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Effect of 1% H2O2 on Three Salivary Stress Biomarkers, Cortisol, Alpha-Amylase, and sIgA.
Jirakittayakorn, N, Tamboon, E, Mitrirattanakul, S
International dental journal. 2024;(2):343-351
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Abstract
BACKGROUND Due to the COVID-19 pandemic, several associations worldwide have been recommending the use of 1% hydrogen peroxide solution as a preprocedural mouth rinse before dental treatments to reduce viral load in saliva. This protocol is also employed in stress studies, especially in the context of dental treatment that uses salivary biomarkers as an indicator. However, the effect of 1% hydrogen peroxide as mouth rinse on salivary biomarkers remains unclear. OBJECTIVE This study aims to investigate the effects of 1% hydrogen peroxide solution as a preprocedural mouth rinse on 3 salivary stress biomarkers-salivary cortisol, salivary secretory IgA, and salivary α-amylase-both on chemical influence and mechanical irrigation. MATERIALS AND METHODS Ninety healthy participants with confirmed negative Reverse Transcription Polymerase Chain Reaction results for COVID-19 at most 2 days prior to the experiment were included in this study. All participants were randomly allocated into 3 groups: experimental (1% hydrogen peroxide solution), positive control (distilled water), and negative control (no mouth rinse). Saliva samples were collected before and after mouth rinsing with the respective solutions. Salivary biomarkers were analysed using specific enzyme-linked immunosorbent assay kits. RESULTS Salivary cortisol and salivary α-amylase did not significantly differ before and after rinsing, whilst salivary sIgA levels decreased in all 3 groups. Nonetheless, there were no significant differences in the changes of these biomarkers across the 3 groups. CONCLUSIONS This study shows that using 1% hydrogen peroxide solution as a preprocedural mouth rinse for universal precaution does not alter the levels of these 3 salivary biomarkers.
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Satisfaction with government recommended pre-procedural mouth rinses in the mitigation of Covid-19 in Hong Kong SAR: A triple blind randomized controlled clinical trial.
Huang, S, Leung, YY, Neelakantan, P, Chan, KH, Leung, JKY, Hung, FN, McGrath, C
Journal of dentistry. 2024;:105082
Abstract
OBJECTIVE To evaluate satisfaction and acceptability with three pre-procedural mouthrinses recommended by the Government of Hong Kong Special Administrative Region (HKSAR) during the COVID-19 pandemic. MATERIAL AND METHODS A triple-blind parallel-arm randomised controlled clinical trial was conducted. Following eligibility assessment, participants were block-randomised to the three intervention pre-procedural mouthrinses groups: Povidone-iodine, Hydrogen Peroxide and Chlorhexidine Digluconate. Participants rinsed with one of the mouthrinses assigned prior to any dental treatment. Participants, operators and assessors were blind to the assigned mouthrinses (triple blind). Satisfaction ratings were assessed on a 10 cm visual analogue scale (VAS) and acceptability of the mouthrinses were determined. RESULTS Following clinical screening, 228 participants were involved in the trial. The mean overall VAS satisfaction was 7.35 (SD 1.68). There was no significant difference in VAS satisfaction ratings among the three groups (p>0.05) nor in between groups. Acceptability of the mouthrinses was high with the vast majority (89.5 %, 204) willing to use the mouthrinses again if pre-procedural mouthrinsing is required. There was no significant difference in acceptability ratings (p>0.05). There were some aspects such as taste and smell that participants commented on (on average, 24.6 %, 56), although no significant difference in prevalence of reports among groups (p>0.05). CONCLUSIONS There were high rates of satisfaction and acceptability of the HKSAR Government recommended pre-procedural mouthrinses for the mitigation of COVID-19 transmission in the dental setting. There was no significant difference in satisfaction and acceptability rates among the three recommended pre-procedural mouthrinses. CLINICAL RELEVANCE The high satisfaction and acceptability rates of the HKSAR Government recommended pre-procedural mouthrinses in the mitigation of COVID-19 in this clinical trial lends support for the HKSAR's policy on pre-procedural mouthrinses in the dental setting and this has implications for practice and policy during pandemics.
