UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4196
1
Braz Dent Sci 2024 Apr/June;27 (2): e4196
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Evaluation of antiseptic mouthwashes protocol against SARS-
CoV-2 on orthodontic appliances (an in vitro study)
Avaliação do protocolo de enxaguantes bucais antissépticos contra SARS-CoV-2 em aparelhos ortodônticos (estudo
in vitro
)
Sarmad Sobhi Salih AL QASSAR1 , Leqaa Hashim QIBI1 , Aisha Akram QASIM1 , Hassan Moyaser DAWOOD2
1 - University of Mosul, College of Dentistry, Department of Pedodontics, Orthodontics and Prevention, Mosul, Iraq.
2 - University of Birmingham, School of Dentistry, College of Medical and Dental Sciences, Birmingham, United Kingdom.
How to cite: AlQassar SSS, Qibi LLH, Qasim AA, Dawood HM. Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on
orthodontic appliances (an
in vitro
study). Braz Dent Sci. 2024;27(2):e4196. https://doi.org/10.4322/bds.2024.e4196
ABSTRACT
Objective: The objective of this study was to evaluate the impact of daily mouthwash rinsing protocols recommended
against SARS-CoV-2 on metal ions discharged from xed orthodontic appliances, specically Nickel (Ni) and
Chromium (Cr). Material and Methods: Total of 400 hemi-arch xed appliances were segregated into two
groups, namely Nickel Titanium (NiTi) and Stainless Steel (SS), based on the type of archwire employed. Each
set was submerged in 2% povidone-iodine, 1% hydrogen peroxide, 0.2% chlorhexidine and cetylpyridinium
chloride mouthwashes. Distilled water was used for comparative measurements of the ions released as a control
group (n=10/group). They were incubated for four periods at 37°C (one hour, twenty-four hours, one, and 3
weeks). Nil and Cr ions released from the xed appliance were evaluated by atomic absorption spectroscopy.
The data were analyzed by the Kruskal-Wallis test and paired comparison analysis. Results: The worst levels
of Ni and Cr liberated from the SS group observed in povidone-iodine mouthwash at 1.173 and 1.701 ppm,
respectively, while the chlorhexidine mouthwash released accepted level of Ni and Cr at 0.033 and 0.056 ppm,
respectively. The NiTi group displayed the appalling ions released of Ni and Cr in povidone-iodine mouthwash
at 1.87 and 2.4 ppm, respectively. Whereas the released levels of Ni and Cr ions from the chlorhexidine group
and cetylpyridinium chloride were 0.048 and 0.127 ppm, respectively, with signicant differences between the
tested groups and intervals. Conclusion: Chlorhexidine and Cetylpyridinium chloride mouthwashes were the
appropriate options for orthodontic patients to minimized ions released according to this study protocol.
KEYWORDS
Metal release; Mouthwash; Nickle Ions released; SARS-CoV-2; WHO.
RESUMO
Objetivo: O objetivo deste estudo é avaliar o impacto dos protocolos diários de enxaguatório bucal recomendados
contra SARS-CoV-2 em íons metálicos liberados de aparelhos ortodônticos xos, especicamente Níquel (Ni)
e Cromo (Cr). Material e Métodos: Um total de 400 aparelhos xos de hemiarcada foram segregados em
dois grupos, Níquel Titânio (NiTi) e Aço Inoxidável (SS), com base no tipo de o utilizado. Cada conjunto foi
submerso em enxaguantes bucais com iodopovidona a 2%, peróxido de hidrogênio a 1%, clorexidina a 0,2%
e cloreto de cetilpiridínio. Água destilada foi utilizada para medições comparativas dos íons liberados como
grupo controle (n=10/grupo). Eles foram incubados por cinco períodos a 37°C (uma hora, vinte e quatro horas,
uma e 3 semanas). Os íons Nil e Cr liberados do aparelho xo foram avaliados por espectroscopia de absorção
atômica. Os dados foram analisados pelo teste de Kruskal-Wallis e análise de comparação pareada. Resultados:
Os piores níveis de Ni e Cr liberados no grupo SS foram observados no enxaguatório bucal com iodopovidona
em 1,173 e 1,701 ppm, respectivamente, enquanto o enxaguatório bucal com clorexidina liberou níveis aceitos
de Ni e Cr em 0,033 e 0,056 ppm, respectivamente. O grupo NiTi exibiu os terríveis íons liberados de Ni e Cr
2
Braz Dent Sci 2024 Apr/June;27 (2): e4196
Al Qassar SSS et al.
Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on orthodontic appliances (an in vitro study)
Al Qassar SSS et al. Evaluation of antiseptic mouthwashes protocol against
SARS-CoV-2 on orthodontic appliances (an
in vitro
study)
INTRODUCTION
Globally, the World Health Organization
(WHO) has received reports of 650,332,899
conrmed COVID-19 cases worldwide, including
6,649,874 fatalities. The disease can be
asymptomatic but is nevertheless contagious [1].
SARS-CoV-2 is extremely spreadable because
it can be disseminated by aerosol droplets [2].
Additionally, cross-infection can be the result of
objects with saliva contamination [3]. Therefore, it
is essential to regulate the viral burden in the saliva
and respiratory secretions [4-6]. Consequently,
numerous entities recommend a daily mouthwash
protocol [2,3].
The New Zealand Dental Association
prescribed gargling either with 0.2% povidone-
iodine (PVP-I), 1% hydrogen peroxide (H2O2),
0.2% chlorhexidine (CHX), or Listerine containing
cetylpyridinium chloride (CPC) for 30 seconds.
In addition, the American Dental Association has
stated that gargling with 0.2% PVP-I twice daily
for 30 seconds could reduce the infectiousness of
SARS-CoV-2 to undetectable levels. In addition,
it was determined that PVP-I mouthwash could
reduce the coronavirus in saliva and prevent
virus attachment to oral and nasopharyngeal
mucosa [2,3,7]. The International Federation
of Endodontic Association and Scottish Dental
Clinical Effectiveness Programs recommended
H2O2 and PVP-I mouthwashes [1,2].
In recent studies, 30 seconds of gargling with
Listerine antiseptic mouthwash that contains CPC
was enough to decrease the coronavirus saliva load
by up to 99.9% [3,8]. CHX is a well-known, broad-
spectrum antiseptic mouthwash that dentists
recommend daily for maintaining oral health [9].
CHX can increase cell wall permeability, disrupting
the microbial membranes, and making it effective
against anaerobes, aerobes, Gram- positive and
negative bacteria, and fungi [3,8]. CHX’s effects
against the SARS-CoV-2 were controversial, in
comparison to other mouthwashes [1]. However,
Chopra et al. [3] suggested it as a simple and
safe choice to inhibit the spread of coronavirus.
Additionally, mouthwashes inuence improving
the buffering capacity of the saliva [10].
WHO deliberates that teeth malocclusion is
the most signicant issue regarding oral health,
following caries and periodontal diseases.
Its incidence among children and adolescents
ranges from 39 to 93 percent. Crowding comes
rst with a prevalence of up to 84%, while spacing
is second, which reached up to 60% [4,11,12].
The effect of these daily mouthwash protocols
on the shear bond strength was previously
evaluated [13]. However, their impact on the
orthodontic appliance has not been clarified
yet, as it was stated that the oral fluids and
mouthwashes signicantly affect ions liberated
from the orthodontic appliance [6].
Thus, this study aimed to estimate the effects
of this daily mouthwash rinsing protocol on
the amount of corrosion in xed appliances as
metal ions are released, especially the Ni and Cr
ions from orthodontic appliances incorporating
SS, NiTi archwires exposed to different time
expositions, and its possibility to reach toxic
levels.
METHODS
Study design and setting
This experimental research was conducted
in vitro
, in the lab of the College of Dentistry of
the University of Mosul - Iraq, from July 2023 to
September 2023. The ethical committee approved
the protocol of this study (no. PO 22O265UoM).
• Each set comprised:
– Five edgewise standard SS brackets
(anterior teeth, canine, and bicuspid).
– One molar band.
no enxaguatório bucal com iodopovidona a 1,87 e 2,4 ppm, respectivamente. Já os níveis liberados de íons Ni
e Cr do grupo clorexidina e cloreto de cetilpiridínio foram 0,048 e 0,127 ppm, respectivamente, com diferenças
signicativas entre os grupos e intervalos testados. Conclusão: Enxaguatórios bucais com clorexidina e cloreto
de cetilpiridínio foram as opções adequadas para pacientes ortodônticos para minimizar a liberação de íons de
acordo com o protocolo deste estudo.
PALAVRAS-CHAVE
Liberação de metal; Enxaguante bucal; Liberação de íons de níquel; SARS-CoV-2; OMS.
3
Braz Dent Sci 2024 Apr/June;27 (2): e4196
Al Qassar SSS et al.
Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on orthodontic appliances (an in vitro study)
Al Qassar SSS et al. Evaluation of antiseptic mouthwashes protocol against
SARS-CoV-2 on orthodontic appliances (an
in vitro
study)
– Either a hemi-arch SS archwire (Gauge
1722”) or a NiTi archwire (Gauge 1722”)
manufactured by Dentarum, Isinberge,
Germany.
