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On recommended mouthwashes during COVID-19 pandemic: A review

Aim and Objective: One of the challenges we are currently facing is the COVID-19 pandemic. With its rapid spread around the world, it has become an unprecedented major health, human, and financial crisis. The saliva of COVID-19 patients contains the virus that can be transmitted. Various studies have shown the effect of mouthwashes in reducing the rate of transmission of the virus and, consequently, reducing the likelihood of infection. Therefore, we considered it important to examine the effect of using different mouthwashes by studying the existing data and articles. 
Materials and Methods: The study was conducted by the review method. The keywords“coronavirus, SARS-CoV-2, COVID-19, mouthwash, hydrogen Peroxide, chlorhexidine, povidone-iodine, cetylpyridinium chloride” were searched in articles and protocols in the following databases: PubMed, Scopus, Embase, Dimensions. The searched articles were submitted from January 2019 to April 2021. Only the articles in English were studied. 
Results: Among 23 reviewed studies, there were 15 review study, 4 in vitro study, two clinical trial, one letter to the editor in chief, and two studies that are, in fact, instructions of Australian and American dental community. 4 studies were published in 2021, 18 articles in 2020, and 1 article in 2019. By investigating 16 reports, Povidone-Iodine mouth wash was the most effective mouthwash ever mentioned. Hydrogen peroxide mouth rinse with nine mentions, chlorohexidine with seven mentions, cetylpyridinium chloride with four mentions, Essential oils with three mentions, and mouth rinses contains Citrox and beta-cyclodextrin, and Methylene blue with one mention was ranked next. Generally, most of the studies have recommended mouth rinses use in patients in dental clinics (or other recipients of health care services). They have emphasized their effectiveness in reducing the viral load in saliva and oral secretions. 
Conclusion: The results of the review showed that povidone-iodine mouthwash and hydrogen peroxide mouthwash can be the first and the second candidates to reduce viral load and, consequently, reduce disease transmission. However, more clinical studies are needed to confirm the results.