Shan Huang, Yan Leung Yiu, Prasanna Neelakantan, Hung Chan Kwok, Yi Leung Joy Ka, Ngai Hung Fan, Colman McGrath
Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, PR China.
Faculty of Dentistry, University of Alberta, San Francisco, California, Canada.
Int Dent J. 2025 Apr;75(2):868-876. doi: 10.1016/j.identj.2024.08.017. Epub 2024 Oct 6.
Bioaerosols generated during dental treatment are considered to be potentially carriers of infectious respiratory pathogens. The use of preprocedural mouthwashes has been suggested to reduce microbial load prior to dental surgery procedures. However, limited evidence on the effectiveness of preprocedural mouthwashes regarding mitigating respiratory pathogens exists. The aim of this clinical trial is to determine and compare the effectiveness of 3 preprocedural mouthwashes recommended by the Department of Health of the Hong Kong Special Administrative Region in the mitigation of respiratory pathogens during dental care in pandemic times.
In all, 228 participants were block-randomised to three groups based on preprocedural mouthwash used: povidone-iodine, hydrogen peroxide, and chlorhexidine digluconate. Participants, operators, and assessors were blinded to the assigned mouthwashes (triple-blind). Saliva was assessed for the presence of a number of respiratory pathogens (19 viruses including SARS-CoV-2). Changes in the prevalence and mean number of "any" pathogen present following mouthwash use were determined.
Overall, the prevalence of any detected respiratory viral pathogens in the preprocedural saliva was 3.5% as compared to the postprocedural saliva: 1.3% (P = .034). The mean (SD) number of viruses was significantly lower following preprocedural mouthwash use, from 0.04 (0.18) to 0.01 (0.11) (P = .025). No significant differences were observed in the downward change (∆) of any detected virus (prevalence) (P = .155) or in the reduction of the mean number (∆) of any detected virus in the postprocedural saliva compared to preprocedural saliva of participants with respect to mouthwash used (P = .375).
The practice of using preprocedural mouthwash, as recommended by the government of Hong Kong, was effective in reducing the number of respiratory pathogens present during dental aerosol-generating treatment. This study lends support for official policy on use of preprocedural mouthwashes, which has significant implications for practice and policy during pandemics.
牙科治疗过程中产生的生物气溶胶被认为可能是传染性呼吸道病原体的携带者。有人建议在牙科手术前使用漱口水，以减少术前微生物负荷。然而，关于术前漱口水在减轻呼吸道病原体方面有效性的证据有限。这项临床试验的目的是确定并比较香港特别行政区卫生署推荐的三种术前漱口水在疫情期间牙科护理中减轻呼吸道病原体的有效性。
总共228名参与者根据术前使用的漱口水被整群随机分为三组：聚维酮碘、过氧化氢和葡萄糖酸氯己定。参与者、操作人员和评估人员对分配的漱口水均不知情（三盲）。检测唾液中多种呼吸道病原体（包括2019冠状病毒病在内的19种病毒）的存在情况。确定使用漱口水后“任何”病原体的流行率和平均数量的变化。
总体而言，术前唾液中检测到的任何呼吸道病毒病原体的流行率为3.5%，术后唾液中为1.3%（P = 0.034）。术前使用漱口水后，病毒的平均（标准差）数量显著降低，从0.04（0.18）降至0.01（0.11）（P = 0.025）。就使用的漱口水而言，在任何检测到的病毒（流行率）的下降变化（∆）或术后唾液中与术前唾液相比任何检测到的病毒平均数量的减少（∆）方面，未观察到显著差异（P = 0.155）（P = 0.375）。
按照香港政府的建议，术前使用漱口水的做法有效地减少了牙科气溶胶生成治疗过程中存在的呼吸道病原体数量。本研究为术前使用漱口水的官方政策提供了支持，这对疫情期间的实践和政策具有重要意义。
