Rinsing away the threat: Antiviral mouthwashes and their efficacy (Review)

Thangamani,Oviya; Kumar,Gayathri; Ravishankar,Potluri Leela; Brahma,Supriti

doi:10.3892/wasj.2025.366

Rinsing away the threat: Antiviral mouthwashes and their efficacy (Review)

Authors:
- Oviya Thangamani
- Gayathri Kumar
- Potluri Leela Ravishankar
- Supriti Brahma
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Affiliations: Department of Periodontology, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, SRM Nagar, Chengalpattu, Tamil Nadu 603203, India
Published online on: June 18, 2025 https://doi.org/10.3892/wasj.2025.366
Article Number: 78
Copyright : © Thangamani et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

The oral cavity is a gateway through which respiratory viruses, such as SARS CoV‑2 enter. Thus, mouthwashes are potential routes of controlling the viral spread. The present review discusses the effectiveness of formulations containing povidone‑iodine, cetylpyridinium chloride, chlorhexidine, hydrogen peroxide and phthalocyanine derivatives. By disrupting viral structures, oxidizing proteins, inhibiting replication and modulating inflammation, these agents exert their antiviral effects. A systematic search on the PubMed and Google Scholar databases was conducted, including articles published between 2020 and 2025. The present review incorporates systematic reviews, as well as in vitro, in vivo, clinical and observational studies evaluating the virucidal activity, real‑world efficacy and preventive potential of antiviral mouthwashes. From these studies, it is indicated that these mouthwashes markedly reduce salivary viral loads; however, this reduction is transient, formulation‑dependent and requires repeated use. Other concerns are variability in effectiveness, potential for the disruption of the oral microbiome and improving user compliance. Future research is required to focus on the long‑term safety of these products, determine prolonged antiviral activity and design optimized formulations. When used in combination with standard infection control practices, antiviral mouthwashes may be effective, low‑cost adjuncts for reducing viral transmission, particularly in high‑risk environments, such as healthcare and dental facilities. As further evidence becomes available, the integration of these mouthwashes into public health plans may enhance the preparedness for future viral outbreaks.

