Spike Glycoprotein Hemagglutinin-esterase dimer
Membrane protein Membrane
Nucleocapsid protein and RNA
Envelop protein
SARS-CoV2
Introduction The COVID-19 pandemic began in late 2019, causing widespread health concerns. COVID-19 (SARS COV-2) belongs to the corona virus family, which is a group of enveloped RNA viruses with spike protein in its membrane envelope. Other members of this family are SARS COV and MERS COV, which have spread in recent years. Researchers have shown that more than 80% of the COVID- 19 genome resembles that of the SARS CoV.
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Chlorhexidine 1,2,3,6,10,11,14,19,21,26,27,29,31
Cationic bisguinide
Broad spectrum
antibacterial activity.
Greatest effect on many gram +ve, gram –ve, aerobic and anaerobic bacteria
Most effective mouthwash for reducing plaque and gingivitis
Acts by increasing cell wall permeability
Interacts with fluoride and sodium lauryl sulfate of toothpaste, hence should be used .5 to 2 hrs after using tooth paste
Effective against lipid- enveloped viruses like influenza A, parainfluenza, herpes 1, hepatitis B
Can inactivate covid and improve symptoms in covid +ve patients.
But studies show it has little effect against corona virus
Side effects: Staining, metallic taste, loss of taste.
Povidone-iodine 1-4,6,10,11,14- 16,18,19,21,22,24-28,30,31
An iodophore
Broad spectrum
antimicrobial activity Effective against a variety of bacteria, fungi, protozoans and viruses
Shows affinity for cell membranes and delivers iodine to the cell surface which further penetrates and causes protein and nucleic acid oxidation Also effective against SARS- COV, MERS-COV, influenza A Has more antiviral properties than other (both for
enveloped and non-
enveloped) viruses
Recommended conc.- 0.23% for 15 sec
Side effects: Excess iodine intake may cause complications in patients with thyroid disease
Hydrogen peroxide 1,2,3,7,10- 12,14,15,19,21,26,27,31
A bleaching agent Has oxidising properties
Broad spectrum
bactericidal agent
Used to relieve minor gingivitis Some products also have ethanol in addition as an antimicrobial, preservative and solvent
Acts by liberating O2, hence killing obligate anaerobes
3% found effective against adenovirus type 3 and 6, adeno-associated virus type 4, rhinoviruse1A, 1B and type 7 Enveloped viruses can be inactivated by 0.5% H2O2
Also effective against corona virus strains
Corona and influenza viruses are most sensitive (both are vulnerable to oxidation)
Methylene blue 33 Effective antioxidant
As a bacteriostatic stain and as an indicator dye Used as urinary tract antiseptic and for neuroinflammation at the microglial level, oral mucositis, and as an early diagnostic tool for oral cancers and precancerous lesions Burak et al studied MB as a mouthwash for periodontal therapy and found it superior to chlorhexidine gluconate
Three mechanisms of actions:
1.Competitively occupy cellular sites
2. By completing defective oxidative processes of cells or by uncoupling oxidation and phosphorylation
3.Direct or indirect virucidal effect
0.5% methylene blue can act as a potent antiviral agent
PORW26
ACE2
Cell Membrane
Potential Mechanisms Of Anti-SARS-CoV-2 Activity Of Mouth Rinses
1. Viral envelope(membrane) disruption - increased permeability, Lipid oxidation 2. Nucleic acid damage
3. Inactivation of viral glycoprotein 4. Blocking viral attachment via GAGs
5. Blocking the binding of spike proteins to ACE2 receptor
Glycosaminoglycans (GAGs) (eg: heparan sulphate)
5 5 1
2
3 4
Despite limited clinical evidence, we suggest the use of preprocedural mouthwashes in dental practice to reduce SARS- CoV-2 viral load of saliva and cross infection risk while treating the patients during this pandemic.
Materials & Method A literature search performed in PubMed, up to 31 st July 2021, focusing on SARS-CoV-2, COVID-19, oral cavity and oral rinses. The keywords searched for were “Covid 19 and mouthwash” or “SARS- COV2 and mouthwash” or “Covid 19 and oral rinses” or
“SARS-COV2 and oral rinses”, and 123 articles surfaced in 2020 and 2021. Inclusion criteria were systematic reviews and reviews; 34 articles formed a part of the poster.
Aim To evaluate the composition and mechanism of action of various oral rinses and their efficacy to reduce viral load in Covid-19 in published literature.
21: Pruthi G, Parkash H, Bharathi P V, Jain R, Gupta A, Rai S. Comprehensive review of guidelines to practice prosthodontic and implant procedures during COVID-19 pandemic. J Oral Biol Craniofac Res. 2020 Oct-Dec;10(4):768-775. doi:
10.1016/j.jobcr.2020.10.010. Epub 2020 Oct 17. PMID: 33101891; PMCID: PMC7568128.
22: Chorney SR, Rizzi MD, Dedhia K. Considerations for povidone-iodine antisepsis in pediatric nasal and pharyngeal surgery during the COVID-19 pandemic. Am J Otolaryngol. 2020 Nov-Dec;41(6):102737. doi: 10.1016/j.amjoto.2020.102737. Epub 2020 Sep 19. PMID: 32979667; PMCID: PMC7501061.
