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Most public health measures to contain the COVID-19 pandemic are based on preventing the pathogen spread, and the use of oral antiseptics has been proposed as a strategy to reduce transmission risk. The aim of this manuscript is to test the efficacy of mouthwashes to reduce salivary viral load in vivo. This is a multi-centre, blinded, parallel-group, placebo-controlled randomised clinical trial that tests the effect of four mouthwashes (cetylpyridinium chloride, chlorhexidine, povidone-iodine and hydrogen peroxide) in SARS-CoV-2 salivary load measured by qPCR at baseline and 30, 60 and 120 min after the mouthrinse. A fifth group of patients used distilled water mouthrinse as a control. Eighty-four participants were recruited and divided into 12–15 per group. There were no statistically significant changes in salivary viral load after the use of the different mouthwashes. Although oral antiseptics have shown virucidal effects in vitro, our data show that salivary viral load in COVID-19 patients was not affected by the tested treatments. This could reflect that those mouthwashes are not effective in vivo, or that viral particles are not infective but viral RNA is still detected by PCR. Viral infectivity studies after the use of mouthwashes are therefore required. ( https://clinicaltrials.gov/ct2/show/NCT04707742 ; Identifier: NCT04707742)

Objectives This study aimed to synthesize and characterize colloidal chitosan-silver nanoparticles-fluoride nanocomposite (CCAgNPF) and evaluate its efficacy compared to chlorhexidine on salivary Streptococcus mutans in orthodontic patients. Materials and methods AgNPs stabilized with chitosan were synthesized by chemical reduction of AgNO 3 . The nanoparticles were characterized with SEM, FTIR, DLS and ICP-OES. The MIC and MBC against S. mutans and IC50 concentration of CCAgNPF were obtained for antibacterial and cytotoxicity evaluations, respectively. For the clinical study, a total of 45 orthodontic patients were divided into three groups of 15 and used the following mouthwashes twice a day for 1 month: CCAgNPF, chlorhexidine 0.2% and the combination of these mouthwashes. The colony count of salivary S. mutans was evaluated before and after using the mouthwashes. The data were analyzed using One-way ANOVA and Tukey's test. Results Stabilized AgNPs were spherical with a diameter of 25.3 ± 3.3 nm. The MIC, MBC and IC50 of CCAgNPF were 4.42, 8.85 and 18.89 µg/ml. All mouthwashes reduced the salivary S. mutans of the orthodontic patients, however, no significant difference was found between the efficacy of CCAgNPF and chlorhexidine (P-value > 0.05). The best results were achieved by the combination of CCAgNPF and chlorhexidine mouthwashes (P-value < 0.05). Conclusion The CCAgNPF and its combination with chlorhexidine present potent bactericidal, biocompatible and effective anti-carious mouthwashes for orthodontic patients. Clinical relevance This study proved CCAgNPF as an antibacterial mouthwash with lower cytotoxicity and side effects for patients undergoing orthodontic treatments to maintain oral hygiene and reduce salivary S. mutans .

Rationale The effect of caffeine mouth rinsing (CAF-MR) on cognitive performance has not been thoroughly investigated. Objectives To evaluate the effects of different concentrations of CAF-MR on selective attention in relation to perceived taste intensity. Methods A total of 30 healthy and recreationally active male subjects were included in this randomized, double-blind, placebo-controlled crossover trial. Interventions included MR for 20 s at rest with three different caffeine solutions (0.24% [60 mg/ 25 mL ], 0.6% [150 mg/ 25 mL ], and 1.2% [300 mg/25 mL]), MR with 25 mL water (placebo), and no MR (control). Data on Victoria Stroop Test (VST) and the perceived taste intensity were recorded at five sessions. Results CAF-MR-300 mg intervention significantly decreased completion time (from 62.93 ± 19.07 to 57.01 ± 16.74 s, p  = 0.002 in Part D), while CAF-MR-150 mg intervention significantly decreased number of errors in Part D (7.00 ± 6.21 vs. 5.63 ± 5.76, p  = 0.04) and Part C ( 8.77  ± 8.80 vs. 7.10 ± 7.11, p  = 0.02). Perceived difficulty was significantly decreased both after CAF-MR with 150 mg (5.57 ± 1.65 vs. 4.77 ± 1.98, p  = 0.006) and 300 mg (5.95 ± 1.77vs. 4.67 ± 1.96, p  < 0.001). Perceived taste intensity for 300 mg of caffeine was negatively correlated with completion time (r: ranged, 0.37 to 0.46, p ranged, 0.045 to 0.009) after 300 mg, 150 mg (p ranged, 0.04 to 0.005) and placebo (p ranged 0.044 to 0.03) interventions. Conclusions This study is the first to demonstrate that CAF-MR shows dose-dependent effects on selective attention in healthy recreational males, such as improved speed (for 300 mg caffeine), reduced error rate (for 150 mg caffeine) and decrease in perceived difficulty (for 150 and 300 mg caffeine).