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1	Hassandarvish P, Tiong V, Mohamed NA, Arumugam H, Ananthanarayanan A, Qasuri M, Hadjiat Y and Abubakar S: In vitro virucidal activity of povidone iodine gargle and mouthwash against SARS-CoV-2: Implications for dental practice. Br Dent J: Dec 10, 2020 (Epub ahead of print).
2	Schürmann M, Aljubeh M, Tiemann C and Sudhoff H: Mouthrinses against SARS-CoV-2: Anti-inflammatory effectivity and a clinical pilot study. Eur Arch Otorhinolaryngol. 278:5059–5067. 2021.PubMed/NCBI View Article : Google Scholar
3	Rodríguez-Casanovas HJ, De la Rosa M, Bello-Lemus Y, Rasperini G and Acosta-Hoyos AJ: Virucidal activity of different mouthwashes using a novel biochemical assay. Healthcare (Basel). 10(63)2021.PubMed/NCBI View Article : Google Scholar
4	Carrouel F, Valette M, Gadea E, Esparcieux A, Illes G, Langlois ME, Perrier H, Dussart C, Tramini P, Ribaud M, et al: Use of an antiviral mouthwash as a barrier measure in the SARS-CoV-2 transmission in adults with asymptomatic to mild COVID-19: A multicentre, randomized, double-blind controlled trial. Clin Microbiol Infect. 27:1494–501. 2021.PubMed/NCBI View Article : Google Scholar
5	Takeda R, Sawa H, Sasaki M, Orba Y, Maishi N, Tsumita T, Ushijima N, Hida Y, Sano H, Kitagawa Y and Hida K: Antiviral effect of cetylpyridinium chloride in mouthwash on SARS-CoV-2. Sci Rep. 12(14050)2022.PubMed/NCBI View Article : Google Scholar
6	Vilhena FV, Brito Reia VC, da Fonseca Orcina B, Santos CA, Zangrando M, Cardoso de Oliveira R and da Silva Santos PS: The use of antiviral phthalocyanine mouthwash as a preventive measure against COVID-19. GMS Hyg Infect Control. 16(Doc24)2021.PubMed/NCBI View Article : Google Scholar
7	Martínez Lamas L, Diz Dios P, Pérez Rodríguez MT, Del Campo Pérez V, Cabrera Alvargonzalez JJ, López Domínguez AM, Fernandez Feijoo J, Diniz Freitas M and Limeres Posse J: Is povidone iodine mouthwash effective against SARS-CoV-2? First in vivo tests. Oral Dis. 28 (Suppl 1):S908–S911. 2022.PubMed/NCBI View Article : Google Scholar
8	Jain A, Grover V, Singh C, Sharma A, Das DK, Singh P, Thakur KG and Ringe RP: Chlorhexidine: An effective anticovid mouth rinse. J Indian Soc Periodontol. 25:86–88. 2021.PubMed/NCBI View Article : Google Scholar
9	Fernandez MDS, Guedes MIF, Langa GPJ, Rösing CK, Cavagni J and Muniz FWMG: Virucidal efficacy of chlorhexidine: A systematic review. Odontology. 110:376–392. 2022.PubMed/NCBI View Article : Google Scholar
10	Perussolo J, Teh MT, Gkranias N, Tiberi S, Petrie A, Cutino-Moguel MT and Donos N: Efficacy of three antimicrobial mouthwashes in reducing SARS-CoV-2 viral load in the saliva of hospitalized patients: A randomized controlled pilot study. Sci Rep. 13(12647)2023.PubMed/NCBI View Article : Google Scholar
11	Choudhury MIM, Shabnam N, Ahsan T, Kabir MS, Khan RM and Ahsan SMA: Effect of 1% povidone iodine mouthwash/gargle, nasal and eye drop in COVID-19 patient. Biores Commun. 7:919–23. 2021.
12	Arefin MK, Rumi SKNF, Uddin AKMN, Banu SS, Khan M, Kaiser A, Chowdhury JA, Khan MAS and Hasan MJ: Virucidal effect of povidone iodine on COVID-19 in the nasopharynx: An open-label randomized clinical trial. Indian J Otolaryngol Head Neck Surg. 74 (Suppl 2):S2963–S2967. 2022.PubMed/NCBI View Article : Google Scholar
13	Weber J, Bonn EL, Auer DL, Kirschneck C, Buchalla W, Scholz KJ and Cieplik F: Preprocedural mouthwashes for infection control in dentistry-an update. Clin Oral Investig. 27 (Suppl 1):S33–S44. 2023.PubMed/NCBI View Article : Google Scholar
14	Buonavoglia A, Camero M, Lanave G, Catella C, Trombetta CM, Gandolfi MG, Palazzo G, Martella V and Prati C: Virucidal activity in vitro of mouthwashes against a feline coronavirus type II. Oral Dis. 28 (Suppl 2):S2492–S2499. 2022.PubMed/NCBI View Article : Google Scholar
15	Elzein R, Abdel-Sater F, Fakhreddine S, Abi Hanna P, Feghali R, Hamad H and Ayoub F: In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial. J Evid Based Dent Pract. 21(101584)2021.PubMed/NCBI View Article : Google Scholar
16	Ortega KL, Rech BD, El Haje GL, Gallo CD, Pérez-Sayáns M and Braz-Silva PH: Do hydrogen peroxide mouthwashes have a virucidal effect? A systematic review. J Hosp Infect. 106:657–662. 2020.PubMed/NCBI View Article : Google Scholar
17	Chen MH and Chang PC: The effectiveness of mouthwash against SARS-CoV-2 infection: A review of scientific and clinical evidence. J Formos Med Assoc. 121:879–885. 2022.PubMed/NCBI View Article : Google Scholar
18	Imran E, Khurshid Z, M Al Qadhi AA, A Al-Quraini AA and Tariq K: Preprocedural use of povidone-iodine mouthwash during dental procedures in the COVID-19 pandemic. Eur J Dent. 14:S182–S184. 2020.PubMed/NCBI View Article : Google Scholar
19	Garcia-Sanchez A, Peña-Cardelles JF, Salgado-Peralvo AO, Robles F, Ordonez-Fernandez E, Ruiz S and Végh D: Virucidal activity of different mouthwashes against the salivary load of SARS-CoV-2: A narrative review. Healthcare (Basel). 10(469)2022.PubMed/NCBI View Article : Google Scholar
