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.