• The 400 sets were divided into two groups
based on the archwire used, with 200 sets
each.
• Each group of 200 sets was further
divided into ve subgroups based on the
mouthwashes used in the study.
• Distilled water was used as a control group
for comparative measurements (40 sets
each).
• Each subgroup was divided into four clusters
based on the testing intervals (10 sets each).
Exposure protocol
Each sample was exposed to the mouthwashes
for 30 seconds twice daily, simulating a gargling
protocol. The mouthwashes used in the study and
their chemical compositions are listed in Table I.
Incubation and measurements
For each mouthwash, 10 samples were
tested, and the reassessment was performed
at four time points. Thus, the vials for each
mouthwash were divided into four subgroups
according to the four incubation periods.
All the samples were incubated for one hour,
twenty-four hours, one week, and three weeks
intervals at 37C˚ using a Memmert Incubator
(model IN 55, USA) with unceasing shaking.
Ten vials of each mouthwash were randomly
selected for analysis at each time interval. After
getting the appliance out of the solution, a drop
of nitric acid (65%) was used to stabilize the
liberated ions in the solution before they were
sent for analysis. A new plastic disposable syringe
with a plastic tip aspirated this solution.
The Atomic Absorption Spectroscopy (Buck
230ATS, USA) was used to compute the Ni and
Cr ions released from each tested mouthwash at
different intervals.
Statistical analysis
SPSS software (version 26) was employed
for statistical data analysis. Descriptive statistics
(mean, standard deviation) were performed
to analyze the Ni and Cr Ions data released
from the hemi-sets of orthodontic appliances.
The Kolmogorov-Smirnov test was used to inspect
the normal distribution of the data. Kruskal-
Wallis statistical test was performed to analyze
the nal data with pairwise comparisons analysis.
The signicant level was adjusted to 5%.
RESULTS
The descriptive statistics (mean, standard
deviation) of the Ni ions released from the SS wire
group for different intervals are shown in Table II.
Table III shows the mean and standard deviation
of the Cr ions released from the SS wire group for
the four tested intervals. Tables IV and V display
the mean of the Ni and Cr ions released from the
tested mouthwashes at different intervals.
This experimental study demonstrated
an increase in the concentration of nickel and
chromium ions emitted from appliances containing
SS and NiTi archwires, with signicant differences
between them (Tables II, III, IV, and V).
The maximum release of Ni and Cr ions
from the SS appliance group was 1.173 and
Table I - Mouthwashes used in this study and their pH
Trade name Company\
manufacturer Chemical composition pH
Klorhex
Chlorhexidine
Drogsan, Ankara -
Turkey 2% chlorhexidine solution 6.5
Naturel Hydrogen
Peroxide
Naturel Medical
Pharma, Istanbul -
Turkey
3% hydrogen peroxide, 0.03% stabilizer, 96.97% solvent 7.3
Colgate Plax
Cool Mint Colgate, London - UK
aqua, glycerin, propylene glycol,
poloxamer, aroma, cetylpyridinium chloride, potassium sorbate, sodium
fluoride, sodium saccharin, menthol
7.1
Batticon ADEKA, Istanbul
-Turkey
10% povidone-iodine solution, 1.5% emulsifier, 0.5% stabilizer, 0.5% pH
adjuster, 87.829% solvent 6.1
Distilled water 7
4
Braz Dent Sci 2024 Apr/June;27 (2): e4196
Al Qassar SSS et al.
Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on orthodontic appliances (an in vitro study)
Al Qassar SSS et al. Evaluation of antiseptic mouthwashes protocol against
SARS-CoV-2 on orthodontic appliances (an
in vitro
study)
Table II - Mean and the standard deviation of Ni ion released from SS appliance at four intervals
Time\
Mouthwash DW H2O2PVP-I CHX CPC
p**
1h 0.01a0.011a0.255b0.0065a0.007a
0.01
(0.0) (0.001) (0.005) (0.0005) (0.0)
24h 0.014a0.033b0.263c0.01d0.022e
0.009
(0.001) (0.001) (0.0015) (0.0011 (0.0005)
1 week 0.0175a0.011a0.345b0.01a0.012a
0.013
(0.0025) (0.0015) (0.035) (0.0) (0.0)
3 weeks 0.009a0.009a0.31b0.0065a0.0285a
0.011
(0.0) (0.001) (0.03) (0.0005) (0.0025)
p*
0.00 0.00 0.000 0.000 0.00
Total 0.0505 0.065 1.173 0.033 0.0695
*
p
Kruskal Wallis test value for the four different intervals; **
p
Kruskal Wallis test value among different mouthwashes used in this study; DW:
Distilled water; H2O2: Hydrogen peroxide: PVP-I: Povidon-eiodine; CHX: Chlorhexidine; CPC: Cetylpyridinium chloride. The same letters at the
same row expressed non-significant differences regarding the tested mouth washes diagnosed by pairs comparison test.
