Stabilized Oxygen by World Nutrition Incorporated

POSSIBLY EFFECTIVE

• Halitosis. Small clinical studies show that chlorine dioxide 0.1% mouthwash improves halitosis. Details: Multiple small clinical studies show that swishing and spitting chlorine dioxide mouthwash can reduce halitosis. Preliminary clinical research shows that rinsing with a specific chlorine dioxide 0.1% mouthwash (RetarDEX or UltraDEX, Periproducts Ltd.) for 30 seconds reduces exhalation of volatile sulfur compounds, which are associated with halitosis, and improves subjective measures of odor pleasantness and odor intensity when compared with a water control or baseline. This improvement was notable after 2 hours and continued for up to 8 hours post-rinse (102813,102814,102816,108749). Additional preliminary clinical research shows that chlorine dioxide mouthwash is similarly effective to chlorhexidine mouthwash and zinc chloride mouthwash for improving halitosis (102812).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Dental plaque. It is unclear if chlorine dioxide mouthwash reduces dental plaque. Details: Preliminary clinical research in healthy volunteers shows that rinsing with a chlorine dioxide 0.01% mouthwash (Quist-forte, De Witte Tanden Winkel) twice daily for 3 days is less effective for inhibiting plaque accumulation than chlorhexidine mouthwash (102815). A meta-analysis of 5 clinical trials conducted in Asia shows that chlorine dioxide mouthwash has similar effects on plaque index, gingival index, and oral bacterial counts when compared with chlorhexidine, aloe vera, and herbal mouthwashes (108750).
• Denture stomatitis. It is unclear if chlorine dioxide mouthwash improves denture stomatitis. Details: Preliminary clinical research in adults with complete dentures and chronic atrophic candidiasis shows that rinsing with a chlorine dioxide 0.8% mouthwash (DioxiDent) twice daily for 10 days, while soaking dentures in this same solution overnight, improves the clinical appearance of candidiasis and the total microbial count when compared with baseline. Total resolution of candidiasis occurred in 83% of patients after 10 days of treatment (102817). The validity of this finding is limited by the lack of a comparator group.
• Wound healing. It is unclear if irrigation with a dilute chlorine dioxide solution is beneficial for wound healing. Details: Clinical research in adults with simple, uncomplicated lacerations shows that using 100-200 mL of a wound irrigation containing 0.005% chlorine dioxide does not alter the rate of wound infections, wound dehiscence, or adverse reactions when compared with normal saline irrigation (102818). More evidence is needed to rate chlorine dioxide for these uses.

(Read more about CHLORINE DIOXIDE)

POSSIBLY SAFE ...when solutions containing 0. 01% to 0.8% chlorine dioxide are used topically as mouthwash. The solution has been swished around the mouth for 30-60 seconds and spit out, once or twice daily, for up to 10 days with apparent safety (102812,102813,102814,102815,102816,102817). ...when a 0.005% solution is used topically for wound irrigation. In one clinical study, a single irrigation with 100-200 mL was used without reported adverse effects (102818).

LIKELY UNSAFE ...when used orally for medicinal purposes. Although chlorine dioxide is used in public water treatment facilities as a disinfectant, the US Environmental Protection Agency (EPA) limits the maximum concentration of chlorine dioxide and chlorite in drinking water to a level that has demonstrated safety with regular use (102803,102805,102811). This safe level is 0.8 mg chlorine dioxide per liter (0.00008%) or 1 mg chlorite per liter (0.0001%). Higher levels of chlorine dioxide can irritate the mouth, esophagus, and stomach (102811). Chlorine dioxide supplements typically contain 28% sodium chlorite, which can provide 3-8 mg of chlorine dioxide per drop when mixed with citric acid as directed. At these doses, chlorine dioxide has been reported to cause serious complications, including severe vomiting and diarrhea, life-threatening low blood pressure, hemolysis, and acute liver failure (102807,102808,102810). ...when inhaled. Occupational and accidental exposure to chlorine dioxide gas can cause lung irritation and long-term respiratory complications (102806,102811).

