Published: 2022-03-25

Active oxygen oral rinse: chairside treatments against coronavirus infections

Hamdan Alghamdi


In 2020, many patients were infected with the coronavirus disease 2019 (COVID-19) worldwide. The identification of coronavirus in saliva have suggested the oral cavity as a potential reservoir for COVID-19 transmission, particularly in dental clinics. Chairside oral rinses have been widely used as a standard measure before routine dental treatment for many years. Recently, the use of chairside oral rinse has been recalled as a pre-procedural infection control measure by several health authorities, especially during the COVID-19 pandemic. Although there is still no clinical evidence, oral rinses containing active oxygen agents (e.g. BlueM formula) have been recommended to reduce the viral load in aerosols and drops during oral procedures. This paper aimed to provide an overview of the current guidelines and recommendations on the use of active oxygen oral rinse as chairside treatment against the COVID-19 pandemic in dentistry.


COVID-19, Coronavirus, Oral rinses, Active oxygen

Full Text:



Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang CB, Bernardini S. The COVID-19 pandemic. Critic Rev Clin Lab Sci. 2020;57(6):365-88.

Kamrujjaman M, Mahmud MS, Islam MS. Coronavirus outbreak and the mathematical growth map of COVID-19. Annual Res Rev Biol. 2020:72-8.

Haynes BF, Corey L, Fernandes P, Gilbert PB, Hotez PJ, Rao S, et al. Prospects for a safe COVID-19 vaccine. Sci Translat Med. 2020;12(568):0948.

Yan Y, Pang Y, Lyu Z. The COVID-19 vaccines: Recent development, challenges and prospects. Vaccine. 2021;9(4): 349.

Watkins J. Preventing a COVID-19 pandemic. British Medical Journal Publishing Group; 2020.

Meyers C, Robison R, Milici J, Alam S, Quillen D, Goldenberg D, et al. Lowering the transmission and spread of human coronavirus. J Med Virol. 2021;93(3):1605-12.

Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P, et al. Saliva or nasopharyngeal swab specimens for detection of SARS-CoV-2. N E J Med. 2020;383(13):1283-6.

Yoon JG, Yoon J, Song JY, Yoon SY, Lim CS, Seong H, et al. Clinical significance of a high SARS-CoV-2 viral load in the saliva. J Korean Med Sci. 2020;35(20).

Lu M. These are the occupations with the highest COVID-19 risk. World Economic Forum. 2020.

Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.

Patel M. Infection control in dentistry during COVID–19 pandemic: what has changed? Heliyon. 2020;6(10):05402.

Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):1-6.

Chaudhary P, Melkonyan A, Meethil A, Saraswat S, Hall DL, Cottle J, et al. Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load: a randomized controlled trial. J Am Dent Assoc. 2021;152(11):903-8.

Gandhi G, Thimmappa L, Upadhya N, Carnelio S. Could mouth rinses be an adjuvant in the treatment of SARS‐CoV‐2 patients? An appraisal with a systematic review. Int J Dent Hyg. 2022;20(1):136-44.

Vergara-Buenaventura A, Castro-Ruiz C. Use of mouthwashes against COVID-19 in dentistry. Br J Oral Maxillofac Surg. 2020;58(8):924-7.

Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses 2020; 12(4): 372.

Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respiratory Soc. 2020.

Olum R, Bongomin F. Uganda’s first 100 COVID-19 cases: trends and lessons. Int J Infect Dis. 2020;96:517-8.

Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis. 2021;40(5):905-19.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-62.

Fan E, Beitler JR, Brochard L. COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted? Lancet Respirat Med. 2020;8(8):816-21.

Atukorallaya DS, Ratnayake RK. Oral mucosa, saliva, and COVID-19 infection in oral health care. Front Med. 2021;8:340.

Badran Z, Gaudin A, Struillou X, Amador G, Soueidan A. Periodontal pockets: a potential reservoir for SARS-CoV-2? Med Hypoth. 2020;143:109907.

Izzetti R, Nisi M, Gabriele M, Graziani F. COVID-19 transmission in dental practice: brief review of preventive measures in Italy. J Dent Res. 2020;99(9):1030-8.

Elzein R, Abdel-Sater F, Fakhreddine S, Hanna PA, Feghali R, Hamad H, et al. 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 Dent Pract. 2021;21(3):101584.

Kolliyavar B, Shettar L, Thakur S. Chlorhexidine: The gold standard mouth wash. J Pharmaceut Biomed Sci. 2016;6(2).

Carrouel F, Gonçalves L, Conte M, Campus G, Fisher J, Fraticelli L, et al. Antiviral activity of reagents in mouth rinses against SARS-CoV-2. J Dent Res. 2021;100(2):124-32.