Table III - Means and standard deviation of Cr ion released from SS appliance at four intervals
Time\
Mouthwash DW H2O2PVP-I CHX CPC
p**
1h 0.01475b0.005a0.1885d0.0085a0.0235c
0.009
(0.025) (0.0000) (0.0035) (0.0005) (0.0015)
24h 0.004a0.004a0.08b0.004a0.0087a
0.026
(0.001) (0.001) (0.01) (0.001) (0.0005)
1 week 0.0055ab 0.0075b0.129d0.005a0.0685c
0.010
(0.0005) (0.0005) (0.001) (0.0) (0.0015)
3 weeks 0.0065a0.005a0.1305c0.0055a0.045b
0.010
(0.0005) (0.0) (0.0035) (0.0005) (0.002)
p*
0.000 0.000 0.000 0.000 0.000
Total 0.03075 0.0215 0.528 0.023 0.146
*
p
Kruskal Wallis test value for the four different intervals; **
p
Kruskal Wallis test value between different mouth washes used in this study;
DW: Distilled water; H2O2: Hydrogen peroxide: PVP-I: Povidon-eiodine; CHX: Chlorhexidine; CPC: Cetylpyridinium chloride. The same letters at
the same raw expressed non-significant differences regarding the tested mouth washes diagnosed by pairs comparison test.
Table IV - Means and standard deviation of Ni ion released from NiTi appliance at four intervals
Time\
Mouthwash DW H2O2PVP-I CHX CPC
p**
1h 0.011c0.005a0.162d0.008b0.007ab
0.009
(0.0006) (0.00029) (0.002) (0.0005) (0.0005)
24h 0.012a0.034b0.299c0.008a0.015a
0.010
(0.001) (0.001) (0.0083) (0.001) (0.001)
1 week 0.55c0.225b0.54c0.0185a0.014a
0.012
(0.01) (0.015) (0.06) (0.0005) (0.001)
3 weeks 0.0105a0.215b0.875c0.014a0.0175a
0.009
(0.0005) (0.005) (0.035) (0) (0.0025)
p*
0.00 0.00 0.00 0.00 0.00
Total 0.5835 0.479 1.876 0.0485 0.0535
*
p
Kruskal Wallis test value for the four different intervals; **
p
Kruskal Wallis test value among different mouthwashes used in this study; DW:
Distilled water; H2O2: Hydrogen peroxide: PVP-I: Povidon-eiodine; CHX: Chlorhexidine; CPC: Cetylpyridinium chloride. The same letters at the
same row expressed non-significant differences regarding the tested mouth washes diagnosed by pairs comparison test.
5
Braz Dent Sci 2024 Apr/June;27 (2): e4196
Al Qassar SSS et al.
Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on orthodontic appliances (an in vitro study)
Al Qassar SSS et al. Evaluation of antiseptic mouthwashes protocol against
SARS-CoV-2 on orthodontic appliances (an
in vitro
study)
1.701 ppm, respectively, from the PVP-I
mouthwash. Meanwhile, the CHX group released
the least amount of Ni and Cr at 0.033 and 0.056
ppm, respectively. The NiTi group displayed the
highest percentage of Ni and Cr ions emitted
in the PVP-I mouthwash, at 1.87 and 2.4 ppm,
respectively. Meanwhile, the least released
amount of the Ni and Cr ions was observed from
the CHX group, and the CPC was 0.048 and 0.127
ppm, respectively.
However, the total Ni ion released from the
SS group ranged between 0.05 to 1.173 ppm, as
shown in Table II. While the total Cr ion released
from the SS group ranged between 0.023 to
0.528 ppm as shown in Table III. The last row
in Tables IV and V displayed the total Ni and Cr
ions released from the NiTi group, which range
between 0.0535 and 1.876 and 0.0175 and
0.525 ppm, respectively.
Kolmogorov-Smirnov test results dis-
played the non-normal distribution of the data
(p = 0.000). The Kruskal-Wallis’s test shows
signicant differences between the number of
ions released from the mouthwashes used at
different intervals. Pairwise comparison analysis
diagnosed the non-signicant difference between
the mouthwashes, expressed as the same letters
in the Tables (II, III, IV, V).
DISCUSSION
Daily gargling with mouthwash is a
recommended procedure by WHO due to its
suitability, safety, and simplicity [1,2]. Clinical
studies have shown that mouthwashes can reduce
the activity of the SARS-CoV-2 in the mouth [2,3].
