The SARS-CoV-2 virus is highly infectious and there is a lot that needs to be understood and studied. What we do know is that COVID spreads primarily due to droplets that are discharged from the nose and mouth via talking, coughing, and sneezing.
For us to go back to our normal lives, it is of prime importance that we prevent the spread of infection inside residences, offices, hospitals, and clinics. However, that is easier said than done. Global data is showing that even after following prevention protocols, healthcare workers are getting infected and some are also losing their lives. Therefore, we must come up with additional layers of protection to prevent the spread of infection inside the clinics.
Mouth Rinses to Reduce Viral Loads in the Mouth
SARS-COV-2 is not a strong virus. It can get inactivated the moment you destroy the envelope surrounding it. Various kinds of chemicals can inactivate it. However, it’s important to note that the antiviral mechanism outside the mouth is quite different, and the challenges inside the mouth are contrasting.
The three crucial points that need to be considered are:
1) It’s not about inactivating the virus once, but about neutralizing the new virus that enters the oral cavity, more than once. Also, it’s about keeping the virus loads low.
2) Any effective agent can be used to inactivate the virus outside the mouth. But the vital question is – how well can it perform and how long it can protect the insides of the mouth.
3) Another question that needs to be pondered upon – For how long can healthcare professionals feel safe with lowered viral loads in the mouth, during which they can finish the appointment and a short procedure?
By combining the above-mentioned points, we can streamline our question as – Which mouthwash can decrease the viral loads in the mouth and keep it reduced for a long duration so that the healthcare workers can work safely in the clinic, without getting infected?
Substantivity: The Most Critical Property of a Mouthwash
Mouthwashes like Povidone-Iodine and H2O2 will kill the virus once you rinse, but their action gets over as soon as you spit them out. And within the next few minutes, the saliva can again get flooded with new viruses that are shed from salivary glands and respiratory system. However, this time, Povidone-Iodine or H2O2 would not be present in the mouth to counter the new virus.
Therefore, we need a mouthwash that not only lowers the viral load but also effectively maintains reduced viral loads for a long duration of time. During this safe period of less viral load, doctors can complete their check-ups, along with a brief clinical procedure.
This quality of a persistent and strong attachment to oral tissues, accompanied by sustained release into saliva is called Substantivity. The only mouthwash that is known to exhibit this property is Chlorhexidine.
Chlorhexidine Against Viruses
1) It is well documented since 1990 that Chlorhexidine can combat against the envelope of enveloped viruses. The novel coronavirus is just one example of that.
2) In the initial phase of the pandemic, there was a misapprehension about Chlorhexidine not being effective against the novel coronavirus. This was largely due to the misinterpretation of evidence.
However, the Lancet article put these doubts to rest. This article highlighted that Chlorhexidine can effectively inactivate the virus in concentrations that are as little as 0.05%. The Chlorhexidine formulations that are currently available are stronger than 0.05% and can easily render the virus inactive.
3) The only mouthwash to exhibit substantivity is Chlorhexidine, which is needed to prevent the spread of COVID and ensure protection for healthcare workers.
How to Use Chlorhexidine Mouthwash?
- Implement the 10–20–30 rule – 10 ml of 0.20% w/v concentrated Chlorhexidine and rinse for a minimum time of 30 seconds.
- It is preferable to use it undiluted. If you find it bothersome, add little water and take the mix in one go.
To summarize, something that may work outside the mouth may not effectively work inside the mouth. Also, what could work inside the mouth, may not possess persistent action. Hence, the key takeaway here is to look for persistent action in the mouth, i.e. Substantivity, and the only mouthwash that displays this quality is Chlorhexidine. Other mouthwashes don’t exhibit this property and may not successfully protect healthcare workers from the COVID infection.