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A Cetylpyridinium Chloride Oral Rinse Reduces Salivary Viral Load in Randomized Controlled Trials.
Graves, C, Ghaltakhchyan, N, Ngo, TQ, Liu, C, Babikow, E, Shoji, A, Bocklage, C, Sang, Y, Phillips, ST, Bowman, N, et al
JDR clinical and translational research. 2024;:23800844241296840
Abstract
INTRODUCTION Evaluating the antiviral potential of commercially available mouthrinses on SARS-CoV-2 holds potential for reducing transmission, particularly as novel variants emerge. Because SARS-CoV-2 is transmitted primarily through salivary and respiratory secretions and aerosols, strategies to reduce salivary viral burden in an antigen-agnostic manner are attractive for mitigating spread in dental, otolaryngology, and orofacial surgery clinics where patients may need to unmask. METHODS Patients (n = 128) with confirmed COVID-19-positive status within 10 days of symptom onset or positive test result were enrolled in a double-blind randomized controlled trial of Food and Drug Administration-approved mouthrinses containing active ingredients ethanol, hydrogen peroxide, povidone iodine, chlorhexidine gluconate, cetylpyridinium chloride (CPC), or saline. The CPC, ethanol, and sterile water rinses were followed in a second double-blind randomized controlled trial (n = 230). Participants provided a saliva sample before rinsing (baseline) and again at 30 and 60 min after rinse. Quantitative polymerase chain reaction was used to determine salivary SARS-CoV-2 viral load at all time points. An adjusted linear mixed-effect model was employed to compare viral load after rinsing relative to baseline. RESULTS The rinse containing CPC significantly reduced salivary SARS-CoV-2 viral load 30 min postrinse relative to baseline (P = .015), whereas no other rinse significantly affected viral load at 30 min after rinsing. At 60 min postrinsing, no group had a significant reduction in SARS-CoV-2 copy number relative to baseline, indicating a rebound in salivary viral load over a 1-hour window. Participants indicated a fair to good rinsing experience with the CPC product and high willingness to use oral rinses before and during dental and medical health care visits. CONCLUSIONS Our findings suggest that preprocedural oral rinsing could be implemented as a feasible, inexpensive approach to mitigate spread of SARS-CoV-2 and potentially other enveloped viruses for short periods, which is relevant to clinical procedures involving the nasal and oropharyngeal region. KNOWLEDGE TRANSFER STATEMENT Rinsing with a cetylpyridinium chloride-containing mouthrinse can significantly reduce salivary SARS-CoV-2 viral load for up to 30 min; patients are willing to use mouthrinses in medical and dental settings to limit transmission risk in clinics.
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Status of Healthy Choices, Attitudes and Health Education of Children and Young People in Romania-A Literature Review.
Roșioară, AI, Năsui, BA, Ciuciuc, N, Sîrbu, DM, Curșeu, D, Pop, AL, Popescu, CA, Popa, M
Medicina (Kaunas, Lithuania). 2024;(5)
Abstract
Background and Objectives: This study aims to assess the health status and factors influencing healthy choices among children and young people in Romania, as well as the efficacy of related health education programs. Through understanding these dynamics, the study seeks to provide insights that can shape targeted interventions, policies, and educational strategies to improve this demographic's overall health and well-being. Materials and Methods: For this study, we performed a literature review of original published papers on the health status, healthy habits, health education, predisposition to making healthy choices in the future, and accessibility to the paediatric health system of Romanian children and young people, as well as the effects of different types of educational interventions on this demographic in Romania. Results: The prevalence of dental caries is high in Romania. In terms of eating habits and nutritional status, a worrying proportion of children are overweight or obese, which can lead to a variety of future physical and psychological problems. In terms of physical activity, few adolescents demonstrate regular fitness practices. Romania presents an increase in alcohol and tobacco consumption among adolescents. The mental health of students has become a pressing public health concern, exacerbated by the COVID-19 pandemic. The use of social networks is linked to mental health issues among young people. Romania still has one of the highest rates of sexually transmitted diseases and faces a high incidence of cervical cancer, with a mortality rate three times higher than the EU average. High rates of teenage pregnancies are linked to limited information about sexuality and a lack of access to family planning at a young age. There are large discrepancies in the accessibility of medical services between urban and rural areas. Conclusions: Romania faces significant obstacles to providing high-quality healthcare to children and young people. Improving nutrition, immunisation rates, and access to medical services represent essential areas for enhancing the health of children and young people in Romania.