However, there is limited academic research
on the impact of certain newer mouthwashes
on metal ions released by fixed orthodontic
appliances, such as PVP-I, H2O2 and CPC.
This study aimed to assess the efficacy
of different mouthwashes against distilled
water in minimizing the release of metal
ions from fixed orthodontic appliances
over varying time intervals. The goal was
determining the most appropriate mouthwash for
individuals undergoing orthodontic treatment.
The investigation specifically targeted metal
ions with the greatest potential to affect human
health and cause sensitivity. Prior research has
established that metal ion release from fixed
orthodontic appliances commences immediately
upon immersion and reaches its highest levels on
the seventh day [14-16].
This research delves into the potential
release of Ni and Cr ions from xed orthodontic
appliances. These ions have been known to
trigger allergies and toxicity, leading to symptoms
that can range from short-lived and intense to
long-lasting and mild [17]. While nickel toxicity is
a concern, the body’s natural ability to eliminate
nickel is more signicant than the accumulation
of nickel, rendering the risks negligible [18,19].
Healthcare professionals should be aware that
metal ion release may cause hypersensitivity of
the buccal soft tissues, such as moderate erythema
and redness with or without oedema [14,20-23].
Additionally, research suggests that an allergic
reaction to Ni or Cr ions released from a xed
Table V - Means and standard deviation of Cr ion released from NiTi appliance at four intervals
Time\
Mouthwashes DW H2O2PVP-I CHX CPC
p**
1h 0.0055a0.004a0.2145b0.007a0.0275a0.009
(0.0005) (0.001) (0.021) (0) (0.0025)
24h 0.002a0.005b0.062d0.003ab 0.008c
0.010
(0.00006) (0.00021) (0.00153) (0.001) (0.001)
1 week 0.004a0.0035a0.11b0.072ab 0.0165a
0.019
(0) (0.0005) (0.01) (0.058) (0.0005)
3 weeks 0.006a0.005a0.1385c0.0055a0.022b
0.016
(0.0) (0.001) (0.0055) (0.0005) (0.002)
p*
0.00 0.00 0.00 0.00 0.00
Total 0.0175 0.0175 0.525 0.0875 0.074
*
p
Kruskal Wallis test value for the four different intervals; **
p
Kruskal Wallis test value among different mouthwashes used in this study; DW:
Distilled water; H2O2: Hydrogen peroxide: PVP-I: Povidon-eiodine; CHX: Chlorhexidine; CPC: Cetylpyridinium chloride. The same letters at the
same row expressed non-significant differences regarding the tested mouth washes diagnosed by pairs comparison test.
6
Braz Dent Sci 2024 Apr/June;27 (2): e4196
Al Qassar SSS et al.
Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on orthodontic appliances (an in vitro study)
Al Qassar SSS et al. Evaluation of antiseptic mouthwashes protocol against
SARS-CoV-2 on orthodontic appliances (an
in vitro
study)
orthodontic appliance, rather than poor dental
hygiene, may be linked to severe gingivitis [24].
The quantity of chromium (Cr) and
nickel (Ni) consumed through food varies
between 5 to 100 mg and 300 to 500 mg daily,
respectively [15,16]. The difference was minimal
when comparing the present research results
to the amount of Ni and Cr ions congested
daily from food and water. Prior research has
established that metal ion release from fixed
orthodontic appliances commences immediately
upon immersion and reaches its highest levels on
the seventh day [14-16].
The study found that H2O2 mouthwashes
resulted in the least amount of Cr release
compared to other mouthwashes evaluated.
CPC came in second regarding the maximum
release of Cr, followed by CHX. However, the
lack of a signicant difference in acidity between
these three mouthwashes may be attributed to
the corrosiveness of CPC compared to the other
mouthwashes, which demonstrated a reduction
in the efciency of stainless steel corrosion [25].
According to this study, using H2O2 mouth-
wash on NiTi archwires can release high Ni ions
over time. This is due to H2O2’s ability to break
down the protective layer on the surface of the
wire, making it easier for the ions to escape.
In addition, certain properties can also be
released by H2O2. Several factors, such as uid
pH, immersion duration, oxygen content and tem-
perature, can inuence the rate of metal corrosion
in a uid. It should be noted that aeration of dis-
tilled water can increase steel corrosion rates, as
oxygen dissolving in water can be up to ve to ten
times more aggressive than carbonic acid [26-28].