23: Klausner M, Handa Y, Aizawa S. In vitro three-dimensional organotypic culture models of the oral mucosa. In Vitro Cell Dev Biol Anim. 2021 Feb;57(2):148-159. doi: 10.1007/s11626-020-00539-1. Epub 2021 Jan 14. PMID: 33447968; PMCID:
PMC7808300.
24: Chowdhry A, Kapoor P, Kharbanda OP, Popli DB. Saliva and COVID 19: Current dental perspective. J Oral Maxillofac Pathol. 2021 Jan-Apr;25(1):18-21. doi: 10.4103/jomfp.jomfp_63_21. Epub 2021 May 14. PMID: 34349404; PMCID: PMC8272509.
25: Castro-Ruiz C, Vergara-Buenaventura A. Povidone-Iodine Solution: A Potential Antiseptic to Minimize the Risk of COVID-19? A Narrative Review. J Int Soc Prev Community Dent. 2020 Oct 19;10(6):681-685. doi: 10.4103/jispcd.JISPCD_304_20.
PMID: 33437699; PMCID: PMC7791588.
26: Mohamed NA, Ahmad Zainol Hady A, Abdul Aziz AH, Isahak I. Could antiseptic gargling prevent COVID-19? Trop Biomed. 2020 Dec 1;37(4):1141-1145. doi: 10.47665/tb.37.4.1141. PMID: 33612766.
27: Mateos-Moreno MV, Mira A, Ausina-Márquez V, Ferrer MD. Oral antiseptics against coronavirus: in-vitro and clinical evidence. J Hosp Infect. 2021 Jul;113:30-43. doi: 10.1016/j.jhin.2021.04.004. Epub 2021 Apr 15. PMID: 33865974; PMCID:
PMC8046704.
28: Chopra A, Sivaraman K, Radhakrishnan R, Balakrishnan D, Narayana A. Can povidone iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence- based update. Jpn Dent Sci Rev. 2021 Nov;57:39-45. doi: 10.1016/j.jdsr.2021.03.001. Epub 2021 Mar 15. PMID: 33747261; PMCID: PMC7959263.
29: Assis MS, Araújo RAAM, Lopes AMM. Safety alert for hospital environments and health professional: chlorhexidine is ineffective for coronavirus. Rev Assoc Med Bras (1992). 2020 Sep 21;66Suppl 2(Suppl 2):124-129. doi: 10.1590/1806- 9282.66.S2.124. PMID: 32965370.
30: Benson KM, Mancini AA, Brodeur MR. A Review of Topical Povidone-iodine to Decrease Viral Load of COViD-19. Sr Care Pharm. 2021 May 1;36(5):238-241. doi: 10.4140/TCP.n.2021.238.. PMID: 33879284.
31: Cavalcante-Leão BL, de Araujo CM, Basso IB, Schroder AG, Guariza-Filho O, Ravazzi GC, Gonçalves FM, Zeigelboim BS, Santos RS, Stechman-Neto J. Is there scientific evidence of the mouthwashes effectiveness in reducing viral load in Covid- 19? A systematic review. J Clin Exp Dent. 2021 Feb 1;13(2):e179-e189. doi: 10.4317/jced.57406. PMID: 33575003; PMCID: PMC7864359.
32: Silva PUJ, Paranhos LR, Meneses-Santos D, Blumenberg C, Macedo DR, Cardoso SV. Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis. Clinics (Sao Paulo). 2021 Jun 11;76:e2659. doi: 10.6061/clinics/2021/e2659. PMID: 34133659; PMCID: PMC8158674.
33.Arakeri G, Rao US V. Methylene blue as an anti-COVID-19 mouthwash in dental practice. Br J Oral Maxillofac Surg (2020).
34.da Fonseca Orcina B, Vilhena FV, Cardoso de Oliveira R, et al. A Phthalocyanine Derivate Mouthwash to Gargling/Rinsing as an Option to Reduce Clinical Symptoms of COVID-19: Case Series.Clin Cosmet Investig Dent. 2021;13:47-50. Published 2021 Feb 18. doi:10.2147/CCIDE.S295423
Photos adapted from: Subramanian Boopathi, Adolfo B. Poma & Ponmalai Kolandaivel (2021) Novel 2019 coronavirus structure, mechanism of action, antiviral drug promises and rule out against its treatment, Journal of Biomolecular Structure and Dynamics, 39:9, 3409-3418, DOI: 10.1080/07391102.2020.1758788.
Xu, C.;Wang, A.; Hoskin, E.R.; Cugini, C.; Markowitz, K.; Chang, T.L.; Fine, D.H. Differential Effects of Antiseptic Mouth Rinses on SARS-CoV-2 Infectivity In Vitro. Pathogens 2021, 10, 272. https:// doi.org/10.3390/pathogens10030272.
Boopathi S, Poma AB, Kolandaivel P. Novel 2019 coronavirus structure, mechanism of action, antiviral drug promises and rule out against its treatment. J Biomol Struct Dyn. 2021;39(9):3409-3418. doi:10.1080/07391102.2020.1758788
