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KRIENS, Switzerland: SARS-CoV-2 has been detected in the saliva of 91.7% of people infected with the virus. This means that dental professionals are particularly vulnerable to infection, and it is recommended that patients rinse with an antiviral mouthwash for 30 seconds before any form of treatment takes place. Researchers from the Université de Lyon have issued a position paper indicating which ingredients a mouthwash should contain in order to effectively reduce the SARS-CoV-2 viral load in the mouth.
The oral cavity is a major portal of entry for infectious agents and is directly associated with SARS-CoV-2 infection and disease progression owing to inhalation and expectoration. Moreover, the higher a person’s viral load in the salivary and nasopharyngeal microbiota, the higher the risk of disease transmission. In order to allow the dental team to work with greater safety, it is recommended that patients rinse three times with a mouthwash the day before the appointment and rinse for 30 seconds immediately before any form of treatment takes place.
Although most mouthwashes contain active ingredients designed to kill or inhibit pathogenic oral bacteria, they do not exert any specific antiviral action. A position paper by Carrouel et al. published in the Journal of Clinical Medicine highlights two specific substances that could reduce the salivary viral load of SARS-CoV-2: Citrox and beta-cyclodextrin.
Owing to their broad spectrum antimicrobial activity, flavonoid preparations such as Citrox could play a major role in inhibiting the SARS-CoV-2 chymotrypsin protease as well as suppressing the host’s innate immune responses. Moreover, the virus is vulnerable to oxidation, making an oxidising agent such as Citrox a great candidate for a mouthwash ingredient.
Cyclodextrin molecules attract viruses before rendering them irreversibly inactive. By disrupting the outer layer of a virus, the molecules can destroy infectious particles by simple contact. In addition, beta-cyclodextrins are notably biocompatible, have very low immunogenicity, are cost-effective and widely available.
A call to action
Mouthrinses containing a combination of beta-cyclodextrins and Citrox are available. However, their current use is restricted to inhibiting cariogenic and periodontal bacteria. In their position paper, the researchers urge national agencies and authorities to start clinical trials to evaluate the preventive effects of these rinses against SARS-CoV-2 infection and disease progression.