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Slipping endlessly through the crack between oral and respiratory medicine, the humble mouthwash has slowly won more respect among savvy practitioners and patients as a solution for a range of indications.1 In Japan many millions of people gargle three times a day with green tea extracts or other mouthwashes to ward off upper respiratory tract infections (URTIs), and Japanese clinical studies have confirmed the value of this approach (Furushima D et al. Molecules. 2018 Jul 20;23(7)). Worldwide, medical practitioners recommend gargling to patients.  Many people on their own have decided that gargling makes sense, while millions swish with mouthwash to protect teeth and gums as well as to combat halitosis.

Still, for curious reasons, this formidable method of suppressing infections remains in medical limbo. Not because there is no need. The average American suffers 2.5 episodes of URTI per year, with high costs for treatment, lost days of work, and morbidity. URTIs also exacerbate asthma, and they can enter the lungs and prove fatal.  As a generic adjuvant therapy, gargling can help reduce viral load during epidemics while remaining hard for mutating viruses to outflank.

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Here are three overlooked methods of treating respiratory and disseminated infections that resemble the one caused by the COVID-19 virus. 

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Studies by Japanese researchers show that gargling is protective against respiratory infections.  Here is a letter that lays out the case for gargling against COVID-19.

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Even though much inhaled COVID-19 virus immediately penetrates into the lungs, some remains in the throat where it replicates to very high numbers–for instance, a peak at 711,000,000 RNA copies per throat swab day 4 (Wölfel R et al.  Nature 2020;Apr 1).  According to a Reinforcement Model of COVID-19 infections, many of these replicates descend into the lungs, where they furnish a stream of reinforcements that cumulatively outweigh the replication of the initial penetrating dose.  Hence treating the throat with gargling seems highly desirable.

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Concerned over shortages of face masks, U.S. medical authorities initially discouraged the use of face masks by the public.  But a good deal of evidence (Jefferson T 2007) shows that face masks reduced the risk of infection by 68% in SARS, an analogue of COVID-19.  This suggests that wearing face masks can go far toward slowing the spread of the pandemic.  Therefore, we need to find a way to provide enough of them not just to protect medical personnel but also to protect the public.  Reusing them seems a very attractive strategy.

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