Australasian Dentist Issue 89

Category 74 AustrAlAsiAn Dentist Introduction the global pandemic due to severe acute respiratory syndrome coronavirus 2 (sArs-CoV-2) has led to numerous changes and restrictions that affect people’s daily lives as well as many professional activities, especially for those caring for symptomatic and infected patients. 1 this COViD-19 pandemic has served as an entry point for the medical research and healthcare communities to emphasize the importance of the oral sphere in the transmission of viruses and infectious diseases. saliva, composed of 99% water, has a significant role in human-to-human transmission during the COViD-19 pandemic. every day, the human salivary glands secrete 600 ml of serous and mucinous saliva containing minerals, buffers, electrolytes, enzymes and enzyme inhibitors, growth factors and cytokines, immunoglobulins (e.g., secretory immunoglobulin A), mucins and other glycoproteins. 2 in addition to saliva secreted by the major and minor salivary glands, saliva samples also contain secretions from the nasopharynx or from the lungs through the action of cilia lining the airway. 3 indeed, sArs-CoV-2 is found in nasopharyngeal secretions, and the viral load is consistently high in the saliva, mainly in the early stage of the disease. 4 saliva samples have previously been shown to be highly consistent, over 90%, with nasopharyngeal samples in the detection of respiratory viruses, including coronaviruses. 5 sArs-CoV-2 is detected in 91·7% of saliva samples from COViD-19 patients, and the number can reach up to 1·2 × 108 infective copies per ml. 6 Knowing well the persistence, transmission, and spread of sArs-CoV-2 through proximity, the oral route is now emerging as a major environmental concern for community transmission. 7 sArs-CoV-2 may be transmitted via saliva directly or indirectly, even in patients who do not cough or have other respiratory symptoms. 8 When a person coughs, sneezes, breathes, or converses, he or she produces saliva droplets containing microorganisms. 9 the quantity and the size of saliva droplets differ between individuals; therefore, the risk of transmission also varies. the quantity and size of saliva droplets differ between individuals; therefore, the risk of transmission also varies. One cough or 5 min of conversation produces approximately 3000 saliva droplets. One sneeze produces approximately 40000 saliva droplets that can be disseminated several meters in the air.9 saliva droplets (> 60 μm) allow the transmission of sArs-CoV-2 when persons are in close contact (1mand 3m). 10 Moreover, although it is not yet clearly established, virus-laden aerosols (droplets < 60 μm) can contribute to the spread of sArs-CoV-2 and allow contamination at a distance of up to 7 to 8 m. 11 Droplets have the ability to fall to the ground. they have a diameter larger than 5 μm. through contact, all the personal items of the infected individual and the immediate environment can be considered a potential medium for the transmission of the virus even by indirect contact with those items. the use of cosmetic mouthwashes is an “adjuvant” treatment part of the usual treatment or individual prophylaxis, especially in oral health. Considering mouthwashes as agents that can reduce the viral load of sArs-CoV-2 in the fight against the COViD-19 pandemic is an extremely attractive concept 12–14 , especially in adults who are asymptomatic or have mild COViD-19. Among a nonexhaustive list of marketed mouthwashes containing antiviral molecules based on in vitro and Use of an antiviral mouthwash as an additional barrier measure in the SARS-CoV-2 transmission in adults with asymptomatic to mild COVID-19: A multicenter, randomized, double-blind controlled trial lInICal Abstract Background the research hypothesis is that commercially available mouthwash with ß-cyclodextrin and citrox (bioflavonoids) could decrease the severe acute respiratory syndrome coronavirus 2 (sArs-CoV-2) salivary viral load in adults with asymptomatic to mild COViD-19. Methods in this rCt, sArs-CoV-2 PCr-positive patients aged 18-85 years with asymptomatic to mild COViD-19 symptoms <8 days were recruited. A total of 154 eligible patients were randomly assigned (1:1) to antiviral ß-cyclodextrin and citrox mouthwash (CDCM) or placebo. three rinses daily were performed for 7 days. saliva sampling was performed on day 1 at 9 a.m. (t1), 1 p.m. (t2) and 6 p.m. (t3). On the following 6 days, one sample was taken at 3 p.m. Quantitative rt-PCr was used to detect sArs-CoV-2. the trial is registered at Clinicaltrials.gov (nCt04349592). Findings CDCM was significantly more effective than placebo 4 hours after the first intake (p<0·001), with a median percentage decrease t1-t2 of -14·25% [95% Ci; -32·68% – 0·06%]. in patients with an initial salivary load > 2·95 log10 copies/ml, there was a significant difference in the reduction in viral load at t2. Over the course of one day, the first mouthwash rinse significantly reduced the viral load, and the second dose maintained this low value, compared to placebo. At day 7, there was still a greater decrease in salivary viral load over time in the CDCM group. in individuals with an initial viral sArs-CoV-2 load higher than 4·12 log10 copies/ ml or 5·16 log10 copies/ml, CDCM reduced the salivary viral load more quickly than placebo (MlM p-value = 0·03; 0·029). Interpretation this trial supports the relevance of using mouthwash with ß-cyclodextrin and citrox as an additional barrier measure on day 1 to reduce the dissemination of sArs-CoV-2. Over 7 days, the use of this mouthwash showed a benefit of viral load reduction for patients with the highest initial loads.