BackgroundGonorrhoea is increasing among men who have sex with men (MSM). We aimed to determine whether Listerine, a commercial mouthwash product, has an inhibitory effect against Neisseria gonorrhoeae in a randomised controlled trial (RCT) and an in vitro study, and therefore may be a potentially useful agent for gonorrhoea control.MethodsIn vitro: a suspension of ∼108 colony forming units per mL (CFU/mL) of N. gonorrhoeae was added to a serial of dilutions (up to 1:32) of alcohol-containing Listerine mouthwashes (Cool Mint and Total Care) for 1 min. A 10 µL aliquot was spread over the surface of a gonococcal agar plate and the number of N. gonorrhoeae colonies present at each dilution was calculated. The phosphate buffered saline (PBS) was used as a control. RCT: we recruited MSM with pharyngeal gonorrhoea who returned for treatment at the Melbourne Sexual Health Centre between May 2015 and February 2016. Untreated men were randomised to rinse and gargle either Listerine Cool Mint or saline for 1 min. Pharyngeal swabs were taken before and after rinsing and gargling for culture of N. gonorrhoeae. The analysis included only men who were culture positive for N. gonorrhoeae before using the allocated solution on the day of recruitment.ResultsIn vitro: Listerine mouthwashes at dilutions of up to 1:4 for 1 min resulted in significant reduction of total N. gonorrhoeae counts but PBS has no inhibitory effect against N. gonorrhoeae. RCT: a total of 196 MSM were recruited, 58 (30%) were culture positive before using the solution. After gargling the allocated solution, men in the Listerine group were significantly less likely to be culture positive on the pharyngeal surface (52%) compared with men in the saline group (84%) (p=0.013).ConclusionsThis data suggest Listerine, significantly reduces the amount of N. gonorrhoeae on the pharyngeal surface. With daily use it may increase gonococcal clearance and have important implications for prevention strategies.Trial registration numberACTRN12615000716561.

Antiseptic mouthwash use is widespread due to its oral health benefits. However, its impact on systemic physiological processes, particularly nitric oxide (NO) bioavailability and muscle contractility, is not fully understood. We sought to determine the effects of cetylpyridinium (antibacterial) versus sodium chloride (control) mouthwashes on salivary and breath NO markers and muscle contractile function in healthy young adults. Thirty participants (n = 15/group) completed a randomized, parallel-arm, blinded trial, comparing the two mouthwashes before and after 7 d of treatment. NO bioavailability was inferred via measurement of salivary nitrate (NO 3 − ), nitrite (NO 2 − ), and cyclic guanyl monophosphate (cGMP) concentrations and breath NO level. Contractile function of the knee extensor muscles was determined via isokinetic dynamometry. No changes in salivary NO 3 − , NO 2 − , or cGMP or in breath NO were observed in response to either treatment. However, cetylpyridinium mouthwash reduced the percentage of NO 2 − in saliva (17 ± 10% vs. 25 ± 13%; p = 0.0036). Peak torque at velocities of 0–6.28 rad/s was unaffected by mouthwash use. Calculated maximal knee extensor velocity (Vmax) and power (Pmax) were therefore also unchanged. Cetylpyridinium mouthwash reduces the relative abundance of NO 2 − in the oral cavity but does not significantly diminish overall NO bioavailability or impair muscle contractile function in healthy young adults.

