Mouthwash
Mouthwash, mouth rinse, oral rinse, or mouth bath[1] is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.
Usually mouthwashes are
Rinsing with water or mouthwash after brushing with a fluoride toothpaste can reduce the availability of salivary fluoride. This can lower the anti-cavity re-mineralization and antibacterial effects of fluoride.[5][6][7] Fluoridated mouthwash may mitigate this effect or in high concentrations increase available fluoride, but is not as cost-effective as leaving the fluoride toothpaste on the teeth after brushing.[5] A group of experts discussing post brushing rinsing in 2012 found that although there was clear guidance given in many public health advice publications to "spit, avoid rinsing with water/excessive rinsing with water"[8] they believed there was a limited evidence base for best practice.[9]
Use
Common use involves rinsing the mouth with about 20–50
Mouthwash should not be used immediately after brushing the teeth so as not to wash away the beneficial fluoride residue left from the toothpaste. Similarly, the mouth should not be rinsed out with water after brushing. Patients were told to "spit don't rinse" after toothbrushing as part of a National Health Service campaign in the UK.[13] A fluoride mouthrinse can be used at a different time of the day to brushing.[8]Gargling is where the head is tilted back, allowing the mouthwash to sit in the back of the mouth while exhaling, causing the liquid to bubble. Gargling is practiced in Japan for perceived prevention of viral infection. One commonly used way is with infusions or tea. In some cultures, gargling is usually done in private, typically in a bathroom at a sink so the liquid can be rinsed away.[14]
Dangerous misuse
If one drinks mouthwash, serious harm and even death can quickly result from the high alcohol content and other substances harmful to ingestion present in mouthwash.[15] It is a common cause of death among homeless people during winter months, because a person can feel warmer after drinking it.[16]
Effects
The most-commonly-used mouthwashes are commercial antiseptics, which are used at home as part of an
Minor and transient side effects of mouthwashes are very common, such as
Prescription mouthwashes are used prior to and after oral surgery procedures, such as
History
The first known references to mouth rinsing is in Ayurveda[27] for treatment of gingivitis.[28] Later, in the Greek and Roman periods, mouth rinsing following mechanical cleansing became common among the upper classes, and Hippocrates recommended a mixture of salt, alum, and vinegar.[29] The Jewish Talmud, dating back about 1,800 years, suggests a cure for gum ailments containing "dough water" and olive oil.[30] The ancient Chinese had also gargled salt water, tea and wine as a form of mouthwash after meals, due to the antiseptic properties of those liquids.[31]
Before Europeans came to the Americas, Native North American and Mesoamerican cultures used mouthwashes, often made from plants such as Coptis trifolia.[32] Peoples of the Americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as teething and mouth ulcers.[32]
That remained the state of affairs until the late 1960s when Harald Loe (at the time a professor at the Royal Dental College in Aarhus, Denmark) demonstrated that a chlorhexidine compound could prevent the build-up of dental plaque. The reason for chlorhexidine's effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours.[35]
Since then commercial interest in mouthwashes has been intense and several newer products claim effectiveness in reducing the build-up in dental plaque and the associated severity of gingivitis, in addition to fighting bad breath. Many of these solutions aim to control the volatile sulfur compound–creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste.[11][10][36][37][38] For example, the number of mouthwash variants in the United States of America has grown from 15 (1970) to 66 (1998) to 113 (2012).[39]
Research
Research in the field of
A clinical trial and laboratory studies have shown that alcohol-containing mouthwash could reduce the growth of Neisseria gonorrhoeae in the pharynx.[41][42] However, subsequent trials have found that there was no difference in gonorrhoea cases among men using daily mouthwash compared to those who did not use mouthwash for 12 weeks.[43][44]
Ingredients
Alcohol
Alcohol is added to mouthwash not to destroy bacteria but to act as a carrier agent for essential active ingredients such as menthol, eucalyptol and thymol, which help to penetrate plaque.