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A MULTICENTER, RANDOMIZED, OPEN-LABEL, PLACEBO-CONTROLLED CLINICAL TRIAL OF THE EFFECT OF CETYLPYRIDINIUM CHLORIDE (CPC) MOUTHWASH AND ON-DEMAND AQUEOUS CHLORINE DIOXIDE MOUTHWASH ON SARS-COV-2 VIRAL TITER IN PATIENTS WITH MILD COVID-19.
Onozuka, D, Konishi, K, Takatera, S, Osaki, M, Sumiyoshi, S, Takahashi, Y, Hamaguchi, S, Imoto, Y, Kutsuna, S
The journal of evidence-based dental practice. 2024;(4):102040
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OBJECTIVES The established effect of cetylpyridinium chloride (CPC) mouthwash on SARS-CoV-2 viral titers is unclear. No clinical trial has examined the impact of on-demand aqueous chlorine dioxide mouthwash on SARS-CoV-2 viral titer. METHODS In this multicenter, 3-armed, randomized, open-label, placebo-controlled clinical trial involving mildly symptomatic COVID-19 patients, we randomly assigned them to receive 20 mL of 0.05% CPC, 10 mL of 0.01% on-demand aqueous chlorine dioxide, or 20 mL of purified water as a placebo mouthwash in a 1:1:1 ratio. The primary measurement was the SARS-CoV-2 viral titer in saliva, evaluated by a mixed-effects linear regression model. RESULTS 49 patients received CPC mouthwash (n=16), on-demand aqueous chlorine dioxide mouthwash (n=16), and placebo (n=17) between January 14, 2024, and February 20, 2024. 0.05% CPC mouthwash significantly reduced salivary viral titer at 10 minutes postuse (-0.97 log10 PFU/mL; 95% CI, -1.64 to -0.30; P = .004), while no such effect was observed at 30 minutes (difference vs placebo, -0.26 log10 PFU/mL; 95% CI, -0.92 to 0.40; P = .435) or 60 minutes (difference vs. placebo, -0.05 log10 PFU/mL; 95% CI, -0.68 to 0.58; P = .877). 0.01% on-demand chlorine dioxide mouthwash did not reduce salivary viral titer at 10 minutes, 30 minutes, or 60 minutes compared to placebo. CONCLUSIONS 10 minutes after using a 0.05% CPC mouthwash, the salivary viral titer of SARS-CoV-2 decreased compared to placebo. 0.01% on-demand aqueous chlorine dioxide mouthwash and placebo had no significant difference in SARS-CoV-2 viral titers. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCT): jRCTs031230566.
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The Pathogenesis of COVID-19-Related Taste Disorder and Treatments.