20	Kramer A, Eggers M, Hübner NO, Walger P, Steinmann E and Exner M: Virucidal gargling and virucidal nasal spray. GMS Hyg Infect Control. 16(Doc02)2021.PubMed/NCBI View Article : Google Scholar
21	Santos C, da Fonseca Orcina B, Brito Reia VC, Ribeiro LG, Grotto RMT, Prudenciatti A, de Moraes LN, Ragghianti Zangrando M, Vilhena FV and da Silva Santos PS: Virucidal activity of the antiseptic mouthwash and dental gel containing anionic phthalocyanine derivative: In vitro study. Clin Cosmet Investig Dent. 13:269–274. 2021.PubMed/NCBI View Article : Google Scholar
22	Moosavi MS, Aminishakib P and Ansari M: Antiviral mouthwashes: Possible benefit for COVID-19 with evidence-based approach. J Oral Microbiol. 12(1794363)2020.PubMed/NCBI View Article : Google Scholar
23	Mezarina Mendoza JPI, Trelles Ubillús BP, Salcedo Bolívar GT, Castañeda Palacios RDP, Herrera Lopez PSG, Padilla Rodríguez DA and Uchima Koecklin KH: Antiviral effect of mouthwashes against SARS-COV-2: A systematic review. Saudi Dent J. 34:167–193. 2022.PubMed/NCBI View Article : Google Scholar
24	Xu C, Wang A, Hoskin ER, Cugini C, Markowitz K, Chang TL and Fine DH: Differential effects of antiseptic mouth rinses on SARS-CoV-2 infectivity in vitro. Pathogens. 10(272)2021.PubMed/NCBI View Article : Google Scholar
25	Zhang M, Meng N, Duo H, Yang Y, Dong Q and Gu J: Efficacy of mouthwash on reducing salivary SARS-CoV-2 viral load and clinical symptoms: A systematic review and meta-analysis. BMC Infect Dis. 23(678)2023.PubMed/NCBI View Article : Google Scholar
26	Huang YH and Huang JT: Use of chlorhexidine to eradicate oropharyngeal SARS-CoV-2 in COVID-19 patients. J Med Virol. 93:4370–4373. 2021.PubMed/NCBI View Article : Google Scholar
27	Kuznetsova MV, Nesterova LY, Mihailovskaya VS, Selivanova PA, Kochergina DA, Karipova MO, Valtsifer IV, Averkina AS and Starčič Erjavec M: Nosocomial Escherichia coli, klebsiella pneumoniae, pseudomonas aeruginosa, and staphylococcus aureus: Sensitivity to chlorhexidine-based biocides and prevalence of efflux pump genes. Int J Mol Sci. 26(355)2025.PubMed/NCBI View Article : Google Scholar
28	Sánchez Barrueco Á, Mateos-Moreno MV, Martínez-Beneyto Y, García-Vázquez E, Campos González A, Zapardiel Ferrero J, Bogoya Castaño A, Alcalá Rueda I, Villacampa Aubá JM, Cenjor Español C, et al: Effect of oral antiseptics in reducing SARS-CoV-2 infectivity: Evidence from a randomized double-blind clinical trial. Emerg Microbes Infect. 11:1833–1842. 2022.PubMed/NCBI View Article : Google Scholar
29	Green A, Roberts G, Tobery T, Vincent C, Barili M and Jones C: In vitro assessment of the virucidal activity of four mouthwashes containing Cetylpyridinium Chloride, ethanol, zinc and a mix of enzyme and proteins against a human coronavirus. BioRxiv: 2020-10, 2020.
30	Rius-Salvador M, García-Múrria MJ, Rusu L, Bañó-Polo M, León R, Geller R, Mingarro I and Martinez-Gil L: Cetylpyridinium chloride and chlorhexidine show antiviral activity against Influenza A virus and Respiratory Syncytial virus in vitro. PLoS One. 19(e0297291)2024.PubMed/NCBI View Article : Google Scholar
31	Saud Z, Tyrrell VJ, Zaragkoulias A, Protty MB, Statkute E, Rubina A, Bentley K, White DA, Rodrigues PDS, Murphy RC, et al: The SARS-CoV2 envelope differs from host cells, exposes procoagulant lipids, and is disrupted in vivo by oral rinses. J Lipid Res. 63(100208)2022.PubMed/NCBI View Article : Google Scholar
32	Rahman GS, Alshetan AAN, Alotaibi SSO, Alaskar BMI and Baseer MA: Is chlorhexidine mouthwash effective in lowering COVID-19 viral load? A systematic review. Eur Rev Med Pharmacol Sci. 27:366–377. 2023.PubMed/NCBI View Article : Google Scholar
33	Onozuka D, Takatera S, Matsuo H, Yoshida H, Hamaguchi S, Yamamoto S, Sada RM, Suzuki K, Konishi K and Kutsuna S: Oral mouthwashes for asymptomatic to mildly symptomatic adults with COVID-19 and salivary viral load: A randomized, placebo-controlled, open-label clinical trial. BMC Oral Health. 24(491)2024.PubMed/NCBI View Article : Google Scholar
34	Ang WX, Tan SH, Wong KT, Perera D, Kuppusamy UR and Ong KC: Antiviral activity of povidone-iodine gargle and mouthwash solution against Enterovirus A71, Coxsackieviruses A16, A10 and A6. Trop Biomed. 41:241–250. 2024.PubMed/NCBI View Article : Google Scholar
35	Vergara-Buenaventura A and Castro-Ruiz C: Use of mouthwashes against COVID-19 in dentistry. Br J Oral Maxillofac Surg. 58:924–927. 2020.PubMed/NCBI View Article : Google Scholar
36	Verma SK, Dev Kumar B, Chaurasia A and Dubey D: Effectiveness of mouthwash against viruses: 2020 Perspective. A systematic review. Minerva Dent Oral Sci. 70:206–213. 2021.PubMed/NCBI View Article : Google Scholar
37	Jaiyesimi R, Oyeniyi S and Bosun-Arije F: The potential benefit of mouthwashes in reducing COVID-19 viral load: A mini review. Proc Niger Acad Sci 13: ISSN 0794-7976, 2020.
38	Avhad SK, Bhanushali M, Sachdev SS, Save SS, Kalra D and DN K: Comparison of effectiveness of chlorine dioxide mouthwash and chlorhexidine gluconate mouthwash in reduction of oral viral load in patients with COVID-19. Indian J Public Health Res Deve. 11:27–32. 2020.