In general mouthwashes fall into two categories, cosmetic and therapeutic. Cosmetic mouthwashes are flavored and temporarily freshen your breath, while therapeutic rinses are used to treat conditions like bad breath, gum disease or tooth decay. Cosmetic mouthwashes freshen your breath for a few hours, but do not attempt to alter the bacteria or other microbes present in your mouth. Therapeutic mouth rinses contain active ingredients that target bacteria and microbes that contribute to oral health concerns. Active ingredients include agents like alcohol, chlorhexidine, cetylpyridinium chloride, essential oils, fluoride, peroxides and even sodium hypochlorite. These agents kill bacteria in your mouth and reduce the overall number of microbes contributing to bad breath or halitosis, periodontal or gum disease and gingivitis, and dental caries or tooth decay. Some mouthwashes may contain whitening agents or help in softening plaque to make it easier to remove. Most mouthwashes are used after brushing and flossing one or two times per day. Mouthwashes are popular and used daily by many people, but should never be used to replace good dental hygiene by regular toothbrushing and flossing.
Does mouthwash even help dental health?
Your mouth is full of microbes, part of the microbiome or biofilm that coats all of the surfaces of your mouth, your teeth, gums and cheeks and even your tongue. Most all of these microbes are considered healthy and are actually necessary to your health. These microbes help keep your teeth mineralized, aid in digestion and protect you from bad or disease causing microbes. By targeting levels of disease causing microbes in your mouth, many of the mouthwashes have been demonstrated in studies to reduce gingivitis and gum disease, bleeding gums and tartar or calculus build up. Other rinses are effective at helping control tooth decay by including xylitol and fluoride, even the mineral your enamel is made of. Mouthwashes are helpful in relieving symptoms like oral sores or dry and burning mouth syndrome. So yes, in short, therapeutic mouthwashes play an important role in long term oral health.
Safety concerns to be aware of when using mouthwash
A common question about mouthwashes is are they safe to use every day, and use for long periods of time? While there is no clear cut answer for all mouthwashes, there are a few concerns that you should be aware of. Generally the biggest concern in mouthwashes being used frequently and long term is if they contain alcohol. Studies in the past few years report an alarming relationship of alcohol based mouthwash and oral cancer risk. So it would be a good idea to use these types of mouthwashes for short limited periods, and look for alcohol free mouthwashes for everyday use. Other studies have raised concerns about chlorhexidine beyond the normal transient side effects of staining your teeth and altering your taste, reporting acute allergic responses and significantly raising your blood pressure.
Therapeutic mouthwash is available both over-the-counter and by prescription, depending on the formulation. For example, mouthwashes containing essential oils are available in stores, while those containing chlorhexidine are available only by prescription. You should always use prescription based mouthwashes by following the directions. But does that mean they are safe? In a recent study, researchers reported a link between diabetes and frequent use of mouthwash. The microbes and bacteria in your mouth form chemicals that play a role in your health, helping regulate blood pressure, insulin sensitivity and other important functions that relate to diabetes. In these studies they found that frequent mouthwash users were at a significantly higher risk of developing diabetes or having dangerous blood sugar spikes.
When it comes to tooth decay, the bacteria and microbes that mediate this disease are acidic, and many of the mouthwashes are also acidic, not really a good strategy to reduce these microbes. In our office we recommend the Carifree product line, with mouth rinses that are alkaline like your saliva, and contain xylitol, fluoride, and come is assorted flavors.