The Novel Coronavirus: An Alert for Pacifiers’ Disinfection

The literature search was conducted on MEDLINE/PubMed, Scielo, Lilacs, Web of Science, and Scopus databases to find all relevant articles published over the past 20 years, based on PRISMA guidelines. Two reviewers extracted data independently by using a standardized form. The following factors were recorded: country of study, type of study, pacifier material, sample number, microorganisms analyzed, decontamination methods used, method accessibility and results found.

Results:

A total of 121 articles were obtained from all databases. The selected documents underwent a final screening, resulting in 8 articles. The method of disinfection analyzed by the literature were: 3.5% neutral detergent, apple cider vinegar 70% spray, boiling water during 15 minutes, sodium hypochlorite 2.5, hydrogen peroxide 70% spray, chlorhexidine 0.12%, Brushtox^®, sterile water and microwave.

Conclusion:

Because of the broad methods for pacifier disinfection and different levels of accessibility to disinfectant agents, the pacifier consensus for decontamination remains unclear. Although the disinfection methods are diverse, the methods suggested to its disinfection were identified and described in this article.

Keywords:
Pacifiers; Sucking Behavior; Environmental Microbiology; Decontamination

Author (Year)	Country	Type of Study	Pacifier	N	Microorganisms	Decontamination Type				Microbiological Analysis	Conclusion
Lopes et al. (2019) ^[⁸[8] Lopes DF, Fernandes RT, Medeiros YL, Apolônio ACM. Disinfection of pacifier focusing on Candida albicans. Clin Pediatr 2019; 58(14):1540-3. https://doi.org/10.1177/0009922819875541 https://doi.org/10.1177/0009922819875541... ^]	Brazil	In Vitro	Silicon	24	C. Albicans	Sterile water	Neutral detergent	Boiling water	Sodium hypochlorite 2.5%	Viable Count	Running water (1st step) can be considered only if others are not possible.

Pedroso et al. (2018) ^[¹³[13] Pedroso JF, Sangalli J, Brighenti FL, Tanaka MH, Koga-Ito CY. Control of bacterial biofilms formed on pacifiers by antimicrobial solutions in spray. Int J Paediatr Dent; 28(6):578-86. https://doi.org/10.1111/ipd.12413 https://doi.org/10.1111/ipd.12413... ^]	Brazil	In Vitro	Silicon	24	S. mutans, S. pyogenes, S. aureus and E. coli	Apple Cider Vinegar (70%)	Hydrogen Peroxide (70%)	-	-	Viable Count	70% hydrogen peroxide has been shown to be a good alternative to chlorhexidine digluconate.

Molaudzi and Molepo (2017) ^[¹¹[11] Molaudzi M, Molepo J. In vitro efficacy of different solutions in the disinfection of silicone pacifiers. SADJ 2017; 72(4):158-61.^]	South Africa	In Vitro	Silicon	160	S. epidermidis and C. parapsilosis.	Chlorhexidine 0.12% (GUM Paraoex)	Brushtox^®	Apple Cider Vinegar (5%)	Sterile water	Viable Count	Brushtox^® and chlorhexidine were efficient for the elimination of C. parapsilosis.

Nelson-Filho et al. (2015) ^[¹⁰[10] Nelson-Filho P, Louvain MC, Macari S, Lucisano MP, Silva RAB, Queiroz AM, et al. Microbial contamination and disinfection methods of pacifiers. J Appl Oral Sci 2015; 23(5):523-8. https://doi.org/10.1590/1678-775720150244 https://doi.org/10.1590/1678-77572015024... ^]	Brazil	Cross-Sectional / In Vitro	Latex	112	S. mutans	Chlorhexidine 0.12% (Periogard)	Brushtox^®	Sterile water	Boiling water	SEM	Boiling water for 15 minutes or 0.12% chlorhexidine showed the best result.

Molepo and Molaudzi (2015) ^[⁹[9] Molepo J, Molaudzi M. Contamination and disinfection of silicone pacifiers: an in vitro study. SADJ 2015; 70(8):351-3.^]	South Africa	In Vitro	Silicon	72	C. Albicans and S. mutans	Chlorhexidine 0.12% (GUM Paroex)	Microwave 750W	Sterile water	-	Viable Count	Microwave better at eliminating C. albicans / Microwave and 0.12% Chlorhexidine equally at eliminating S. mutans.

Nelson-Filho et al. (2011) ^[³[3] Nelson-Filho P, da Silva LA, da Silva RA, da Silva LL, Ferreira PD, Ito IY. Efficacy of microwaves and chlorhexidine on the disinfection of pacifiers and toothbrushes: an in vitro study. Pediatr Dent 2011; 33(10):10-3.^]	Brazil	In Vitro	Silicon	60	S. mutans	Chlorhexidine 0.12% (Periogard)	Microwave	Sterile water	-	SEM	Chlorhexidine spray (0.12%) and 7 min microwave irradiation were effective.

Silva et al. (2008) ^[¹⁵[15] Silva RC, Spolidorio DMP, Zuanon ACC, Godoi RHM. Pacifier disinfection procedure: superficial morphological aspects and microorganisms colonization. RSBO 2008; 5:30-3.^]	Brazil	In Vitro	Latex / Silicon	40	C. Albicans and S. mutans	Boiling water	Microwave	-	-	SEM	Five minutes of boiling water or microwave energy was sufficient to observe disinfection.

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[1] Author to whom correspondence should be addressed: Ana Carolina Morais Apolônio, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil. 36036-900. Phone: +55 32 21023213. E-mail: carolina.apolonio@ufjf.edu.br.