Athletes require proper nutrition to enhance training and performance. Studies indicate that alternative sources of caffeine, such as caffeinated chewing gum, mouth rinses, energy gels, and coffee can improve performance. Therefore, this study investigated the impact of consuming caffeinated gum (CG) and repeated coffee mouth rinsing (CMR) on professional male table tennis players' aerobic capacity and explosive power. A randomized, cross-over, placebo-controlled, and double-blinded study was conducted with eighteen male table tennis players (Age: 21.86 ± 2.40 yr, Height: 173.80 ± 6.88 cm, Weight: 61.81 ± 10.32 kg). In each test session, the participants were randomly placed in one of the three conditions including i) Chewing caffeinated gum (CG,  = 6), ii) Coffee mouth rinsing (CMR,  = 6), iii) Starch capsule as a placebo (PLA,  = 6). All participants consumed caffeine with an average dose of ∼3 to 4.5 mg·kg . Also, a one-week interval was considered a washout period for each condition. First, the participants were given the required supplement and performed functional tests such as throwing medicine balls and Sargent's jump tests. Then, the maximum oxygen consumption (VO ), time to exhaustion (TTE), oxygen consumption equivalent at primary ventilatory threshold (VO at VT ), and oxygen consumption equivalent at respiratory compensation point (VO at RCP) were measured during the Bruce test. All data were analyzed using SPSS Windows software, repeated measure analysis ANOVA, and Bonferroni post hoc tests at  < 0.05. The current study's findings illustrated that TTE significantly increased in CG (  = 0.000) and CMR (  = 0.012) conditions compared to PLA, but no significant difference was observed between CMR and CG (  = 1.00). VO at VT was significantly higher in CG (  = 0.004) and CMR (  = 0.000) compared to PLA; however, no significant difference was observed between CMR and CG (  = 0.335). VO at RCP increased significantly in CG (  = 0.000) and CMR (  = 0.000) compared to the PLA condition, and despite this, no significant difference was observed between CG and CMR (  = 1.000). Nevertheless, there were no significant differences between the three conditions in VO , throwing a medicine ball, and Sarjent's jump height. The study found that CMR and CG had a relatively positive impact on male table tennis players' aerobic capacity; however, they did not significantly improve their explosive power.

Objectives To evaluate the anti-demineralizing effect of a mouthwash comprising pomegranate peel extract (PPE 3%), sodium trimetaphosphate (TMP 0.3%), and fluoride (F 225 ppm) in an in situ study, and to assess its irritation potential in an ex vivo study. Methods This double-blind crossover study was conducted in four phases with 7 days each. Twelve volunteers used palatal appliances containing enamel blocks, which were subjected to cariogenic challenges. The ETF formulation (PPE + TMP + F, pH 7.0), TF formulation (TMP + F, pH 7.0), deionized water (W, pH 7.0), and essential oil commercial mouthwash (CM, 220 ppm F, pH 4.3) were dropped onto the enamel twice daily. The percentage of surface hardness loss, integrated loss of subsurface hardness, calcium, phosphorus, and fluoride in enamel and biofilms were determined. In addition, alkali-soluble extracellular polysaccharide concentrations were analyzed in the biofilms. The irritation potential was evaluated using the hen’s egg chorioallantoic membrane test through the vascular effect produced during 300-s of exposure. Results ETF was the most efficacious in preventing demineralization. It also showed the highest concentrations of calcium and phosphorus in the enamel and in the biofilm, as well as the lowest amount of extracellular polysaccharides in the biofilm. In the eggs, ETF produced light reddening, whereas CM led to hyperemia and hemorrhage. Conclusions The addition of PPE to formulations containing TMP and F increased its anti-demineralizing property, and this formulation presented a lower irritation potential than the CM. Clinical relevance ETF can be a promising alternative alcohol-free mouthwash in patients at high risk of caries.

PurposeTo explore the effect of tasting unpleasant salty or bitter solutions on lower limb corticomotor excitability and neuromuscular function.MethodsNine females and eleven males participated (age: 27 ± 7 years, BMI: 25.3 ± 4.0 kg m−2). Unpleasant salty (1 M) and bitter (2 mM quinine) solutions were compared to water, sweetened water, and no solution, which functioned as control conditions. In a non-blinded randomized cross-over order, each solution was mouth rinsed (10 s) and ingested before perceptual responses, instantaneous heart rate (a marker of autonomic nervous system activation), quadricep corticomotor excitability (motor-evoked potential amplitude) and neuromuscular function during a maximal voluntary contraction (maximum voluntary force, resting twitch force, voluntary activation, 0–50 ms impulse, 0–100 impulse, 100–200 ms impulse) were measured.ResultsHedonic value (water: 47 ± 8%, sweet: 23 ± 17%, salt: 71 ± 8%, bitter: 80 ± 10%), taste intensity, unpleasantness and increases in heart rate (no solution: 14 ± 5 bpm, water: 18 ± 5 bpm, sweet: 20 ± 5 bpm, salt: 24 ± 7 bpm, bitter: 23 ± 6 bpm) were significantly higher in the salty and bitter conditions compared to control conditions. Nausea was low in all conditions (< 15%) but was significantly higher in salty and bitter conditions compared to water (water: 3 ± 5%, sweet: 6 ± 13%, salt: 7 ± 9%, bitter: 14 ± 16%). There was no significant difference between conditions in neuromuscular function or corticomotor excitability variables.ConclusionAt rest, unpleasant tastes appear to have no influence on quadricep corticomotor excitability or neuromuscular function. These data question the mechanisms via which unpleasant tastes are proposed to influence exercise performance.