It is hypothesized that alcohol in mouthwashes acts as a carcinogen (cancer-inducing agent). Generally, there is no scientific consensus about this.[50][51][52] One review stated:
There is now sufficient evidence to accept the proposition that developing oral cancer is increased or contributed to by the use of alcohol-containing mouthwashes. Whilst many of these products may have been shown to be effective in penetrating oral microbial biofilms in vitro and reducing oral bacterial load, it would be wise to restrict their use to short-term therapeutic situations if needed. Perhaps the use of mouthwashes that do not contain alcohol may be equally effective. Further, mouthrinses should be prescribed by dentists, like any other medication. There may well be a reason for the use of alcohol-containing mouthrinses, but only for a particular situation and for a limited and controlled period of time. As such, patients should be provided with written instructions for mouthwash use, and mouthwash use should be restricted to adults for short durations and specific, clearly defined reasons. It is the opinion of the authors that, in light of the evidence currently available of the association of alcohol-containing mouthwashes with the development of oral cancer, it would be inadvisable for oral healthcare professionals to recommend the long-term use of alcohol-containing mouthwashes.[53]
The same researchers also state that the risk of acquiring oral cancer rises almost five times for users of alcohol-containing mouthwash who neither smoke nor drink (with a higher rate of increase for those who do).[54] In addition, the authors highlight side effects from several mainstream mouthwashes that included dental erosion and accidental poisoning of children.[55] The review garnered media attention[56] and conflicting opinions from other researchers. Yinka Ebo of Cancer Research UK disputed the findings, concluding that "there is still not enough evidence to suggest that using mouthwash that contains alcohol will increase the risk of mouth cancer".[57] Studies conducted in 1985,[58] 1995,[59] 2003,[50] and 2012[60] did not support an association between alcohol-containing mouth rinses and oral cancer. Andrew Penman, chief executive of The Cancer Council New South Wales, called for further research on the matter.[61] In a March 2009 brief, the American Dental Association said "the available evidence does not support a connection between oral cancer and alcohol-containing mouthrinse".[62] Many newer brands of mouthwash are alcohol-free, not just in response to consumer concerns about oral cancer, but also to cater for religious groups who abstain from alcohol consumption.
Benzydamine (analgesic)
In painful oral conditions such as aphthous stomatitis, analgesic mouthrinses (e.g. benzydamine mouthwash, or "Difflam") are sometimes used to ease pain, commonly used before meals to reduce discomfort while eating.
Benzoic acid
Benzoic acid acts as a buffer.[45]
Betamethasone
Betamethasone is sometimes used as an anti-inflammatory, corticosteroid mouthwash. It may be used for severe inflammatory conditions of the oral mucosa such as the severe forms of aphthous stomatitis.[63]: 209
Cetylpyridinium chloride (antiseptic, antimalodor)
Cetylpyridinium chloride containing mouthwash (e.g. 0.05%) is used in some specialized mouthwashes for halitosis.[64] Cetylpyridinium chloride mouthwash has less anti-plaque effect than chlorhexidine and may cause staining of teeth, or sometimes an oral burning sensation or ulceration.[65]
Chlorhexidine digluconate and hexetidine (antiseptic)
Chlorhexidine digluconate is a chemical antiseptic and is used in a 0.05–0.2% solution as a mouthwash.[66][11][45][67] There is no evidence to support that higher concentrations are more effective in controlling dental plaque and gingivitis.[68] A randomized clinical trial conducted in Rabat University in Morocco found better results in plaque inhibition when chlorohexidine with alcohol base 0.12% was used, when compared to an alcohol-free 0.1% chlorhexidine mouthrinse.[69]
Chlorhexidine has good substantivity (the ability of a mouthwash to bind to hard and soft tissues in the mouth).
