Mouthwash

Mouthwash or mouth rinse is a product used to enhance oral hygiene. Some manufacturers of mouthwash claim that antiseptic and anti-plaque mouth rinse kill the bacterial plaque causing caries, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both brushing and flossing.^[1][2][3] As per the American Dental Association, regular brushing and proper flossing are enough in most cases although the ADA has placed its Seal of Approval on many alcohol containing mouthwashes (in addition to regular dental check-ups).^[4] However, one Australian researcher believes mouthwash should only be used as a short-term solution.^[5]

Mouthwash may also be used to help remove mucus and food particles deeper down in the throat. Alcoholic and strongly flavored mouthwash may cause coughing when used for this purpose.

History

The first known references to mouth rinsing is in Ayurveda and Chinese medicine, about 2700 BC, for treatment of gingivitis. Later, in the Greek and Roman periods, mouthrinsing following mechanical cleansing became common among the upper classes, and Hippocrates recommended a mixture of salt, alum, and vinegar.^[6] The Jewish Talmud, dating back about 1800 years, suggests a cure for gum ailments containing "dough water" and olive oil.^[7]

Anton van Leeuwenhoek, the famous 17th century microscopist, discovered living organisms (living, because they were motile) in deposits on the teeth (what we now call dental plaque). He also found organisms in water from the canal next to his home in Delft. He experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. Next he tried rinsing the mouth of himself and somebody else with a rather foul mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. He concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms.

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 effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours.^[8]

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 (inflammation of the gums), in addition to fighting bad breath. Many of these solutions aim to control the Volatile Sulfur Compound (VSC)-creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste.^[9][10]

Usage

Common use involves rinsing the mouth with about 20ml (2/3 fl oz) of mouthwash two times a day after brushing. The wash is typically swished or gargled for about half a minute and then spat out. In some brands, the expectorate is stained, so that one can see the bacteria and debris.^[11][12] It is probably advisable to use mouthwash at least an hour after brushing with toothpaste when the toothpaste contains sodium lauryl sulfate, since the anionic compounds in the SLS toothpaste can deactivate cationic agents present in the mouthrinse.^[13]

Active ingredients

OTC mouthwash containing chlorhexidine from Mexico.

Active ingredients in commercial brands of mouthwash can include thymol, eucalyptol,^[14] hexetidine, methyl salicylate, menthol, chlorhexidine gluconate,^[12][15] benzalkonium chloride, cetylpyridinium chloride,^[16] methylparaben, hydrogen peroxide, domiphen bromide and sometimes fluoride,^[17] enzymes and calcium. Ingredients also include water, sweeteners such as sorbitol, sucralose, sodium saccharin, and xylitol (which doubles as a bacterial inhibitor).^[18]

Sometimes a significant amount of alcohol (up to 27% vol) is added,^[19] as a carrier for the flavor, to provide "bite",^[20] but at these levels it has no antibacterial effect.^[21] Because of the alcohol content, it is possible to fail a breathalyzer test after rinsing although breath alcohol levels return to normal after 10mins; in addition, alcohol is a drying agent and may worsen chronic bad breath. Furthermore, it is possible for alcoholics to abuse mouthwash. Recently, the possibility that the alcohol used in mouthrinses acts as a carcinogen was raised, but there is to date no scientific consensus on the issue.^[22][23][24] Commercial mouthwashes usually contain a preservative such as sodium benzoate to preserve freshness once the container has been opened. Many newer brands are alcohol-free and contain odor-elimination agents such as oxidizers, as well as odor-preventing agents such as zinc ion to keep future bad breath from developing.

Alternative mouthwash ingredients

A salt mouthwash is a home treatment for mouth infections and/or injuries, or post extraction, and is made by dissolving a teaspoon of salt in a cup of warm water.

Recently, the use of herbal mouthwashes such as persica is increasing, due to the perceived discoloration effects and unpleasant taste of Chlorhexidine.^[25] Research has also indicated that sesame and sunflower oils as cheap alternatives compared to chlorhexidine.^[26][27]

Other products like hydrogen peroxide have been tried out as stand-alone^[28] and in combination^[29] with chlorhexidine, due to some inconsistent results regarding its usefulness.

