Use of chlorhexidine mouthwash to crush the COVID-19 pandemic

1. Chlorhexidine’s antiviral effect on enveloped viruses is known since the year 1990. The novel coronavirus SARS-COV-2 is an enveloped virus.

Ref: Bernstein D, Schiff G, Echler G, Prince A, Feller M, Briner W. In vitro virucidal effectiveness of a 0.12%-chlorhexidine gluconate mouthrinse. J Dent Res. 1990 Mar;69(3):874-6. doi: 10.1177/00220345900690030901. PMID: 2109001. Click here to read the article.

2. Lancet’s study in April 2020 showed that chlorhexidine could inactivate SARS-COV-2 in a concentration as low as 0.05%. Currently available mouthwashes of 0.2% w/v concentration are four times stronger than 0.05%. Click here to read the article

Ref: Chin AWH, Chu JTS, Perera MRA, Hui KPY, Yen HL, Chan MCW, Peiris M, Poon LLM. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe. 2020 May;1(1):e10. doi: 10.1016/S2666-5247(20)30003-3. Epub 2020 Apr 2. PMID: 32835322; PMCID: PMC7214863.

3. Another study (May 2020) showed that a single rinse with chlorhexidine reduced the SARS-COV-2 viral load in the mouth for 2 hours, which can help reduce the viral transmission in the pandemic. Click here to read the article

Ref: Yoon JG, Yoon J, Song JY, Yoon SY, Lim CS, Seong H, Noh JY, Cheong HJ, Kim WJ. Clinical Significance of a High SARS-CoV-2 Viral Load in the Saliva. J Korean Med Sci. 2020 May 25;35(20):e195. doi: 10.3346/jkms.2020.35.e195. PMID: 32449329; PMCID: PMC7246183.

4. An Indian study has found that chlorhexidine in 0.2% concentration inactivated SARS CoV 2 in minimal contact time, i.e., 30 secs. With a much better efficacy than povidone-iodine. Click here to read the article

Ref: Jain A, Grover V, Singh C, Sharma A, Das DK, Singh P, Thakur KG, Ringe RP. Chlorhexidine: An effective anticovid mouth rinse. J Indian Soc Periodontol. 2021 Jan-Feb;25(1):86-88. doi: 10.4103/jisp.jisp_824_20. Epub 2021 Jan 7. PMID: 33642749; PMCID: PMC7904017.

5. Taking it further, a March 2021 study states that four days of chlorhexidine use can eliminate oropharyngeal SARS-COV-2 in Covid-19 patients.

Ref: Huang YH, Huang JT. Use of chlorhexidine to eradicate oropharyngeal SARS-CoV-2 in COVID-19 patients. J Med Virol. 2021 Mar 23. doi: 10.1002/jmv.26954. Epub ahead of print. PMID: 33755218. Click here to read the article

With four days of chlorhexidine use in hospitalized COVID-19 patients, 62 % of chlorhexidine mouthwash users could eliminate SARS-COV-2 from the oropharynx. In comparison, only 5.5% of people from the control group were able to achieve it.

The number of people who eliminated the virus rose to 86 % when they also used a chlorhexidine oropharyngeal spray along with the mouthwash (vs. 6.3% control).

Hence, if you use chlorhexidine mouthwash to rinse the mouth and gargle the throat, you will control the infection more effectively.

The study says that chlorhexidine is a simple and safe addition to current COVID‐19 prevention guidelines and may significantly reduce disease spread.

Comparison with other mouthwashes:

1. A mouthwash will significantly help, only if it binds strongly to the teeth and oral mucosal surfaces. Persistent attachment and sustained release into the mouth are critical for a prolonged antiviral action of a mouthwash inside the mouth. This property of mouthwash is known as substantivity.
2. For many decades we know that chlorhexidine is the only mouthwash to have a prolonged action inside the mouth (1974, Archives of Oral Biology), the only mouthwash with substantivity (1999 British Dental Journal), and can be detected even 24 hours after a single rinse. (2020 Archives of Oral Biology). No other mouthwash demonstrates these properties.
3. A study (Jan 2021, JISP) showed that chlorhexidine inactivates SARS-CoV-2 faster than povidone-iodine.

We should use these newer lines of evidence and educate the people and help them make use of chlorhexidine mouthwash to eliminate the virus and reduce the transmission of the virus.

Along with safe distancing, proper use of masks, hand sanitization, and eye wear, chlorhexidine can reduce virus transmission effectively, safeguard the doctors and clinics, offices and households from indoor transmission. It can also help hospitalized patients to reduce their oropharyngeal viral load effectively.

This way, chlorhexidine can help reduce infection as well as infectivity. Thus, it will help us minimize community transmission and control the pandemic crisis.