020 [18]Distilled waterBovine serum albumin group
15 s
15 s
30 s
30 s
60 s
60 s

Bovine serum albumin
+ Human RBC group
15 s
15 s
30 s
30 s
60 s
60 s


PVP-I 0.5%
PVP-I 1.0%
PVP-I 0.5%
PVP-I 1.0%
PVP-I 0.5%
PVP-I 1.0%





PVP-I 0.5%
PVP-I 1.0%
PVP-I 0.5%
PVP-I 1.0%
PVP-I 0.5%
PVP-I 1.0%
NRNR

>5
>4
>5
>4
>5
>5





>5
>4
>5
>5
>5
>5
Kariwa et al., 2021 [19]0.5% sodium thiosulfate30 s
30 s
30 s
30 s
30 s
60s
60 s
60 s
60 s
60 s
PVP-I 0.47%
PVP-I 0.23%
PVP-I 0.23%
PVP-I 0.35%
PVP-I 0.45%
PVP-I 0.47%
PVP-I 0.23%
PVP-I 0.23%
PVP-I 0.35%
PVP-I 0.45%
NR>99.94
>99.93
>99.92
>99.94
>99.99
>99.99
>99.98
>99.97
>99.96
>99.99
>3.2
>3.1
>3.1
>3.2
>3.8
>4.0
>3.6
>3.6
>3.4
>3.8
Koch-Heier et al., 2021 [20]Infection medium controlNR0.05% CPC and 1.5% H2O2
0.1% CHX, 0.05% CPC, and 0.005%
F (fluoride), without ethanol
0.05% CPC
0.1% CHX
0.05% CPC and 0.1% CHX
1.5% H2O2
Virucidal

Virucidal



Virucidal
No effect
Virucidal

No effect
NRNR
Komine et al., 2021 [21]PBS
(Negative control)
Ethanol 70%
(Positive control)
20 s
30 s
20 s
30 s
30 s

30 s

30 s

20 s
20 s
0.5% CPC
0.075% CPC
0.04% CPC
0.12% CHX
0.06% CHX + 0.05% CPC
0.12% CHX + 0.05% CPC
0.20% Delmopinol
Hydrochloride
Negative control
Positive control
3.13
<3.00
<3.00
7.10
<3.00

<3.00

<2.00

7.35
<2.00
99.994
>99.995
>99.996
42.5
>99.995

>99.995

>99.9995

NR
>99.9996
4.2
>4.3
>4.4
0.2
>4.3

>4.3

>5.3

NR
>5.4
Meister et al., 2020 [22]Medium control
Strain 1
(UKEssen strain)
Strain 2
(BetaCoV/Germany/Ulm/01/2020)
Strain 3
(BetaCoV/Germany/Ulm/02/2020)


30 s
30 s

30 s



30 s

30 s
30 s

30 s

30 s



H2O2
CHX
(Chlorhexamed)
Dequalinium chloride and benzalkonium chloride
CHX
(Dynexidine)
PVP-I
Ethanol and essential oils
Octenidine dihydrochloride
Polyaminopropyl biguanide (polyhexanide)
NRNRStrain
1  2  3
0.78 0.61 0.33
1.00 0.78 1.17

≥3.11 ≥2.78 ≥2.61



0.50 0.56 0.50

≥3.11 ≥2.78 ≥2.61
≥3.11 ≥2.78 ≥2.61

1.11 0.78 0.61

0.61 ≥1.78 1.61

Moskowitz and Mendenhall 2020 [23]Water
(Negative control)
Ethanol
(Positive control)
15 s
15 s
15 s
15 s



30 s
30 s
30 s
30 s

60s
60 s
60 s
60 s
1.5% H2O2
0.2% PVP-I
0.12% CHX
Formula 100-S molecular iodine
(100ppm molecular iodine)
1.5% H2O2
0.2% PVP-I
0.12% CHX
Formula 100-S molecular iodine
1.5% H2O2
0.2% PVP-I
0.12% CHX
Formula 100-S molecular iodine
NRNR<1.0
2.0
<1.0
2.6