Another study has demonstrated that daily use of an alum-containing mouthrinse was safe and produced a significant effect on plaque that supplemented the benefits of daily toothbrushing.^[30]

However, many studies acknowledge that Chlorhexidine remains the most effective mouthwash when used on an already clean tooth surface or immediately after surgery. As chlorhexidine has difficulty in penetrating plaque biofilm, other mouthwashes may be more effective where pre-existing plaque is present. One side-effect as noted on the label is the staining of the teeth will occur for prolong usage.

Compounding

Custom mouthwashes, called "magic mouthwash" may be prescribed by dentists for post oral surgeries. Variations are common, and some are done with over-the-counter products.

Health risks

In January 2009 a report published in the Dental Journal of Australia concluded there is "sufficient evidence" that "alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer".^[31] However, this claim has been disputed by Yinka Ebo of Cancer Research UK, concluding that "there is still not enough evidence to suggest that using mouthwash that contains alcohol will increase the risk of mouth cancer".^[32] More recent studies have shown that the risk of acquiring cancer rises almost five times in alcohol-containing mouthwash users who neither smoke nor drink (with a higher rate of increase in those who do).^[33] The same study also highlighted side effects from several mainstream mouthwashes that included dental erosion and accidental poisoning of children.

Brands

• Tantum verde
• Listerine
• Astring-O-Sol
• Scope (mouthwash)
• Dentyl pH
• Sarakan
• SmartMouth
• Oral-B ^[34]
• Colgate ^[35]

See also

• Kunzea ericoides
• Leptospermum scoparium
• Magic mouthwash
• Mucositis
• Sodium fluoride
• Sodium monofluorophosphate ^[36]

Notes and references

External links

• Article on Bad-Breath Prevention Products – from MSNBC
• Clinical Study on Anti-Oral Malodor Mouthrinse – from Unbound Medline

Routes of administration / Dosage forms Oral Digestive tract (enteral) Solids Pill · Tablet · Capsule · Osmotic controlled release capsule (OROS) · Softgel Liquids Solution · Suspension · Emulsion · Syrup · Elixir · Tincture · Hydrogel Buccal / Sublabial / Sublingual Solids Orally Disintegrating Tablet (ODT) · Film · Lollipop · Lozenges · Chewing gum Liquids Mouthwash · Toothpaste · Ointment · Oral spray Respiratory tract Solids Smoking device · Dry Powder Inhaler (DPI) Liquids pressurized Metered Dose Inhaler (pMDI) · Nebulizer · Vaporizer Gas Oxygen mask · Oxygen concentrator · Anaesthetic machine · Relative analgesia machine Ocular / Otologic / Nasal Nasal spray · Ear drops · Eye drops · Ointment · Hydrogel · Nanosphere suspension · Mucoadhesive microdisc (microsphere tablet) Urogenital Ointment · Pessary (vaginal suppository) · Vaginal ring · Vaginal douche · Intrauterine device (IUD) · Extra-amniotic infusion · Intravesical infusion Rectal (enteral) Ointment · Suppository · Enema (Solution · Hydrogel) · Murphy drip · Nutrient enema Dermal Ointment · Liniment · Paste · Film · Hydrogel · Liposomes · Transfersome vesicals · Cream · Lotion · Lip balm · Medicated shampoo · Dermal patch · Transdermal patch · Transdermal spray · Jet injector Injection / Infusion (into tissue/blood) Skin Intradermal · Subcutaneous · Transdermal implant Organs Intracavernous · Intravitreal · Transscleral Central nervous system Intracerebral · Intrathecal · Epidural Circulatory / Musculoskeletal Intravenous · Intracardiac · Intramuscular · Intraosseous · Intraperitoneal · Nanocell injection Additional explanation: Mucous membranes are used by the human body to absorb the dosage for all routes of administration, except for "Dermal" and "Injection/Infusion". Administration routes can also be grouped as Topical (local effect) or Systemic (defined as Enteral = Digestive tract/Rectal, or Parenteral = All other routes).