It is worth noting that the quantity of ions that a
hemi-xed appliance releases is not exclusively
dependent on CHX’s corrosive capability. This is
because corrosion can happen in an acidic atmo-
sphere. Furthermore, research has demonstrated
that H2O2 cannot release Cr ions. From a clinical
standpoint, the corrosion of the hemi-xed appli-
ance can impact the sliders’ movement over the
archwire, which may jeopardize the efcacy of
orthodontic treatment [29,30].
The corrosion mechanism and consequent
liberation of metal ions from xed orthodontic
devices entail the depletion of the chromium
hydroxide and chromium oxide passive layer that
develops on the stainless steel surface upon contact
with oxygen. Crevice corrosion, characterized by
highly concentrated and localized corrosion that
occurs at shielded regions of a metal surface, is
the underlying mechanism behind the corrosion
of orthodontic brackets [27,31].
The levels of nickel and chromium released
throughout three weeks in distilled water in the
current investigation were higher than those
reported in a previous study by Barrett et al. [15].
Differences in study design, tested mouthwash
solutions, measurement methods, and duration
could account for this discrepancy. Barrett et al.
used atomic absorption spectrophotometry to
measure the ion releases in articial saliva from
bands and brackets over four weeks. Additionally,
discrepancies in the metal release have been
discovered between equivalent items from various
manufacturers [31,32]. This investigation did not
include the determination of the surface area and
geometry of orthodontic bands, archwires, and
brackets despite the signicance of the surface area
in metal corrosion [14,32,33]. The concentrations
of chromium (Cr) and nickel (Ni) ions that
were released in both CHX and distilled water
over three weeks were found to be higher than
the levels obtained through other means [33].
Comparing research studies can be challenging
due to variations in study designs and diverse
electrochemical variables. Difculties in measuring
surface areas with intricate geometries must be
considered when comparing studies [31,32].
Based on our findings, we concluded that the
corrosiveness of mouthwash, which is determined
by its chemical structure, is the primary cause of
xed appliance corrosion.
The limitations of this study include the
full surface area of brackets exposed to the
solution, which is not representative of the
clinical situation where the bases of the brackets
were xed to the tooth surface via an adhesive.
Furthermore, the study did not consider the effect
of thermocycling [27].
Future research could explore the effects
of different concentrations of mouthwashes
on the release of Ni and Cr ions, as well as the
impact of saliva on these mouthwashes and their
relationship to metal release.
CONCLUSION
According to this study protocol, the
following points could be concluded:
7
Braz Dent Sci 2024 Apr/June;27 (2): e4196
Al Qassar SSS et al.
Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on orthodontic appliances (an in vitro study)
Al Qassar SSS et al. Evaluation of antiseptic mouthwashes protocol against
SARS-CoV-2 on orthodontic appliances (an
in vitro
study)
1. CHX and CPC mouthwashes are the
appropriate options for orthodontic patients
to mitigate the quantity of metal discharge
amid the ongoing pandemic;
2. It is recommended to refrain from using
PVP-I mouthwashes in orthodontic patients
due to their potential to induce a signicant
release of Ni and Cr.
Acknowledgements
The authors thank the University of Mosul for
their support and encouragement in conducting
this research.
Author’s Contributions
SS, LHQ: Conceptualization. SSS, AAQ:
Data Curation. SSS, LHQ, AAQ: Formal Analysis.
SSS, LHQ, AAQ, HMD: Funding Acquisition.
SSS, LHQ, AAQ, HMD: Investigation. SSS, LHQ:
Methodology. SSS, AAQ: Project Administration.
SSS, LHQ, AAQ: Resources. SSS: Software. AAQ:
Supervision. SSS, LHQ, AAQ: Validation. SSS,
LHQ: Visualization. SSS, HMD: Writing - Original
Draft Preparation. SSS, HMS: Writing - Review
& Editing.
Conicts of Interest
There are no conicts of interest.
Funding
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors.
Regulatory Statement
This study was conducted in accordance with
all the provisions of University of Mosul Ethical
Committee Agency. The approval code for this
study is: no. PO 22O265UoM.
REFERENCES
1. Banakar M, Bagheri Lankarani K, Jafarpour D, Moayedi S, Banakar
MH, MohammadSadeghi A. COVID-19 transmission risk and
protective protocols in dentistry: a systematic review. BMC
Oral Health. 2020;20(1):1-12. http://doi.org/10.1186/s12903-
020-01270-9.
2. Bidra AS, Pelletier JS, Westover JB, Frank S, Brown SM, Tessema
B. Comparison of
in vitro
inactivation of SARS CoV‐2 with
hydrogen peroxide and povidone‐iodine oral antiseptic rinses.
J Prosthodont. 2020;29(7):599-603. http://doi.org/10.1111/
jopr.13220. PMid:32608097.