Wang, J, Liu, R, Ma, H, Zhang, W
Journal of dental research. 2023;(11):1191-1198
Abstract
COVID-19, mainly manifested as acute respiratory distress syndrome, has afflicted millions of people worldwide since 2019. Taste dysfunction is a common early-stage symptom of COVID-19 infection that burdens patients for weeks or even permanently in some cases. Owing to its subjectivity and complexity, the mechanism of taste disorder is poorly studied. Previous studies have reported that the COVID-19 entry receptors are highly expressed in taste buds, thereby intensifying the cytocidal effect. Taste receptor cells are vulnerable to inflammation, and the COVID-19-induced cytokine storm causes secondary damage to taste function. Interferon and various proinflammatory cytokines can trigger cell apoptosis and disrupt the renewal of taste bud stem cells. This immune response can be further enhanced by the accumulation of Angiotensin II (Ang II) caused by an unbalanced local renin-angiotensin system (RAS) system. In addition, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is neurotropic and can invade the brain through the olfactory bulb, affecting the nervous system. Other factors, such as host zinc deficiency, genetic susceptibility, sialic acid, and some neurotransmitters, also contribute to the pathogenesis process. Although several medical interventions have displayed effectiveness, only a few strategies exist for the treatment of postinfectious dysgeusia. Stem cell-based taste regeneration offers promise for long-term taste disorders. Clinical studies have demonstrated that stem cells can treat long COVID-19 through immune regulation. In dysgeusia, the differentiation of taste bud stem cells can be stimulated through exogenous epithelial-derived and neural-derived factors to regenerate taste buds. Tongue organoids are also emerging as functional taste buds, offering new insights into the study of taste regeneration. This review presents the current evidence of the pathogenesis of COVID-19-related dysgeusia, summarizes currently available treatments, and suggests future directions of taste regeneration therapy.
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Reduction of SARS-CoV-2 salivary viral load with pre-procedural mouth rinses: a randomised, controlled, clinical trial.
Farmaha, JK, James, JN, Frazier, K, Sahajpal, NS, Mondal, AK, Bloomquist, DT, Kolhe, R, Looney, SW, Bloomquist, R
British dental journal. 2023;(8):593-600
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Introduction The purpose of this study was to test the short-term efficacy of four commercial mouthwashes versus water in reducing SARS-CoV-2 viral load in the oral cavity over clinically relevant time points.Methods In total, 32 subjects that were proven SARS-CoV-2-positive via polymerase chain reaction (PCR)-based diagnostic test were recruited and randomised into five parallel arms. Cycle threshold (Ct) values were compared in saliva samples between the groups, as well as within the groups at baseline (pre-rinse), zero hours, one hour and two hours post-rinse, using SARS-CoV-2 reverse transcription-PCR analysis.Results We observed a significant increase in Ct values in saliva samples collected immediately after rinsing with all the four mouthwashes - 0.12% chlorhexidine gluconate, 1.5% hydrogen peroxide, 1% povidone iodine, or Listerine - compared to water. A sustained increase in Ct values for up to two hours was only observed in the Listerine and chlorohexidine gluconate groups. We were not able to sufficiently power this clinical trial, so the results remain notional but encouraging and supportive of findings in other emerging mouthwash studies on COVID-19, warranting additional investigations.Conclusions Our evidence suggests that in a clinical setting, prophylactic rinses with Listerine or chlorhexidine gluconate can potentially reduce SARS-CoV-2 viral load in the oral cavity for up to two hours. While limited in statistical power due to the difficulty in obtaining this data, we advocate for pre-procedural mouthwashing, like handwashing, as an economical and safe additional precaution to help mitigate the transmission of SARS-CoV-2 from a potentially infected patient to providers.
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Economic Evaluation of the Protecting Teeth @ 3 Randomized Controlled Trial.
