Dental, Throat, Nasal, Head and Neck Mucosal Procedures During and After the COVID-19 Pandemic:
Hydrogen Peroxide and Povidone Iodine Utilization Before Procedures May Protect Against Spread of COVID-19
- Hydrogen Peroxide Oral Gel/Rinse/Gargle/Mouthwash
- Povidone Iodine Oral Rinse/Gargle/Mouthwash
- Povidone Iodine Nasal Spray or Swab
For either the practitioner or the patient, there are going to be concerns about protection throughout the continued phases of the COVID-19 Pandemic. Any practitioner who comes in close contact with patients must think about protecting not only the patient, but also themselves and then the subsequent patients they will see. Viral particles that one patient sheds may easily be transmitted to the next patient if proper precautions are not taken.
To decrease the risk of viral transmission, the American Dental Association (ADA) recommends rinsing the mouth with 1.5% hydrogen peroxide prior to conducting procedures in a dental office (ADA COVIF-19 Center).
Practitioners at Risk
Practitioners who work more closely with areas of potential mucosal or aerosol contact are clearly at a greater risk and have thought about how to reduce transmission. In addition to dentists, several types of practitioners who perform procedures on the respiratory tract and the upper part of the digestive tract have reached out for information.
- Nasal and oral procedures
Hydrogen Peroxide & Povidone Iodine Against Coronavirus
Hydrogen peroxide mouth rinse and povidone iodine mouth rinse have been shown to break the layer of fat on the virus that protects the viral RNA, which is important for replication of the virus once it gets in the cells. The assumption is that these types of mouth rinses kill the virus. Dr Marcelo Araujo, DDS, MS, PhD explains in the video by the American Dental Association how the virus is a layer of fat with RNA inside.
Some patients have a milder form of the disease, some differ in the frequency of flare ups, and others have a more severe level of disease.
VIDEO: American Dental Association (ADA)
Should Dentists Have Patients Use Hydrogen Peroxide or Povidone Mouthrinses Before Procedures?
Dr. Dave Preble, Dr. Marcelo Araujo and Dr. Mia Geisinger discuss why some dentists have considered using commonly used preprocedural mouthrinses such as 1.5% hydrogen peroxide or 0.2% povidone. They note that, because SARS-CoV-2 lives in the lungs, the effectiveness of these mouthrinses against the virus would be minimal at best.
What is Hydrogen Peroxide Gel (Perio Gel®)®
Hydrogen peroxide “rinses” have a burst effect and will act quickly. You want a longer contact time. Rinse for at least a minute. The gel gives a longer contact time—brush the teeth, tongue, and gums with Perio Gel®. It is not a burst effect but it has more contact time.
If you have the prescription Perio Tray ,use more gel than you are used to using. Keep it in your mouth, swish, gargle. Use it 10-15 minutes a day or multiple times per day if necessary. Don’t rinse your mouth out with water afterwards.
There is no way with just brushing or flossing they can get deep enough. Hydrogen peroxide gel (Perio Gel®) can reduce the burden on the immune system. Why is chronic inflammation something to take seriously? You want your immune system to be efficient. Especially during the COVID-19 Pandemic, you want your immune system to be strong.
Periodontal infections are common in the U.S., and many people have gingivitis, causing inflammation. Patients have been waiting to see you for weeks and there is delayed care. Chronic inflammation anywhere in your body will put stress on your immune system.
Povidone Iodine Nasal Spray or Swab and Mouthwash
Utilizing povidone iodine nasal spray and mouthwash during the COVID-19 pandemic may reduce cross infection and protect healthcare workers. The goal is to reduce the viral load in the saliva and nasal secretions in order to reduce transmission of the disease as well as cross contamination back and forth between patients to health care workers. It is not intended to be a cure.
A 0.5% Povidone Iodine solution can be considered for routine use in all patients and healthcare workers for procedures dealing with the respiratory tract and the upper part of the digestive tract . Some examples may be:
- Nasal and oral procedures
*It is recommended for all patients during the COVID-19 Pandemic since there are high rates of asymptomatic cases.
Povidone Iodine Oral Rinse
Povidone Iodine 0.23% oral rinse showed virucidal activity vitro and may provide protection for those with a high risk of exposure to oral and respiratory pathogens. Source: ncbi.nlm.nih.gov/pmc/articles/PMC5986684/
A preoperational antimicrobial mouthrinse is generally believed to reduce the number of oral microbes. However, chlorhexidine may not be effective to kill 2019-nCoV. Since SARS-CoV-2 may be vulnerable to oxidation, use preprocedural mouthrinse containing oxidative agents such as 1.5% hydrogen peroxide (commercially available in the US) or 0.2% povidone, for purpose of reducing the salivary load of oral microbes, including potential 2019-nCoV carriage. A preprocedural rinse would be most useful in cases when rubber dams cannot be used.
“Since SARS-CoV-2 may be vulnerable to oxidation, use 1.5% hydrogen peroxide (commercially available in the US) or 0.2% povidone as a preprocedural mouthrinse.” Source: American Dental Association
Other goals of using hydrogen peroxide are to protect the patient and the team; to reduce the risk of oral viral transmission and treat gingival inflammation without producing aerosols. The SARS CoV-2 virus first targets the salivary glands.
Having the Perio Tray deliver deep below the gum will give benefit while the patients are waiting for your care. It can reduce the burden on the immune system.
How to Get Hydrogen Peroxide & Povidone Iodine
Town & Country Compounding can compound various strengths needed for specific patients with a prescription:
- Hydrogen Peroxide oral rinse at 1-1.5% concentration
- Povidone Iodine oral rinse/gargle/mouthwash 0.2%
- Nasal Povidone Iodine formulations – can be compounded in a variety of strengths for health care worker protection, and for nasal/head/neck/mucosal procedures, most commonly ranging from 0.23%-.5%
Hydrogen Peroxide Gel ( Perio Gel®)
Town & Country Compounding has over-the-counter Perio Gel® in stock, which is 1.7% hydrogen peroxide, and is already commonly used by patients with the Perio Protect system for gingivitis, since it kills harmful bacteria.
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We’re In This Together
We can win this fight against COVID-19 with the help of our communities. Every person has a role to play. Town & Country Compounding Pharmacy continues to provide medications & supplements needed throughout the quarantine period.
For the safety of our patients and staff we kindly ask that customers comply with our COVID-19 Policy: Curbside Pickup & Shipping Only.
Read more about T&C’s Patient Protection Plan.
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