Randomized, double-blind prospective trial to test the efficacy and acceptability of therapeutic, antiseptic mouth rinses to inactivate severe acute respiratory syndrome coronavirus (SARS-CoV-2) in saliva of COVID-19 positive patients aged 18-65 years old. All mouthrinses are commercially available and will be used according to on-label instructions. Patients will be randomized to a mouthrinse and will be asked to give a saliva sample immediately before and after a one minute mouthwash. Saliva samples will be collected from patients at 15 minute intervals thereafter up to an hour (15, 30, 45 and 60 minutes). The samples will be stored and used for real-time reverse transcription polymerase chain reaction (RT-PCR) detection of viral SARS-CoV-2 RNA and viral infectivity assays. Patients will also complete a short-survey on the taste and experience of using the mouthwash. This study involves 480 subject participants and one, 75-90 minute visit.
Consenting Procedure Patients will be contacted first by phone and, if not available, then by
email. Interested patients will make an appointment to visit the GO Health Clinical Research
Unit at Adams School of Dentistry for this study. Study participation includes only one
visit. For Spanish speaking patients and/or parents, Spanish forms will be provided and
communication will occur through a Spanish translator. All patients are adults and over
normal cognitive capacity, and therefore will be able to consent for themselves.
Screening
- At the visit, a consented patient will answer screening questions regarding inclusion
and exclusion criteria. Answers will be entered into the Carolina Data Acquisition and
Reporting Tool (CDART) research database managed by UNC.
- Prior to finalizing these screening questions, women participants of childbearing
potential will be asked to provide a urine sample in the restroom, to undergo a rapid
pregnancy test by study personnel. Any pregnant or lactating patients will be excluded.
Enrollment, Baseline, and/or Randomization Outpatient subjects will be recruited from
patients seen in the UNC Respiratory Distress Clinic (RDC) who have tested positive for
COVID+ and consented to be contacted for participation in COVID-related research studies. The
subjects being approached by phone or email have signed a prior facility consent at the
Respiratory Distress Clinic confirming willingness to share their name and contact
information to be contacted for study participation in COVID related research. Investigators
will not receive information on subjects that decline this internal consent. Subjects will be
contacted for recruitment by phone and (if unreachable by phone) by secure email by study
personnel; patients will have the study rationale and risks explained and will be provided
time to ask questions and consider participation. If patients are interested in
participating, a single appointment will be scheduled for them at the Adams School of
Dentistry GO Health Clinical research core. Consent documentation will be signed in person
and in private in the GO Health Clinical Research Core. A list of COVID+ subjects that have
consented to be contacted for research, will be provided by the RDC clinic, sent via secure
University of North Carolina (UNC) at Chapel Hill NC servers or secure UNC email to the
research team's clinical coordinator, and this list will include names and contact details
(PHI). This list is updated daily and provided to approved research sites..
Randomization The study statistician will create a block randomization schedule and perform
these computations. The researcher in charge of collecting the salivary samples will be
blinded to the mouthwash solution, as they will be given a pre-aliquoted mouthrinse in an
unlabeled storage tube to provide to the patient for the rinse.
Blinding Subjects will be provided with an unlabeled/blinded mouthrinse. The researcher in
charge of collecting the salivary samples will be blinded to the mouthwash solution as well,
as they will be given a pre-aliquoted mouthrinse in an unlabeled storage syringe to provide
to the patient for the rinse. The study statistician will set up a block randomization
schedule that the team will abide by for assignment of enrolled subjects.
Follow-up Visits This study requires only one 70-90 minute, single visit appointment. No
diagnostic tests will be run as part of this clinical trial. All participants will already
have known COVID+ status, and therefore no follow-up reporting is needed.
Completion/Final Evaluation This study requires only one 70-90 minute, single visit
appointment. Subjects will be asked to rinse with an unlabeled/blinded antiviral mouth rinse
for 60 seconds and provide 5 mL of saliva prior to the rinse and 2 mL of saliva immediately
post-rinse, 15 minutes post-rinse, 30 minutes post-rinse, 45 minutes post-rinse, and 60
minutes post-rinse. Subjects will also be asked to complete a short survey about the rinsing
experience.
Subjects may withdraw from the trial at any time or they may be withdrawn at any time at the
discretion of the Investigator or Sponsor for safety, behavioral or administrative reasons.