Anopa, Y, Macpherson, LMD, McMahon, AD, Wright, W, Conway, DI, McIntosh, E
JDR clinical and translational research. 2023;(3):207-214
Abstract
INTRODUCTION An economic evaluation (EE) was conducted alongside a randomized controlled trial (the Protecting Teeth @ 3 Study [PT@3]), exploring the additional preventive value of fluoride varnish (FV) application at 6-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multicomponent national child oral health improvement intervention, the Childsmile program, apart from nursery FV. METHODS The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the 2-y follow-up period. The Child Health Utility 9 Dimensions questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios were calculated. RESULTS Data from 534 participants from the 2014-2015 PT@3 intake were used in the EE analyses, n = 265 (50%) in the FV arm and n = 269 (50%) in the TAU arm. Mean incremental cost per child in the FV arm was £68.37 (P = 0.382; 95% confidence interval [CI], -£18.04 to £143.82). Mean incremental QALY was -0.004 (P = 0.636; 95% CI, -0.016 to 0.007). The probability that the FV intervention was cost-effective at the UK £20,000 threshold was 11.3%. CONCLUSION The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form should be reviewed given its low probability of cost-effectiveness. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by child oral health policy makers and dental public health professionals. They can form part of the evidence to inform the Scottish, UK, and international guidance on community-based child oral health promotion programs.
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Treatments of COVID-19-Associated Taste and Saliva Secretory Disorders.
Tsuchiya, H
Dentistry journal. 2023;(6)
Abstract
Since the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, treating taste and saliva secretory disorders associated with coronavirus disease 2019 (COVID-19) has become a critical issue. The aim of the present study was to update information on treatments applicable to such oral symptoms and discuss their pathogenic mechanisms. The literature search indicated that different treatments using tetracycline, corticosteroids, zinc, stellate ganglion block, phytochemical curcumin, traditional herbal medicine, nutraceutical vitamin D, photobiomodulation, antiviral drugs, malic acid sialagogue, chewing gum, acupuncture, and/or moxibustion have potential effects on COVID-19-associated ageusia/dysgeusia/hypogeusia and xerostomia/dry mouth/hyposalivation. These treatments have multiple modes of action on viral cellular entry and replication, cell proliferation and differentiation, immunity, and/or SARS-CoV-2 infection-induced pathological conditions such as inflammation, cytokine storm, pyroptosis, neuropathy, zinc dyshomeostasis, and dysautonomia. An understanding of currently available treatment options is required for dental professionals because they may treat patients who were infected with SARS-CoV-2 or who recovered from COVID-19, and become aware of their abnormal taste and salivary secretion. By doing so, dentists and dental hygienists could play a crucial role in managing COVID-19 oral symptoms and contribute to improving the oral health-related quality of life of the relevant patients.
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[Estilo de vida, hábitos de higiene oral y autopercepción del estado anímico en estudiantes de Odontología de la Comunidad de Madrid durante la pandemia de la COVID-19: ¿pudo la pandemia tener algún efecto favorable?].
Descalzo-Casado, E, Martín Morales, JF, Arias-Macias, CM, Romero-Lastra, PT, Kobayashi, H, Casado-Gómez, I
Revista espanola de salud publica. 2023
Abstract
OBJECTIVE The COVID-19 pandemic and its control measures seem to have altered the vital dynamics of the population. It was justifiable, therefore, to try to specify the impact on lifestyle, oral hygiene and mood, in specific groups, such as dental university students in Madrid, who were accessible to us. METHODS An anonymous and voluntary cross-sectional observational study was carried out in the first fortnight of December 2021, through an ad hoc online questionnaire, in dentistry students from the Autonomous Community of Madrid. Descriptive analysis of the variables was performed and the associations and significance were assessed using Chi-square and T-student. RESULTS There were received seventy-two surveys. 82% were women and 18% men, with 23±3 years of mean age. 94% had good oral hygiene habits that improved with the pandemic. Their usual diet was varied and complete. Women consumed less meat (p=0.014) and more fruit (p=0.066), habits that they maintained, and men have improved with an increase in fruits (p<0.002), vegetables and legumes (p<0.003) in the pandemic. Tobacco (23,4%) and alcohol (54%) consumption decreased in confinement and increase in post-confinement. 36% increased their physical activity, initially low, especially in post-confinement. CONCLUSIONS The students in the sample have good oral hygiene and eating habits, which they keep and even improve with the pandemic, including an increase in physical exercise in a significant fraction of the sample. The confinement affect the mood and social relationships, even altering the sleep of women, with an increase in night awakenings, especially in post-confinement.