<1.0
2.0
<1.0
>3.6 complete inactivation
<1.0
3.0
1.0
>3.6 complete inactivation
Pelletier et al., 2021 [24]Water60 s
60 s
60 s
60 s
60 s
1.5% PVP-I
0.75% PVP-I
0.5% PVP-I
Ethanol 70%
Virus control
<0.67
<0.67
<0.67
<0.67
5.3
NR4.63
4.63
4.63
4.63
NA
Santos et al., 2021 [25]Viral solution and cellular system
(Positive Control)
Cellular system only (Negative Control
30 s
60 s
300 s
0.1% anionic phthalocyanine derivate (APD)NR90
90
90
NR
Shet et al., 2022 [26]Water
(negative control)
Ethanol 70%
(positive control)
15 s
15 s
15 s
30 s
30 s
30 s
60 s
60 s
60 s
300 s
300.s
300 s
0.5% PVP-I
Positive control
Negative control
0.5% PVP-I
Positive control
Negative control
0.5% PVP-I
Positive control
Negative control
0.5% PVP-I
Positive control
Negative control
2.5
1.3
5.3
<0.67
<0.67
4.67
1.0
<0.67
4.67
<0.67
<0.67
4.67
NR2.8
4.0
NA
>4.0
>4.0
NA
3.67
>4.0
NA
>4.0
>4.0
NA
Shewale et al., 2021 [27]PBS

30 s

30 s
60 s

60 s
Stabilized chlorine dioxide
Ultra sensitive rinse
Sensitive rinse
Ultra sensitive rinse
Sensitive rinse
NR

98.4

98.4
96.3

98.0
NR
Steinhauer et al., 2021 [28]Validation control
(EN14476 protocol)
300 s

600 s

300 s
600 s
15 s
30 s
60 s
15 s
0.1% CHX (80% conc)
0.2% CHX (80% conc)
0.1% Octenidine dihydrochloride (OCT) (80% conc)
0.1% Octenidine dihydrochloride (OCT) (20% conc)
NRNR0.76

0.37

0.81
0.4
≥4.38
≥4.38
≥4.38
≥4.38
Tiong et al., 2021 [29]Cell culture medium
(EN14476:2013/
FprA1:2015 protocol)

Clean
(0.3 g/L BSA)

Dirty
(0.3 g/L BSA + 3 mL/L
human erythrocytes)

30 s
30 s

30 s
30 s

30s
60 s
60 s

60 s

60 s

60 s
0.12% CHX
0.075% CPC and 0.05% SF
0.05% Thymol
0.1% Hexetidine and 9% Ethanol
2% NaCl
0.12% CHX
0.075% CPC and 0.05% SF
0.05% Thymol
0.1% Hexetidine and 9% Ethanol
2% NaCl
NRNRClean Dirty
4.0     4.0
5.0     5.0

0.5     0.5
5.0     5.0

0.0     0.0
4.0     4.0
5.0     5.0

0.75     0.5

5.0     5.0

0.0     0.0
NR: not reported. NA: not applicable.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Ting, M.; Suzuki, J.B. The In Vitro Virucidal Effects of Mouthwashes on SARS-CoV-2. Int. J. Transl. Med. 2022, 2, 387-397. https://doi.org/10.3390/ijtm2030030

AMA Style

Ting M, Suzuki JB. The In Vitro Virucidal Effects of Mouthwashes on SARS-CoV-2. International Journal of Translational Medicine. 2022; 2(3):387-397. https://doi.org/10.3390/ijtm2030030

Chicago/Turabian Style

Ting, Miriam, and Jon B. Suzuki. 2022. "The In Vitro Virucidal Effects of Mouthwashes on SARS-CoV-2" International Journal of Translational Medicine 2, no. 3: 387-397. https://doi.org/10.3390/ijtm2030030

Article Metrics

Back to TopTop