Why is the oral cavity important in the COVID-19 pandemic?

The mouth is one of the main entry routes for SARS-CoV-2 (the coronavirus that causes the COVID-19 pandemic). This virus is mainly transmitted in droplets of saliva that are expelled when an infected person speaks, coughs, sneezes, etc.

Different studies have shown that a high number of the specific receptors to which SARS-CoV-2 binds are found in the oral cavity (Xu et al. 2020), even in greater numbers than in the lungs.

Not only that, but during the first 10 days of the disease, when the patient can be asymptomatic and highly contagious, SARS-CoV-2 mainly infects the upper respiratory tract: nose, throat and mouth (Wölfel et al. 2020).

What oral health recommendations are advisable to follow during this period?

  • Brushing 3 times a day or after meals. Use a brush with a cap to avoid contamination with other brushes or the environment. Renew the brush after passing the illness. Disinfect the head weekly by immersing it in my Cetylpyridinium Chloride 0.05% for 1 minute.
  • Daily interproximal hygiene.
  • Daily tongue hygiene. It is very important, since the epithelial cells of the tongue have a high density of receptors to which the SARS-CoV-2 coronavirus binds .
  • Use of toothpastes and mouthwashes with Cetylpyridinium Chloride . In the case of mouthwashes, it is advisable to use them 2 times a day for 1 minute and that they are used as gargles, to reach the outermost part of the pharynx, since the virus actively replicates in this area before passing to the lower respiratory tract.

What is the Cetylpyridinium Chloride?

cetylpyridinium chloride

Image Source Wikimedia

CPC or cetylpyridinium chloride , is a safe and effective antiseptic , which has been shown to be effective in reducing certain bacteria, fungi and viruses. It is widely used in toothpastes and mouthwashes for the prevention of oral diseases.

Specifically, it has shown efficacy against viruses such as influenza, rotavirus, herpes simplex virus, hepatitis B and some Coronavirus (Popkin et al. 2017; Mukherjee et al. 2017; Shen et al. 2019; Álvarez et al. 2020; Seo et al. 2019), including coronavirus strains that are used to evaluate potential efficacy against SARS-CoV-2 (Green et al. 2020; Meyers et al. 2020).

Studies recently completed by the IRSI Caixa group (Barcelona) have confirmed the ability of the CPC to act on SARS-CoV-2 .

Why could cetylpyridnium chloride (CPC) be effective in COVID-19?

Because it could help decrease the amount of the SARS-CoV-2 virus in the mouth . Having less virus in the oral cavity and in saliva would reduce the risk that a person infected with the coronavirus could transmit it to a healthy person. It could also help develop a less severe COVID-19 (Herrera et al. 2020).

What is the mechanism of action of CPC in the SARS-CoV-2 coronavirus?

The membrane of this coronavirus is a fundamental element in the process of infection of human cells. CPC is capable of destabilizing this viral membrane , thus preventing it from infecting human cells. In other words, CPC would help reduce the infectivity of SARS-CoV-2 .

Would a lower amount of virus in my mouth protect me from acquiring the COVID-19 infection, transmitting it or making it less serious?

If there is already a virus in the mouth, it is a sign that you have the infection. However, although there is still no clinical evidence of this, the lower the amount of virus in saliva, the lower the risk that the virus can be transmitted through saliva when talking, coughing, sneezing, etc. .

Some studies have shown that there is a direct relationship between the amount of virus and the severity of COVID-19 (Liu et al. 2020). That is, the greater the presence of viruses, the greater the risk that COVID-19 is serious. Taking into account that during the first days the virus is located in the oral cavity and throat (Wolfel et al. 2020) and that it subsequently passes into the body (to the lungs), reducing the virus in the mouth could help to that there was less risk of severity of COVID-19 . However, other risk factors influence such as, above all, the immune system of each person and not having other pathologies such as hypertension, heart disease, diabetes or obesity.

Can CPC use cure COVID-19?

No, the CPC does not cure COVID-19 disease, nor does it prevent contagion. CPC may help lower viral load and prevent transmission from a person with the virus . It is one more preventive measure , to be included within the rest of measures such as social distancing, hand washing with soap and water or hydroalcoholic gels, the use of masks, etc.