Background: Carbohydrate mouth rinsing (CHOmr), a nutritional intervention for delaying fatigue and meeting the energy demands of soccer, and the motivational strategy of coach encouragement (CE) are widely recognized as effective approaches for enhancing athletic performance in soccer. Objectives: This study aimed to compare the effects of CHOmr + CE, CHOmr, and CE on heart rate (HR) and kinematic profiles during four-a-side small-sided soccer games (SSGs). Methods: Twenty-four young soccer players (age: 17.2 ± 0.8 years) played six bouts of four-a-side SSGs with CHOmr + CE, CHOmr, or CE at 3-day intervals in a randomized, single-blinded, placebo-controlled, or crossover study design. The HR and kinematic responses were continuously recorded during all games. Results: There were no statistically significant differences between the groups in peak heart rate (HRpeak) (p ≥ 0.05, F = 0.326, p = 0.723, η2 = 0.014) and mean heart rate (HRmean) (p ≥ 0.05, F = 0.845, p = 0.436, η2 = 0.035). No significant differences were found for distances in Zone 1 (p ≥ 0.05, F = 1.21, p = 0.306, η2 = 0.050), Zone 4 (p ≥ 0.05, F = 0.310, p = 0.735, η2 = 0.013), Zone 5 (p ≥ 0.05, F = 1.02, p = 0.368, η2 = 0.042), or Zone 6 (p ≥ 0.05, F = 0.161, p = 0.211, η2 = 0.055), nor acceleration (p ≥ 0.05, F = 0.208, p = 0.137, η2 = 0.083) and deceleration (p ≥ 0.05, F = 0.790, p = 0.460, η2 = 0.033). Similarly, although no significant differences were observed in the distance in Zone 3 (p ≥ 0.05, F = 3.12, p = 0.054, η2 = 0.119) or repeated sprint distance (p ≥ 0.05, F = 2.96, p = 0.062, η2 = 0.114), the CHOmr +CE group exhibited higher average values for these variables. However, a statistically significant difference was observed in the distance covered in Zone 2 (p ≤ 0.05, F = 3.89, p = 0.028, η2 = 0.145), with the CHOmr +CE group performing better, as confirmed by the post-hoc analyses. Conclusions: Although our findings indicate that CE alone may influence kinematic profiles during SSGs, similar to CHOmr or its combination with CE, further research should explore the underlying mechanisms and potential contextual factors influencing these outcomes. Therefore, we suggest that coaches prefer CE because it is easy to implement.

There is growing interest in the potential of alternative modes of caffeine administration for enhancing sports performance. Given that alternative modes may evoke improved physical performance via distinct mechanisms, effects may not be comparable and studies directly comparing the erogenicity of alternative modes of caffeine administration are lacking. To address this knowledge gap, the present study evaluated the effect of 3 mg·kg caffeine delivered in anhydrous form via capsule ingestion, chewing gum or mouth rinsing on measures of muscular strength, power, and strength endurance in male Rugby Union players. Twenty-seven participants completed the study (Mean ± SD: Age 20 ± 2 yrs; daily caffeine consumption 188 ± 88 mg). Following assessments and reassessment of chest press (CP), shoulder press (SP), Deadlift (DL), and Squat (SQ) 1-repetition maximum (1RM) and familiarization to the experimental procedures, participants completed six experimental trials where they were administered 3 mg.kg caffeine (Caff) or placebo (Plac) capsule , chewing gum or mouth rinse in a randomized, double-blind and counterbalanced fashion prior to force platform assessment of countermovement jump, drop jump and isometric mid-thigh pull performance. Strength endurance was measured across two sets of CP, SP, DL, and SQ at 70% 1RM until failure. Pre-exercise perceptions of motivation and arousal were also determined. Caffeine increased perceived readiness to invest mental effort (  = .038; ηp =.156), countermovement jump height (  = .035; ηp =.160) and SQ repetitions until failure in the first set (  < .001; d = .481), but there was no effect of delivery mode (  > .687; ηp <.015). Readiness to invest physical effort, felt arousal, drop jump height, countermovement jump, drop jump and isometric mid-thigh pull ground reaction force-time characteristics and repetitions until failure in CP, SP and DL were not affected by caffeine administration or mode of caffeine delivery (  > .0.052; ηp < .136). 3 mg.kg caffeine administered via capsule, gum or mouth rinse had limited effects on muscular strength, power, and strength endurance. Small effects of caffeine on CMJ height could not be explained by changes in specific ground reaction force-time characteristics and were not transferable to DJ performance, and effects specific to the SQ RTP exercise underpin the complexity in understanding effects of caffeine on muscular function. Novel modes of caffeine administration proposed to evoke benefits via distinct mechanisms did not offer unique effects, and the small number of effects demonstrated may have little translation to a single performance trial when data examining direct comparison of each caffeine vehicle compared against a mode matched placebo is considered.