Davies K, Buczkowski H, Welch SR, Green N, Mawer D, Woodford N, et al. Effective in vitro inactivation of SARS-CoV-2 by commercially available mouthwashes. J Gen Virol. 2021;102(4).

Amtha R, Kanagalingam J. Povidone-iodine in dental and oral health: a narrative review. J Int Oral Health. 2020;12(5):407.

Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In vitro bactericidal and virucidal efficacy of povidone-iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther. 2018;7(2):249-59.

Bescos R, Casas-Agustench P, Belfield L, Brookes Z, Gabaldón T. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(9):1113.

Willis JR, Gabaldón T. The human oral microbiome in health and disease: from sequences to ecosystems. Microorganisms. 2020;8(2):308.

Tlaskalová-Hogenová H, Štěpánková R, Hudcovic T, Tucková L, Cukrowska B, Lodinová-Zádníková R, et al. Commensal bacteria (normal microflora), mucosal immunity and chronic inflammatory and autoimmune diseases. Immunol Letter. 2004;93(2-3):97-108.

Ichinohe T, Pang IK, Kumamoto Y. Microbiota regulates immune defense against respiratory tract influenza A virus infection. Proceed Natl Acad Sci. 2011;108(13):5354-9.

Grootveld M, Lynch E, Page G, Chan W, Percival B, Anagnostaki E, et al. Potential advantages of peroxoborates and their ester adducts over hydrogen peroxide as therapeutic agents in oral healthcare products: chemical/biochemical reactivity considerations in vitro, ex vivo and in vivo. Dentist J. 2020;8(3):89.

Mattei BM, Imanishi SA, Ramos G, Campos PS, Weiss SG, Deliberador TM. Mouthwash with active oxygen (blue® m) reduces postoperative inflammation and pain. Case Rep Dentist. 2021;2021.

Fernandez Y, Mostajo M, Reijden WA, Buijs MJ. Effect of an oxygenating agent on oral bacteria in vitro and on dental plaque composition in healthy young adults. Front Cell Infect Microbiol. 2014;4:95.

Deliberador TM, Weiss SG, Rychuv F, Cordeiro G, Cate MCLT, Leonardi L, et al. Comparative analysis in vitro of the application of blue® m oral gel versus chlorhexidine on Porphyromonas gingivalis: a pilot study. Adv Microbiol. 2020;10(04):194.

Mattei BM, Imanishi SA, Ramos G, Campos PS, Weiss SG, Deliberador TM. Mouthwash with active oxygen (blue® m) induces keratinocytes proliferation. Open J Stomatol. 2020;10(06):107.

Shibli JA, Rocha TF, Coelho F. Metabolic activity of hydro-carbon-oxo-borate on a multispecies subgingival periodontal biofilm: a short communication. Clin Oral Investigat. 2021;25(10):5945-53.

Makeeva I, Tambovtseva N. Applying toothpaste and mouthwash BLUEM in complex oral care in patients with coronary heart disease. Stomatologiia. 2014;93(3):18-20.

Caruso AA, Prete A, Lazzarino AI, Capaldi R, Grumetto L. Might hydrogen peroxide reduce the hospitalization rate and complications of SARS-CoV-2 infection? Infect Control Hospital Epidemiol. 2020;41(11):1360-1.

Kell DB, Heyden EL, Pretorius E. The biology of lactoferrin, an iron-binding protein that can help defend against viruses and bacteria. Front Immunol. 2020:1221.

Krupińska AM, Bogucki Z. Clinical aspects of the use of lactoferrin in dentistry. J Oral Biosci. 2021;63(2):129-33.

Mateos-Moreno M, Mira A, Ausina-Márquez V, Ferrer M. Oral antiseptics against coronavirus: in-vitro and clinical evidence. J Hospital Infect. 2021;113:30-43.

Seneviratne CJ, Balan P, Ko KKK. Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore. Infection. 2021;49(2):305-11.

Cirillo N. COVID-19 outbreak: succinct advice for dentists and oral healthcare professionals. Clin Oral Investigat. 2020;24(7):2529-35.

Shamszadeh S, Parhizkar A, Mardani M, Asgary S. Dental considerations after the outbreak of 2019 novel coronavirus disease: a review of literature. Arch Clin Infect Dis. 2020;15(2):103257.

Dziedzic A, Tanasiewicz M, Tysiąc-Miśta M. Dental care provision during coronavirus disease 2019 (COVID-19) pandemic: the importance of continuous support for vulnerable patients. Medicina. 2020;56(6):294.