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Aerosols in the Dental Office: Best Practices for Patient and Practitioner Safety

Course Number: 619

Antiseptic Rinses

Preprocedural rinses have been shown to reduce overall salivary and aerosol microbial loads.110 It was, therefore, proposed that the use of antimicrobial mouthrinses, including hydrogen peroxide, chlorhexidine gluconate, cetylpyridium chloride, and/or povidone iodine could be used to reduce overall numbers of SARS-CoV-2 viral particles in saliva. In vitro evidence does suggest that oral antiseptics may have efficacy to eliminate SARS-CoV-2 viral particles through a variety of mechanisms111, but in vivo studies have failed to show statistically significant benefit.112 Table 3 summarizes the effects of various common antiseptic mouthrinses on SARS-CoV-2. It should be noted that for all of the antiseptics described, rinsing for at least 30 seconds is necessary to see viricidal results.111

Table 3: Mechanism of Action of Oral Antiseptics Against SARS-CoV-2111

Antiseptic TypeAntimicrobial Mechanism of Action Agains SARS-CoV-2Viral Disruption
Hydrogen Peroxide Production of hydroxyl free radicals
Oxygen release
Damage lipids, proteins, and viral DNA
and disruption of
the viral envelope
after mouthrinsing
for at least 30 seconds
Povidone Iodine Release of iodine
Formation of pores in the cell membrane
Inhibition of exo and endotoxins
RNA oxidation
Chlorhexidine Gluconate Binding to membrane phospholipids
Alteration of osmotic regulation
Loss of structural stability
Displacement of viral protein cations by anion exchange
Cetyl Pyridium Chloride Displacement of magnesium and calcium cations
Exit of cytoplasmic components
Membrane solubilization
Reduced viral gene transcription