3. Chopra A, Sivaraman K, Radhakrishnan R, Balakrishnan D,
Narayana A. Can povidone iodine gargle/mouth rinse inactivate
SARS-CoV-2 and decrease the risk of nosocomial and community
transmission during the COVID-19 pandemic? An evidence-
based update. Jpn Dent Sci Rev. 2021;57:39-45. http://doi.
org/10.1016/j.jdsr.2021.03.001. PMid:33747261.
4. Santos M, de Araujo Almeida G, Normando D. The impact of
COVID-19 pandemic on total treatment time of fixed appliances.
Prog Orthod. 2022;23(1):42. http://doi.org/10.1186/s40510-022-
00437-0. PMid:36066702.
5. Kumar G, Mohan R, Prasad Hiremutt D, Vikhram K. COVID-
19 pandemic and safe dental practice: need of the hour. J
Indian Acad Oral Med Radiol. 2020;32(2):164-71. http://doi.
org/10.4103/jiaomr.jiaomr_80_20.
6. Kovac V, Poljsak B, Bergant M, Scancar J, Mezeg U, Primozic J.
Differences in metal ions released from orthodontic appliances in
an
in vitro
and in vivo Setting. Coatings. 2022;12(2):190. http://
doi.org/10.3390/coatings12020190.
7. Meister TL, Brüggemann Y, Todt D, Conzelmann C, Müller JA,
Groß R,etal. Virucidal efficacy of different oral rinses against
severe acute respiratory syndrome coronavirus 2. J Infect Dis.
2020;222(8):1289-92. http://doi.org/10.1093/infdis/jiaa471.
PMid:32726430.
8. Palla B, Callahan N. What is the rate of COVID-19 infection
in a population seeking oral health care? J Am Dent Assoc.
2021;152(6):448-54. http://doi.org/10.1016/j.adaj.2021.02.009.
PMid:34044976.
9. Marinello C. Current uses of chlorhexidine for management of
oral disease: a narrative review. Int J Prosthodont. 2021;34(1):119.
10. Alkasso IR, Al Qassar SSS, Taqa GA. Durability of different types
of Mouthwashes on the Salivary Buffering system in Orthodontic
Patients. Dent 3000 2021;9(1):178-92. https://doi.org/10.5195/
d3000.2021.161.
11. Stomatologic SI. Worldwide prevalence of malocclusion in the
different stages of dentition: A systematic review and meta-
analysis. Eur J Paediatr Dent. 2020;21(2):115-22. PMid:32567942.
12. Burnheimer JM, Serio CG, Loo BH, Hartsock LA. Prevalence of
white spot lesions and risk factors associated with the COVID-
19 pandemic. J World Fed Orthod. 2022;11(4):125-9. http://doi.
org/10.1016/j.ejwf.2022.03.003. PMid:35624003.
13. Ghobadi A, Golshah A, Safaei M. The effect of hydrogen peroxide
and povidone-iodine on the shear bond strength of orthodontic
brackets: an
in vitro
study. Open Access Maced J Med Sci.
2022;10(D):274-80. http://doi.org/10.3889/oamjms.2022.9662.
14. Park HY, Shearer TR.
In vitro
release of nickel and chromium from
simulated orthodontic appliances. Am J Orthod. 1983;84(2):156-9.
http://doi.org/10.1016/0002-9416(83)90180-X. PMid:6576640.
15. Barrett RD, Bishara SE, Quinn JK. Biodegradation of orthodontic
appliances. Part I. Biodegradation of nickel and chromium
in vitro
.
Am J Orthod Dentofacial Orthop. 1993;103(1):8-14. http://doi.
org/10.1016/0889-5406(93)70098-9. PMid:8422037.
16. Hwang C-J, Shin J-S, Cha J-Y. Metal release from simulated
fixed orthodontic appliances. Am J Orthod Dentofacial Orthop.
2001;120(4):383-91. http://doi.org/10.1067/mod.2001.117911.
PMid:11606963.
17. Mockers O, Deroze D, Camps J. Cytotoxicity of orthodontic bands,
brackets and archwires
in vitro
. Dent Mater. 2002;18(4):311-7.
http://doi.org/10.1016/S0109-5641(01)00055-0. PMid:11992908.
18. Schmalz G, Garhammer P. Biological interactions of dental cast
alloys with oral tissues. Dent Mater. 2002;18(5):396-406. http://
doi.org/10.1016/S0109-5641(01)00063-X. PMid:12175579.
8
Braz Dent Sci 2024 Apr/June;27 (2): e4196
Al Qassar SSS et al.