Other: Saline
Saline placebo rinse
Other Name: Isotonic Saline
Drug: 1.5% w/v Hydrogen Peroxide
Over-the-counter antiseptic mouth rinse
Drug: 0.12% Chlorohexidine Gluconate
Dentist prescribed antimicrobial mouth rinse
Drug: 27% Ethanol plus essential oils
Over-the-counter antiseptic mouth rinse
Drug: 0.5% w/v Povidone-iodide
Over-the-counter antiseptic mouth rinse
Drug: 0.075% Cetylpyridinium Chloride
Over-the-counter antiseptic mouth rinse
Inclusion Criteria: Subjects must meet all of the following inclusion criteria to be
eligible for enrollment in the study:
- Diagnosed COVID+ status by physician. Either became symptomatic in the prior 7 days,
or if not symptomatic, likely infected/exposed within the prior 7 days.
- Individuals (all sex, all gender) at least 18 years of age and at most 65 years of age
and in good oral health without any known allergies to commercial dental products or
cosmetics. American Society of Anesthesiologists (ASA) class I or II prior to COVID
infection
- Evidence of a personally signed and dated informed consent document indicating the
subject (or legally acceptable representative) has been informed of all pertinent
aspects of the trial and all of their questions have been answered.
- Able to comprehend and follow the requirements of the study (including availability on
scheduled visit dates) based on research site personnel's assessment.
- Females of childbearing potential will have a negative urine pregnancy test (on site)
or be physically incapable of pregnancy (implants or injections, Intrauterine device,
Bilateral tubal ligation, Hysterectomy, Ovariectomy, Women post-menopausal)
Exclusion Criteria: Subjects presenting with any of the following will not be included in
the study:
- Patients who have been eating or drinking within an hour of the study
- Patients under 18 years old and older than 65 years old
- Subjects presenting with and/or self-reporting any of the following will not be
included in the study:
- history of significant adverse effects following use of oral hygiene products
such as toothpastes and mouthrinses. (self-reported)
- Self-reported allergy to iodine, ethanol, essential oils (Eucalyptol, Menthol,
Methyl salicylate, Thymol), hydrogen peroxide, chlorhexidine gluconate, peroxyl,
listerine, betadine, peridex, cetylpyridinium chloride, and other components in
the mouth rinses (methyl salicylate, ethanol, saccharin sodium, glycerin,
propylene glycol, sorbitol, Federal Food, Drug, and Cosmetic (FD&C) blue no. 1,
Poloxamer 407, Benzoic acid, Zinc chloride, Sodium benzoate, Sucralose,
PolyEthylene Glycol - 40 (PEG-40) sorbitan diisostearate, potassium sorbate,
citric acid).
- History of serious medical conditions that, at the discretion of the
Investigator, will disqualify the subject. (Self-reported)
- A history of severe dry mouth (xerostomia), drug-induced xerostomia
(antidepressants, anticonvulsants, antihypertensives), or Sjogren's syndrome
- A history of recent (within the last 30 days) or current recent oral herpes flare
up, candida (thrush) infection, apthous ulcer flare up, current/active severe
periodontal disease, or other recent oral viral infection or flare up within the
past 30 days (self-reported)
- Current history of alcohol or drug abuse (self-reported).
- History of drinking water or eating food within an hour of the study visit.
- History of drinking alcohol within 12 hours of the study visit.
- History of using a commercial mouthrinse within 24 hours of the study visit.
- Participation in any study involving oral care products, concurrently or within
the previous 30 days. (self-reported)
- Positive pregnancy test, reported pregnancy or lactation (this criterion is due
to oral tissue changes related to pregnancy and nursing which can affect
interpretation of study results. Additionally, women are advised to check with
their physician before using Povidone-iodine during pregnancy and lactation,
which cannot occur in a blinded, randomized trial.)
- Other severe acute or chronic medical or psychiatric condition or laboratory
abnormality that may increase the risk associated with trial participation or
investigational product administration or may interfere with the interpretation
of trial results and, in the judgment of the Investigator, would make the subject
inappropriate for entry into this trial.
- Patient with developmental/cognitive disability that cannot self-consent,
comprehend and follow the requirements of the study based on research site
personnel's assessment.
- Patient who has or ever had a thyroid problem, including swelling (nodular
colloid goitre, endemic goitre or Hashimoto's thyroiditis)
- Patients currently having lithium therapy for depression
- Patients with sizable mucosal tears, abrasions, growths or burns in the mouth
General and Oral Health Center
Chapel Hill, North Carolina, United States
Laura Jacox, DMD, PhD, Principal Investigator
University of North Carolina, Chapel Hill