Why is it important to use CPC mouthwashes during the COVID-19 pandemic period

Mouthwashes with CPC can play a fundamental role during this period for different reasons:

  • Reduce the risk of transmission of the virus from a person carrying the infection to a healthy person (Herrera et al. 2020)
  • Decrease the risk of severity of COVID-19 by reducing viral load (Herrera et al. 2020).
  • They help maintain good oral health and reduce pathogenic microorganisms in the oral cavity. Poor oral health has been associated with different respiratory diseases such as pneumonia and chronic obstructive pulmonary disease (Sampson et al. 2020; Gomes-Filho et al. 2020; Jeronimo et al. 2020; Mammen et al. 2020)

How does COVID-19 affect the oral cavity?

It has been shown that ECA2 receptors are found in different parts of the oral cavity , such as the salivary glands and the tongue , to which this coronavirus binds .
At the level of harmful effects on the oral cavity, some cases have been described to date, the most frequent being loss of smell and taste and epithelial lesions on the oral mucosa.

What DENTAID products contain CPC?

VITIS CPC protect CPC toothpaste 0.14%
VITIS CPC protect CPC mouthwash 0.07%
VITIS CPC protect CPC spray 0.07%
VITIS gums CPC toothpaste 0.05%
VITIS gums CPC mouthwash 0.05%
VITIS orthodontic CPC toothpaste 0.05%
VITIS orthodontic CPC mouthwash 0.05%
VITIS electric CPC toothpaste 0.05%
VITIS aloe vera CPC mouthwash 0.02%
PERIOAID 0.12% treatment / Intensive Care CHX mouthwash 0.12% + CPC 0
.05 % PERIO · AID 0.12% treatment / Intensive Care Spray CHX 0.12% + CPC 0.05%
PERIO · AID 0.05% maintenance and control / Active control Mouthwash CHX 0.05% + CPC 0.05 %
HALITA Toothpaste CPC 0.05%
HALITA Mouthwash CPC 0.05%
HALITA Spray CPC 0.05%
HALITA Spray forte CPC 0.05%
INTERPROX Gel CPC 0.30%
PHB gums CPC toothpaste 0.05%
PHB gums CPC mouthwash 0.05%
PHB total Toothpaste CPC 0.05%
PHB total CPC mouthwash 0.02%
PHB total plus CPC mouthwash 0.05%
PHB fresh CPC mouthwash 0.02%

What international organizations recommend the use of antiseptics such as CPC?

There are several international organizations that incorporate rinsing with antiseptic mouthwashes, such as CPC, before a patient is operated on in the dental clinic :

Country – Health Authority
Germany – Federal Dental Association
Australia – Australian Dental Association
Belgium – Conseil de l’art dentaire de Belgique
Canada – Canadian Dental Association
Chile – College of Dentists of Chile
Colombia – Minsalud / Ministry of Health
Spain – General Council of Dentists of Spain
United States – American Dental Association (ADA)
France – Association dentaire française (ADF)
Holland – Nederland Commissie Leidraad Mondzorg Corona
Italia – Associazione Nazionale Dentisti Italiani (ANDI)
Malta – Superintendent of Public Health
Morocco – CCTD – CHU Ibn ROCHD – Casablanca
Norway – Norwegian Institute of Public Health
Netherlands – Royal Dutch Dental Association / Commissie Leidraad Mondzorg Corona
Peru – Colegio Odontológico de Perú
Portugal
– Swiss Dental Association – Swiss Dental Association (SSO)

In addition to being used in the dental clinic, they could be extremely useful for extended daily use during the period of the pandemic , to avoid possible transmission by carriers of the virus, both symptomatic and those who do not know it.

How useful can VITIS CPC protect spray be?

VITIS CPC protect spray can be used at any time and place (for example, before an event), maintaining the protection of the CPC for longer . In addition, it allows you to reach areas that are difficult to access, such as the back of the mouth.

Can pregnant women use CPC products?

Yes, they can use it, under the supervision of their dentist. In pregnancy, there is an increased risk of gum disease caused by the accumulation of bacterial plaque and increased by the physiological changes that occur in pregnancy.

Cetylpyridinium Chloride is considered safe and effective at authorized concentrations, and has shown an improvement in periodontal and plaque indices in pregnant women (Jeff Coat et al. 2011; Grainger et al. 2013; Jiang et al. 2016)

In addition, there is evidence linking periodontitis (more serious gum disease) with adverse pregnancy outcomes, such as an increased risk of preterm delivery and low birth weight. In fact, studies have been conducted in pregnant women with periodontitis that evaluated whether the use of Cetylpyridinium Chloride helped improve periodontitis and thus reduce the risk of adverse pregnancy outcomes (Jeff coat et al. 2011; Jiang et al. . 2016).

For this reason, the care of the gums during pregnancy becomes even more important, with measures such as brushing, daily interproximal hygiene and the use of toothpastes and mouthwashes with CPC