Evaluation of antiseptic mouthwashes protocol against SARS-CoV-2 on orthodontic appliances (an in vitro study)
Al Qassar SSS et al. Evaluation of antiseptic mouthwashes protocol against
SARS-CoV-2 on orthodontic appliances (an
in vitro
study)
19. Jamilian A, Moghaddas O, Toopchi S, Perillo L. Comparison of
nickel and chromium ions released from stainless steel and Niti
wires after immersion in Oral B®, Orthokin® and artificial saliva. J
Contemp Dent Pract. 2015;15(4):403-6. http://doi.org/10.5005/
jp-journals-10024-1552. PMid:25576103.
20. Magnusson B, Bergman M, Bergman B, Söremark R. Nickel
allergy and nickel‐containing dental alloys. Eur J Oral Sci.
1982;90(2):163-7. http://doi.org/10.1111/j.1600-0722.1982.
tb01540.x.
21. Rickles NH. Allergy in surface lesions of the oral mucosa. Oral
Surg Oral Med Oral Pathol. 1972;33(5):744-54. http://doi.
org/10.1016/0030-4220(72)90442-2. PMid:4502149.
22. Schriver WR, Shereff RH, Domnitz JM, Swintak EF, Civjan S.
Allergic response to stainless steel wire. Oral Surg Oral Med
Oral Pathol. 1976;42(5):578-81. http://doi.org/10.1016/0030-
4220(76)90207-3. PMid:1068414.
23. Bobić Z, Kojić S, Stojanović GM, Terek V, Kovačević L, Terek
P. Nanotopography evaluation of NiTi alloy exposed to
artificial saliva and different mouthwashes. Materials (Basel).
2022;15(23):8705. http://doi.org/10.3390/ma15238705.
PMid:36500200.
24. Danaei SM, Safavi A, Roeinpeikar SMM, Oshagh M, Iranpour
S, Omidekhoda M. Ion release from orthodontic brackets in 3
mouthwashes: an in-vitro study. Am J Orthod Dentofacial Orthop.
2011;139(6):730-4. http://doi.org/10.1016/j.ajodo.2011.03.004.
PMid:21640878.
25. Atia AA, Saleh MM. Inhibition of acid corrosion of steel using
cetylpyridinium chloride. J Appl Electrochem. 2003;33(2):171-7.
http://doi.org/10.1023/A:1024083117949.
26. Maijer R, Smith DC. Corrosion of orthodontic bracket bases.
Am J Orthod. 1982;81(1):43-8. http://doi.org/10.1016/0002-
9416(82)90287-1. PMid:6758590.
27. Gwinnett AJ. Corrosion of resin-bonded orthodontic brackets.
Am J Orthod. 1982;81(6):441-6. http://doi.org/10.1016/0002-
9416(82)90421-3. PMid:6758601.
28. Ozcan T, Sonat B, Dartar OMBS. Determining the corrosion rates
of rotary Ni-Ti instruments in different irrigating solutions. Int
Endod J. 2007;40:997.
29. Nakagawa M, Matsuya S, Udoh K. Corrosion behavior of pure
titanium and titanium alloys in fluoride-containing solutions.
Dent Mater J. 2001;20(4):305-14. http://doi.org/10.4012/
dmj.20.305. PMid:11915624.
30. Schiff N, Dalard F, Lissac M, Morgon L, Grosgogeat B. Corrosion
resistance of three orthodontic brackets: a comparative study
of three fluoride mouthwashes. Eur J Orthod. 2005;27(6):541-9.
http://doi.org/10.1093/ejo/cji050. PMid:16049037.
31. Grimsdottir MR, Gjerdet NR, Hensten-Pettersen A. Composition
and
in vitro
corrosion of orthodontic appliances. Am J
Orthod Dentofacial Orthop. 1992;101(6):525-32. http://doi.
org/10.1016/0889-5406(92)70127-V. PMid:1350883.
32. Fróis A, Mendes AR, Pereira SA, Louro CS. Metal release and
surface degradation of fixed orthodontic appliances during the
dental levelling and aligning phase: a 12-week study. Coatings.
2022;12(5):554. http://doi.org/10.3390/coatings12050554.
33. Kerosuo H, Moe G, Kleven E.
In vitro
release of nickel and
chromium from different types of simulated orthodontic
appliances. Angle Orthod. 1995;65(2):111-6. PMid:7785801.
Sarmad Sobhi Salih Al Qassar
(Corresponding address)
University of Mosul, College of Dentistry, Department of Pedodontics,
Orthodontics and Prevention, Mosul, Iraq.
Email: sarmadsobhi@uomosul.edu.iq
Date submitted: 2023 Dec 15
Accept submission: 2024 Apr 22