ORAL ANTISEPTICS AGAINST CORONAVIRUS: IN VITRO AND CLINICAL EVIDENCE.

ABSTRACT Background Angiotensin converting enzyme II (ACE2) is the cellular receptor for SARS-CoV-2, so ACE2-expressing cells can act as target cells and are susceptible to infection. ACE2 receptors are highly expressed in the oral cavity so this may be a potential high-risk route for SARS-CoV-2 infection. Furthermore, the virus can be detected in saliva, even before COVID-19 symptoms appear, with the consequent high risk of virus transmission in asymptomatic/pre-symptomatic patients. Reducing oral viral load could lead to a lower risk of transmission via salivary droplets or aerosols and therefore contribute to the control of the pandemic. Aim To evaluate the available evidence testing the in vitro and in vivo effects of oral antiseptics to inactivate or eradicate coronaviruses. Methods The criteria used were those described in the PRISMA® Declaration for performing systematic reviews. An electronic search in MEDLINE (via PubMed) and in Web of Sciences, using the terms MeSH: “mouthwash” OR “oral rinse” OR “mouth rinse” OR “povidone iodine” OR “hydrogen peroxide” OR “cetylpyridinium chloride” AND “COVID-19” OR “SARS-CoV-2” OR “coronavirus” OR “SARS” OR “MERS”. Findings The initial search strategy identified 619 articles on two electronic databases. A total of 17 articles were included assessing the virucidal efficacy of oral antiseptics against coronaviruses. Conclusions There is sufficient in vitro evidence to support the use of antiseptics to potentially reduce the viral load of SARS-CoV-2 and other coronaviruses. However, in vivo evidence for most oral antiseptics is limited. Randomized clinical trials with a control group are needed to demonstrate its clinical efficacy.