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Meta-Analysis
. 2023 Jul 3;23(1):443.
doi: 10.1186/s12903-023-03126-4.

Effectiveness of mouthwashes on reducing SARS-CoV-2 viral load in oral cavity: a systematic review and meta-analysis

Tayebe Ebrahimi  1   2 , Ahmad Reza Shamshiri  1   2 , Masoud Alebouyeh  3 , Simin Z Mohebbi  4   5
Affiliations
Meta-Analysis

Effectiveness of mouthwashes on reducing SARS-CoV-2 viral load in oral cavity: a systematic review and meta-analysis

Tayebe Ebrahimi et al. BMC Oral Health. .

Abstract

Background: The risk of SARS-COV-2 transmission is relatively high during dental procedures. A study was conducted to investigate the effects of mouthwashes on SARS-COV-2 viral load reduction in the oral cavity.

Methods: A systematic search was performed in PubMed, EMBASE, Scopus, Web of Science, and Cochrane library for relevant studies up to 20 July, 2022. Randomized and non-randomized clinical trial and quasi-experimental studies evaluating patients with Covid-19 infection (patients) who used mouthwashes (intervention) compared to the same patients before using the mouthwash (comparison) for reducing the SARS-COV-2 load or increasing the cycle threshold (Ct) value (outcome) were searched according to PICO components. Three independent reviewers conducted literature screening and data extraction. The Modified Downs and Black checklist was used for quality assessment. A meta-analysis was performed with a random effects model in the Revman 5.4.1software using the mean difference (MD) of cycle threshold (Ct) values.

Results: Of 1653 articles, 9 with a high methodological quality were included. A meta-analysis indicated that 1% Povidone-iodine (PVP-I) was an effective mouthwash for reducing the SARS-COV-2 viral load [MD 3.61 (95% confidence interval 1.03, 6.19)]. Cetylpyridinium chloride (CPC) [MD 0.61 (95% confidence interval -1.03, 2.25)] and Chlorhexidine gluconate (CHX) [MD -0.04 95% confidence interval (-1.20, 1.12)] were not effective against SARS-COV-2.

Conclusion: Using mouthwashes containing PVP-I may be recommended for reducing the SARS-COV-2 viral load in the oral cavity of patients before and during dental procedures, while the evidence is not sufficient for such effects for CPC and CHX-containing mouthwashes.

Keywords: Mouthwash; SARS-CoV-2; Viral load.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA flow diagram of screening and selection process
Fig. 2
Fig. 2
Forest plot of meta-analysis of the effect of PVP-I mouthwash on Cycle threshold value of SARS-COV-2
Fig. 3
Fig. 3
Forest plot of meta-analysis of the effect of Chlorhexidine gluconate-containing mouthwash on Cycle threshold value of SARS-COV-2
Fig. 4
Fig. 4
Forest plot of meta-analysis of the effect of CPC-containing mouthwash on Cycle threshold value of SARS-COV-2
Fig. 5
Fig. 5
Funnel plots based on Ct value changes. a) PVP mouthwash b) CHX mouthwash C) CPC mouthwash
See this image and copyright information in PMC

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