After 2 long years, COVID restrictions have been relaxed and the mask mandate has been removed in many countries.¹ This decision following a constant dip in the number of COVID cases in many countries has not only brought some relief and happiness to the public but also indicates behavioral responsibility to avoid any more COVID waves in the future. 

Reducing salivary viral titers could play a crucial role in COVID-19 transmission control.² Effective measures could include strict oral hygiene protocols that reduce salivary viral load.² Povidone-iodine (PVP-I) comes as a broad-spectrum antiseptic that has been used for over 60 years in infection control and prevention.²

PVP-I mouth gargle (0.5–1%), when used every 4th hourly in COVID-19 patients, can effectively lower salivary SARS-CoV-2 viral load, thereby reducing the carriage of infectious virion in adults.² And when used in conjunction with other nasal hygiene measures can dramatically reduce hospitalization, oxygen support, and mortality in COVID-19 patients.²

While Khalil I and Barma P. recommend using prepared saline diluted 0.4% to 0.23 % gargle and nasal spray (1:1.5 dilution of 1% and 1:30 for 10% PVP-I) to protect from the risk of SARS-CoV-2 transmission.³ They suggest administering two sprays in each nasal cavity, feeling it in the throat, holding it for 30 seconds followed by gargling for 30 seconds and avoiding eating or drinking till 30 minutes.³ Both PVP-I gargle and nasal spray can be used every 3 hours or 4 times a day.³ They report no side effects with 0.4% to 0.23% even on continuous use of 3 months to 2 years and also recommend using 0.4%-0.5% throat spray for a gag reflex and unconscious cases.³

For the patient before an examination and/or treatment, and the clinical staff before patient contact, Kirk-Bailey et al recommend using 9 mL 0.5% PVP-I as a mouthwash and 0.28–0.3 mL 0.5% PVP-I as a nasal spray solution in each nostril (repeated every 2–3 hours, up to 4 times a day).⁴ However, the chemical instability of PVP-I warrants the usage of freshly prepared dilutions which should be preserved in the refrigerator for subsequent patients throughout the day.⁴

Furthermore, its Safety and tolerance have been established as the prolonged use of PVP-I does not exhibit adverse side effects, like irritation of oral mucosa, discolouration of teeth/tongue, or changes in taste sensation.⁵ In the oral mucosa, it has been used safely at doses from 1% to 10% for infection prophylaxis and prevention in surgical procedures involving the upper respiratory tract.⁵

Thus using PVP-I nasal sprays and gargles could assist medical practitioners, dentists, dental care workers, healthcare workers as well as the general public in controlling SAR-CoV-2 infection.²

REFERENCES-

1. Mask mandate may not be necessary for now, say experts. Accessed on 15 April 2022. Available from: https://economictimes.indiatimes.com/news/india/mask-mandate-may-not-be-necessary-for-now-say-experts/articleshow/90722221.cms
2. Vinodhini Sudhakar TS, Venkatachalapathy S, Balasubramanian B, et al. In Vivo Efficacy of Povidone-iodine Mouth Gargles in Reducing Salivary Viral Load in COVID-19 Patients: A Systematic Review. World J Dent 2021;12(6):504–509.
3. Khalil I, Barma P. Povidone Iodine (PVP-I) mouth gargle/nasal spray may be the simplest and cost effective therapeutic antidote for COVID-19 Frontier. Arch Community Med Public Health, 2020;6(2): 138-141. DOI: 10.17352/2455-5479.000093
4. Maurya RK, Singh H, Kapoor P, Sharma P, Srivastava D. Povidone-iodine preprocedural rinse-An evidence-based, second-line defense against severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in dental healthcare [published online ahead of print, 2021 Mar 12]. Infect Control Hosp Epidemiol. 2021;1-2. doi:10.1017/ice.2021.90
5. Castro-Ruiz C, Vergara-Buenaventura A. Povidone-Iodine Solution: A Potential Antiseptic to Minimize the Risk of COVID-19? A Narrative Review. J Int Soc Prev Community Dent. 2020;10(6):681-685. Published 2020 Oct 19. doi:10.4103/jispcd.JISPCD_304_20