CHILDREN: LIKELY UNSAFE
when used orally for medicinal purposes. Chlorine dioxide supplement products typically contain 28% sodium chlorite, which can provide 3-8 mg of chlorine dioxide per drop when mixed with citric acid as directed. At these doses, chlorine dioxide has been reported to cause serious complications, including severe vomiting and diarrhea, life-threatening low blood pressure, hemolysis, and acute liver failure (102807,102808,102810). There is insufficient reliable information available about the safety of chlorine dioxide when used topically; avoid using.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally for medicinal purposes. Chlorine dioxide supplement products typically contain 28% sodium chlorite, which can provide 3-8 mg of chlorine dioxide per drop when mixed with citric acid as directed. Chlorine dioxide has been reported to cause serious complications, including severe vomiting and diarrhea, life-threatening low blood pressure, hemolysis, and acute liver failure (102807,102808,102810). There is insufficient reliable information available about the safety of chlorine dioxide when used topically; avoid using.

(Read more about CHLORINE DIOXIDE)

(Read more about CHLORINE DIOXIDE)

General ...Orally, chlorine dioxide supplements are generally considered unsafe and can cause serious adverse effects. Topically, adequately diluted chlorine dioxide seems to be well tolerated.
Most Common Adverse Effects:
Orally: When consumed in amounts commonly found in supplements, chlorine dioxide can cause diarrhea, irritation of the mouth, esophagus, and stomach, hemolysis, hypotension, liver failure, and vomiting.

Cardiovascular ...Orally, consuming large quantities of chlorine dioxide has been reported to cause life-threatening hypotension (102810).

Dermatologic ...Case reports have described toxic irritant dermatitis associated with topical exposure to chlorine dioxide (108747).

Gastrointestinal ...Orally, consuming chlorine dioxide in quantities exceeding the maximum allowable concentration can irritate the mouth, esophagus, and stomach (102811). Consuming large quantities of chlorine dioxide has been reported to cause severe vomiting and diarrhea (102810).

Hematologic ...Orally, chlorine dioxide has been reported to cause hemolysis. In one case series, two healthy adults presented with reddish urine, jaundice, tachycardia, and tachypnea three days after ingesting 100 mL each of chlorine dioxide 2% solution. Hemolysis resolved after 7 days (102807). Patients with G6PD deficiency are at increased risk for hemolysis with chlorine dioxide. There are multiple reports of patients with G6PD deficiency experiencing hemolysis after consuming chlorine dioxide as Miracle Mineral Solution (MMS) (102809,102820). There is also a case report of a 55-year-old male who developed disseminated intravascular coagulation and acute kidney injury requiring hemodialysis after taking an unknown dose of chlorine dioxide orally daily for 5 days for prophylaxis of COVID-19 (108746). Other case reports have described methemoglobinemia and hemolytic anemia (108747).

Hepatic ...Orally, consuming large quantities of chlorine dioxide has been reported to cause acute liver failure (102810).

Pulmonary/Respiratory ...Occupational and accidental inhalation of chlorine dioxide gas can cause lung irritation and long-term respiratory complications (102806,102811).

Renal ...A 55-year-old male who took an unknown dose of chlorine dioxide orally daily for 5 days as prophylaxis for COVID-19, presented with nausea and vomiting, dehydration, altered mental status, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis (108746).

Other ...Orally, chlorine dioxide solution in doses of up to 10 mL diluted in 1 liter of water, consumed over 8 hours daily for 9 months, has resulted in fatal toxicity. A 65-year-old male presented with nausea and vomiting, melena, drowsiness, hypotension, tachycardia, electrolyte imbalance, peritoneal irritation, absent peristalsis, abdominal distension due to fluid accumulation, and perforation of the jejunum. After gastrointestinal surgery, the patient developed septic shock with multiple organ failure, leading to death (108748).
Orally, chlorine dioxide has been reported to cause Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis) in one patient. A 41-year-old female presented with fever and lymphadenopathy after consuming "one glassful" of chlorine dioxide as Miracle Mineral Solution (MMS). The disease may have been triggered by oxidative injury from chlorine dioxide, leading to an inflammatory response (102808).

(Read more about CHLORINE DIOXIDE)