Chlorhexidine mouthwash is known to have minor adverse effects.[72] Chlorhexidine binds to tannins, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth.[65] A systematic review of commercial chlorhexidine products with anti-discoloration systems (ADSs) found that the ADSs were able to reduce tooth staining without affecting the beneficial effects of chlorhexidine.[73] Chlorhexidine mouthwash can also cause taste disturbance or alteration.[68] Chlorhexidine is rarely associated with other issues like overgrowth of enterobacteria in persons with leukemia, desquamation, irritation, and stomatitis of oral mucosa,[65][72] salivary gland pain and swelling, and hypersensitivity reactions including anaphylaxis.[65]
Hexetidine[45] also has anti-plaque, analgesic, astringent and anti-malodor properties, but is considered an inferior alternative to chlorhexidine.[74]
Chlorine dioxide
In dilute concentrations, chlorine dioxide is an ingredient that acts as an antiseptic agent in some mouthwashes.[75][76]
Edible oils
In traditional
Oil pulling has received little study and there is little evidence to support claims made by the technique's advocates.[77] When compared with chlorhexidine in one small study, it was found to be less effective at reducing oral bacterial load,[80][81] and the other health claims of oil pulling have failed scientific verification[77] or have not been investigated.[77] There is a report of lipid pneumonia caused by accidental inhalation of the oil during oil pulling.[82][83][84]
The mouth is rinsed with approximately one tablespoon of oil for 10–20 minutes then spat out.[77][79] Sesame oil, coconut oil and ghee are traditionally used,[79] but newer oils such as sunflower oil are also used.[79]
Essential oils
Phenolic compounds and monoterpenes include essential oil constituents that have some antibacterial properties,[45][85] such as eucalyptol,[14] eugenol,[45] hinokitiol,[86] menthol,[87] phenol,[45] or thymol.[45]
Fluoride (anticavity)
Anti-cavity mouthwashes use sodium fluoride to protect against tooth decay.[89] Fluoride-containing mouthwashes are used as prevention for dental caries for individuals who are considered at higher risk for tooth decay, whether due to xerostomia related to salivary dysfunction or side effects of medication, to not drinking fluoridated water, or to being physically unable to care for their oral needs (brushing and flossing), and as treatment for those with dentinal hypersensitivity, gingival recession/ root exposure.
Flavoring agents and Xylitol
Xylitol rinses double as a bacterial inhibitor,[90] and have been used as substitute for alcohol to avoid dryness of mouth associated with alcohol.[2]
Hydrogen peroxide
Lactoperoxidase (saliva substitute)
Enzymes and non-enzymatic proteins, such as lactoperoxidase, lysozyme, and lactoferrin, have been used in mouthwashes (e.g., Biotene) to reduce levels of oral bacteria, and, hence, of the acids produced by these bacteria.[92]
Lidocaine/xylocaine
Oral lidocaine is useful for the treatment of mucositis symptoms (inflammation of mucous membranes) induced by radiation or chemotherapy.[93] There is evidence that lidocaine anesthetic mouthwash has the potential to be systemically absorbed, when it was tested in patients with oral mucositis who underwent a bone marrow transplant.[94]
Methyl salicylate
Methyl salicylate functions as an antiseptic, antiinflammatory, and analgesic agent, a flavoring, and a fragrance.[49] Methyl salicylate has some anti-plaque action, but less than chlorhexidine.[65] Methyl salicylate does not stain teeth.[65]
Nystatin
Potassium oxalate
A randomized clinical trial found promising results in controlling and reducing dentine hypersensitivity when potassium oxalate mouthwash was used in conjugation with toothbrushing.[96]
Povidone/iodine (PVP-I)
A 2005 study found that gargling three times a day with simple water or with a
PVP-I in general covers "a wider virucidal spectrum, covering both enveloped and nonenveloped viruses, than the other commercially available antiseptics",
Sanguinarine
Sodium bicarbonate (baking soda)
Sodium bicarbonate is sometimes combined with salt to make a simple homemade mouthwash, indicated for any of the reasons that a saltwater mouthwash might be used. Pre-mixed mouthwashes of 1% sodium bicarbonate and 1.5% sodium chloride in aqueous solution are marketed, although pharmacists will easily be able to produce such a formulation from the base ingredients when required. Sodium bicarbonate mouthwash is sometimes used to remove viscous saliva and to aid visualization of the oral tissues during examination of the mouth.[63]: 4
Sodium chloride (salt)
Saline has a mechanical cleansing action and an antiseptic action, as it is a
Saltwater mouthwashes are also routinely used after oral surgery, to keep food debris out of healing wounds and to prevent infection. Some oral surgeons consider saltwater mouthwashes the mainstay of wound cleanliness after surgery.[106] In dental extractions, hot saltwater mouthbaths should start about 24 hours after a dental extraction.[106] The term mouth bath implies that the liquid is passively held in the mouth, rather than vigorously swilled around (which could dislodge a blood clot). Once the blood clot has stabilized, the mouthwash can be used more vigorously.[106] These mouthwashes tend to be advised for use about 6 times per day, especially after meals (to remove food from the socket).[106]
Sodium lauryl sulfate (foaming agent)
Sucralfate
Tetracycline (antibiotic)
Tranexamic acid
A 4.8% tranexamic acid solution is sometimes used as an antifibrinolytic mouthwash to prevent bleeding during and after oral surgery in persons with coagulopathies (clotting disorders) or who are taking anticoagulants (blood thinners such as warfarin).[110]: 473
Triclosan
Zinc
See also
References
- ^ S2CID 3995032.
