Impact of gargling on respiratory infections

Respiratory infection is one of the leading causes of death in the world. The outbreaks of influenza and the Middle East respiratory syndrome have added to the miseries of human beings. Interventions such as the use of masks, social distancing, hand washing, and the use of personal protective equipment by health care professionals have minimized the transmission of pathogens from infected to healthy individuals. Another intervention is gargling which is most commonly performed by the Japanese to avoid respiratory infections. PubMed was used to search articles on gargling in respiratory infections published in the last three decades. Gargling is effective in upper respiratory infections (URTIs). URTI precedes lower respiratory tract infection;early intervention could prevent complications. The gargling agents in this review are classified as synthetic and natural gargling agents. The mouthwashes or gargling agents reviewed in this article have proven efficacy in reducing either bacterial or viral (or both) respiratory infections. The mouthwashes available over the counter may also have side effects. The use of mouthwash should be based on the potential benefit of oral and systemic conditions.

Evaluation of RT-qPCR of mouthwash and buccal swabs for detection of SARS-CoV-2 in children and adults.

BACKGROUND: The use of nasopharyngeal (NP) swabs as a specimen collection method to diagnose SARS-CoV-2 infection is frequently perceived as uncomfortable by patients and requires trained personnel. In this study, detection rate of SARS-CoV-2 in mouthwash samples and buccal swabs were compared in both children and adults. MATERIAL AND METHODS: In patients admitted to hospital with confirmed COVID-19 within the previous 72 hours, NP and buccal swabs as well as mouthwash samples were collected. RT-qPCR was performed on all samples. RESULTS: In total, 170 samples were collected from 155 patients (137 adults and 18 children). Approximately 91.7% of the collected NP swabs were positive in RT-PCR compared to 63.1% of mouthwash samples and 42.4% of buccal swabs. Compared to NP swabs, the sensitivity of using mouthwash was 96.3% and 65.4% for buccal swabs in NP swab samples with a CT value <25. With increasing CT values, sensitivity decreased in both mouthwash and buccal swabs. The virus load was highest during the first week of infection, with a continuous decline observed in all three collection methods over time. DISCUSSION: Mouthwash presents an alternative collection method for detecting SARS-CoV-2 in the case of unfeasible NP swab sampling. Buccal swabs should not be used due to their low sensitivity.

Mouthrinses against SARS-CoV-2: anti-inflammatory effectivity and a clinical pilot study.

PURPOSE: The scope of this research endeavor was the determination of the applicability of over the counter mouthwash solutions in reducing the viral load in the saliva of COVID-19 patients and hence decreasing their infectivity. Beyond that, new experimental mouthwashes were investigated in terms of a possible positive immune modulation, which might offer an additional opportunity for a positive pharmaceutical effect. METHODS: The effectivity of the mouth washing solution was determined on 34 hospitalized COVID-19 patients by measuring the viral load by RT-qPCR in pharyngeal swabs, which were taken before and after rinsing. The inflammatory modulation thru the experimental solutions was assayed in an in vitro model of virus infected nasopharyngeal epithelium cells. RESULTS: The clinical pilot study demonstrated that the mouth rinsing solution was able to reduce the viral load by about 90% in the saliva of most patients. This reduction was determined to persist for about 6 h. In the experimental solutions, the ingredients dexpanthenol and zinc were able to reduce the expression of proinflammatory cytokines in the cell culture model, while the antiviral response was not altered significantly. CONCLUSION: We recommend the application of mouth wash solutions to COVID-19 patients, since our results indicate a reduction in infectivity and might govern the protection of health care professionals. Further improvement to the over the counter formulation can be made by utilizing zinc and dexpanthenol, as they which might be beneficial for the patients' health.

Chlorhexidine: An effective anticovid mouth rinse.

CONTEXT: Dentists across the globe are witnessing a completely unforeseen and uncertain professional situation during these times of COVID-19 pandemic. There is conflicting evidence regarding the effectiveness of routinely used mouthwashes and especially Chlorhexidine, to reduce the viral load in oral cavity and the aerosols during oral procedures. AIMS: Comparative evaluation of the effectiveness of the current 'gold standard' chlorhexidine and povidone iodine as a control agent, through an in-vitro analysis. SETTINGS AND DESIGN: In-vitro laboratory analysis. METHODS AND MATERIAL: All the experiments for analysis of antiviral efficacy of chlorhexidine digluconate (2%)and povidone iodine(1%), against SARS-CoV-2 virus were performed in the BSL3 facility at the Council of Scientific and Industrial Research-Institute of Microbial Technology, using the VeroE6 cell lines. The analysis of the virus inactivation was based on quantification of viral RNA (Cycle threshold (Ct) profile) present in the culture supernatant using Real-Time Quantitative Reverse Transcription PCR (qRT-PCR). STATISTICAL ANALYSIS USED: Descriptive analysis (Statistical package for social sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows). RESULTS: Chlorhexidine digluconate in 0.2% concentration inactivated more than 99.9% of SARS CoV 2 virus, in minimal contact time of 30 seconds, which was considered better efficacy than povidone-iodine utilized for 30 and 60 seconds. Subtle differences were observed in the activity of both the compounds in terms of percent inactivation of virus, though a greater relative change in Ct values was observed for chlorhexidine. CONCLUSIONS: Within the limitations of the present study, it can be concluded that Chlorhexidine digluconate in 0.2% concentration inactivated SARS CoV 2 in minimal contact time i.e 30 secs, however both compounds tested i.e Chlorhexidine and povidone-iodine were found to have antiviral activity against SARS CoV2 virus.