SARS-CoV-2 Transmission Risk and Oral Decontamination: Scarce Evidence Albeit Promising Future

Abstract

Background: Oral decontamination recommendations/guidelines have exploded during the COVID-19 pandemic for the contemporary dental practice, due to SARS-CoV-2 relative high presence in saliva and the possibility of risk contagion through its aerosolization. However, such guidelines are mostly based on research carried out for other diseases caused by different viruses and/or bacteria, low-level evidence publications, and/or anecdotal information. Purpose: To review the biological basis for the use of oral antiseptics to decrease viral load in saliva as a plausible mechanism for reducing SARS-CoV-2 transmission risk, including other aspects such as pathogenesis, angiotensin converting enzyme 2 expression in the oral cavity, aerosolization, and oral antiseptics potential mechanistic virucidal properties. Results: Our group could only identify a limited number of reports evaluating specific direct effects of commonly used oral antiseptics (Hydrogen Peroxide, Povidone-Iodine and Chlorhexidine) on SARS-CoV-2, however, these reports are limited to surface disinfection, in vitro activity, or preliminary in vivo observations. Conclusion: Although we conclude that there is no direct evidence of clinical effectiveness of the use of mouth rinses prior to dental procedures with antiseptic solutions for SARS-CoV-2 specifically to date, we here present recommendations that could aid in reducing the risk of transmission in the dental office.