- ^ a b c Reddy S (12 January 2015). "There is More to Your Mouthwash Than a Minty Taste". The Wall Street Journal.
- ^ Tufts University (23 March 2015). "Should I use mouthwash?". Medical Xpress.
- ^ "Learn More About Mouthrinses". American Dental Association. Archived from the original on 11 October 2014.
- ^ PMID 21591596.
- PMID 1423447.
- S2CID 31708112.
- ^ a b "Delivering better oral health: an evidence-based toolkit for prevention" (PDF) (3rd ed.). Public Health England, Department of Health. March 2017.
- PMID 22498529.
- ^ PMID 8794967.
- ^ PMID 1552460.
- PMID 2076696.
- ^ "Oral health promotion messages: "Spit don't rinse"".
- ^ a b Pubchem. "Eucalyptol | C10H18O - PubChem". pubchem.ncbi.nlm.nih.gov. Retrieved 1 December 2016.
- ^ "What Are the Dangers of Drinking Mouthwash? | Laguna Hospital". Laguna Treatment Hospital. Retrieved 22 January 2023.
- ^ "The People Giving Alcoholics Beer to Get Them to Stop Drinking Mouthwash". www.vice.com. 16 March 2016. Retrieved 22 January 2023.
- S2CID 9347082.
- PMID 2366142.
- ^ "Listerine no replacement for flossing?". NBC News. 7 January 2005. Retrieved 14 October 2013.
- ^ Jake (1 April 2015). "Should I use Mouthwash".
- .
- ISBN 9780191628733.
- ^ Philipp J (16 July 2015). "Medications, diseases among factors for dry mouth". azcentral.com.
- ^ a b c Tom WC (3 July 2007). "Magic Mouthwash" (PDF). Pharmacist's Letter/Prescriber's Letter. 23 (230703): 1–5. Archived (PDF) from the original on 9 October 2022. Retrieved 9 December 2009.
- ^ Otterholt R. "Magic Mouthwash". Retrieved 5 December 2009.
- ^ "Magic Mouthwash". Pharmacist's Letter. Therapeutic Research Center. Retrieved 5 December 2009.
- ^ PMID 21760690.
- hdl:2263/14207.
- PMID 9643227.
- PMID 12389360.
- ^ "Getting to the roots of dentistry in ancient China". South China Morning Post. 12 December 2019. Retrieved 18 May 2022.
- ^ ISBN 978-1-4381-0990-9.
- ISBN 978-0-19-157850-2.
- ^ Lingner-Archiv (German)
- PMID 4575037.
- PMID 8133414.
- PMID 12013345.
- PMID 1499240.
- .
- ^ Greenwood V (2 February 2012). "Hacking the Microbiome for Fun and Profit: Can Killing Just One Mouth Bacterium Stop Cavities?". Discover Magazine. Retrieved 31 October 2012.
- S2CID 3479567.
- PMID 35579459.
- S2CID 232142254.
- S2CID 232142467.
- ^ ISBN 9780313325793
- ^ Lachenmeier DW, Keck-Wilhelm A, Sauermann A, Mildau G (2008). "Safety Assessment of Alcohol-Containing Mouthwashes and Oral Rinses". SOFW Journal. 134 (10): 70–8.
- ISSN 0361-4387.
- ^ "Dangers of Drinking Mouthwash | Alcohol Rehab Advice". alcoholrehabadvice.com. Retrieved 1 December 2016.
- ^ a b "Behind the label: Listerine teeth and gum defence". The Ecologist. Retrieved 1 December 2016.
- ^ PMID 12956348.
- PMID 14990877.
- PMID 19014531.
- PMID 19133944.
- .
- PMID 9348605.
- ^ Weaver C (11 January 2009). "Mouthwash linked to cancer". Daily Telegraph. News Ltd. Retrieved 11 January 2009.
- ^ Ebo Y (14 January 2009). "Does mouthwash cause cancer?". Cancer Research UK. Retrieved 20 June 2009.
- PMID 3859544.
- S2CID 20725009.
- PMID 22742785.
- ^ Weaver C (11 January 2009). "Mouthwash linked to cancer". The Daily Telegraph. Retrieved 12 January 2009.
- ^ Science brief on alcohol-containing mouthrinses and oral cancer (PDF), American Dental Association, March 2009, archived from the original (PDF) on 19 March 2012
- ^ ISBN 978-0443071065.
- PMID 31825092.
- ^ ISBN 9780702049484.
- PMID 35409608.
- PMID 17391828.
- ^ PMID 28362061.
- PMID 23229237.
- PMID 23579302.
- ^ a b c d e f g h i j k "Mouthwashes, gargles, and dentifrices". British National Formulary March 2014. BMJ Group and the Royal Pharmaceutical Society of Great Britain 2014.
- ^ PMID 36156769.
- PMID 31054209.
- ^ "Effect of hexetidine mouthwash - systematic review". Archived from the original on 4 March 2016. Retrieved 12 October 2015.
- PMID 32410557.
- PMID 36634129.
- ^ a b c d e Beck J (19 March 2014). "Swishing With Oil for Oral Health: Not Recommended". The Atlantic.
- Fox News Channel. Retrieved 24 March 2014.
- ^ a b c d Butler B (20 March 2014). "Everyone is talking about 'oil pulling.' But does this health practice actually work?". The Washington Post. Washington State, U.S.A.
- PMID 19336860.
- ^ "A second look at oil pulling as dental home care therapy". 16 May 2014.
- PMID 24429325.
- ^ Novella S (12 March 2014). "Oil Pulling Your Leg". Science Based Medicine.
- ^ Arbogast S (21 May 2014). "Does 'Oil-Pulling' Actually Have Health Benefits?". CBS Pittsburgh.
- ^ PMID 17608576.
- PMID 23969334.
- PMID 30166864.
- PMID 21043801.
- PMID 27472005.
- S2CID 46789673.
- PMID 379049.
- ISBN 978-0-8247-7298-7.
- PMID 12547053.
- PMID 10235370.
- ^ "NYSTATIN- nystatin suspension". Qualitest Pharmaceuticals. Retrieved 17 March 2018.
- PMID 29728195.
- PMID 16242593.
- Japan Times, 15 December 2009
- PMID 9403252.
- PMID 32608097.
- PMID 33706836.
- ^ "COLCORONA COVID19 Clinical Trial". www.colcorona.net. Retrieved 11 December 2022.
- ^ Leukoplakia Archived 3 July 2013 at the Wayback Machine, (pdf format) hosted by the American Academy of Oral and Maxillofacial Pathology. Page accessed on 19 December 2006.
- ISBN 978-0721690032.
- ISBN 9780853696278.
- ^ ISBN 978-0443070839.
- PMID 11905111.
- ^ PMID 23832272.
- PMID 28411006.
- ISBN 978-1550091861.
- ^ "Products That Contain Triclosan". drbenkim.com.
- ^ "New studies show dangers of Triclosan in Toothpastes and Mouthwash". New York Orthodontists. 15 August 2012.
- ^ "FAMILY GENTLE DENTAL CARE - Mouth Rinses". 14 September 2022.
- ^ McNamara M. "Zinc for Bad Breath (Halitosis)". LIVESTRONG.COM. Retrieved 1 December 2016.