Mouthwash
Encyclopedia
Mouthwash or mouth rinse is a product used to enhance oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...

. Some manufacturers of mouthwash claim that antiseptic
Antiseptic
Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction...

 and anti-plaque mouth rinse kill the bacterial plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...

 causing cavities
Dental caries
Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...

, gingivitis
Gingivitis
Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

, and bad breath. Anti-cavity mouth rinse uses fluoride
Fluoride
Fluoride is the anion F−, the reduced form of fluorine when as an ion and when bonded to another element. Both organofluorine compounds and inorganic fluorine containing compounds are called fluorides. Fluoride, like other halides, is a monovalent ion . Its compounds often have properties that are...

 to protect against tooth decay. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both brushing
Toothbrush
The toothbrush is an oral hygiene instrument used to clean the teeth and gums that consists of a head of tightly clustered bristles mounted on a handle, which facilitates the cleansing of hard-to-reach areas of the mouth. Toothpaste, which often contains fluoride, is commonly used in conjunction...

 and flossing. As per the American Dental Association
American Dental Association
The American Dental Association is an American professional association established in 1859 which has more than 155,000 members. Based in Chicago, the ADA is the world's largest and oldest national dental association and promotes good oral health to the public while representing the dental...

, regular brushing and proper flossing are enough in most cases although the ADA has placed its Seal of Approval on many mouthwashes containing alcohol (in addition to regular dental check-ups).

Mouthwash may also be used to help remove mucus
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...

 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
Ayurveda
Ayurveda or ayurvedic medicine is a system of traditional medicine native to India and a form of alternative medicine. In Sanskrit, words , meaning "longevity", and , meaning "knowledge" or "science". The earliest literature on Indian medical practice appeared during the Vedic period in India,...

 and Chinese medicine, about 2700 BC, for treatment of gingivitis
Gingivitis
Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

. Later, in the Greek
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...

 and Roman
Ancient Rome
Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....

 periods, mouth rinsing following mechanical cleansing became common among the upper classes, and Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...

 recommended a mixture of salt, alum
Alum
Alum is both a specific chemical compound and a class of chemical compounds. The specific compound is the hydrated potassium aluminium sulfate with the formula KAl2.12H2O. The wider class of compounds known as alums have the related empirical formula, AB2.12H2O.-Chemical properties:Alums are...

, and vinegar. The Jewish Talmud
Talmud
The Talmud is a central text of mainstream Judaism. It takes the form of a record of rabbinic discussions pertaining to Jewish law, ethics, philosophy, customs and history....

, dating back about 1800 years, suggests a cure for gum ailments containing "dough water" and olive oil.

Anton van Leeuwenhoek
Anton van Leeuwenhoek
Antonie Philips van Leeuwenhoek was a Dutch tradesman and scientist from Delft, Netherlands. He is commonly known as "the Father of Microbiology", and considered to be the first microbiologist...

, the famous 17th century microscopist, discovered living organisms (living, because they were motile) in deposits on the teeth (what we now call dental plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...

). 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 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
Aarhus
Aarhus or Århus is the second-largest city in Denmark. The principal port of Denmark, Aarhus is on the east side of the peninsula of Jutland in the geographical center of Denmark...

, Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. 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.

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.

Usage

Common use involves rinsing the mouth with about 20ml (2/3 fl oz
Fluid ounce
A fluid ounce is a unit of volume equal to about 28.4 mL in the imperial system or about 29.6 mL in the US system. The fluid ounce is distinct from the ounce, which measures mass...

) of mouthwash two times a day after brushing. The wash is typically swished or gargled
Gargling
Gargling is the act in which one bubbles a liquid in one's mouth. It usually requires that the head be tilted back, allowing a mouthful of liquid to sit in the upper throat. The head can be tilted by extending either the neck or the back, depending on what is comfortable for the gargler...

 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. Some may suggest that 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
Toothpaste
Toothpaste is a paste or gel dentifrice used with a toothbrush as an accessory to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it serves as an abrasive that aids in removing the dental plaque and food from the teeth, assists in suppressing...

 can deactivate cationic agents present in the mouthrinse. However, many would disagree with this hypothesis; in fact, many of the popular mouthwashes contain sodium lauryl sulfate as an ingredient (e.g., Listerine Total Care).

Active ingredients

Active ingredient
Active ingredient
An active ingredient is the substance of a pharmaceutical drug or a pharmaceutical ingredient and bulk active in medicine; in pesticide formulations active substance may be used. Some medications and pesticide products may contain more than one active ingredient...

s in commercial brands of mouthwash can include thymol
Thymol
Thymol is a natural monoterpene phenol derivative of cymene, C10H14O, isomeric with carvacrol, found in oil of thyme, and extracted from Thymus vulgaris and various other kinds of plants as a white crystalline substance of a pleasant aromatic odor and strong antiseptic properties...

, eucalyptol
Eucalyptol
Eucalyptol is a natural organic compound which is a colorless liquid. It is a cyclic ether and a monoterpenoid.Eucalyptol is also known by a variety of synonyms: 1,8-cineol, 1,8-cineole, limonene oxide, cajeputol, 1,8-epoxy-p-menthane, 1,8-oxido-p-menthane, eucalyptol, eucalyptole,...

, hexetidine
Hexetidine
Hexetidine is an anti-bacterial and anti-fungal agent commonly used in both veterinary and human medicine. It is a local anesthetic, astringent and deodorant and has antiplaque effects....

, methyl salicylate
Methyl salicylate
Methyl salicylate is a natural product of many species of plants. Some of the plants which produce it are called wintergreens, hence the common name.-Botanical background:...

, menthol
Menthol
Menthol is an organic compound made synthetically or obtained from peppermint or other mint oils. It is a waxy, crystalline substance, clear or white in color, which is solid at room temperature and melts slightly above. The main form of menthol occurring in nature is -menthol, which is assigned...

, chlorhexidine gluconate
Chlorhexidine gluconate
Chlorhexidine is a chemical antiseptic. It is effective on both Gram-positive and Gram-negative bacteria, although it is less effective with some Gram-negative bacteria. It has both bactericidal and bacteriostatic mechanisms of action, the mechanism of action being membrane disruption, not ATPase...

, benzalkonium chloride
Benzalkonium chloride
Benzalkonium chloride, also known as alkyldimethylbenzylammonium chloride and ADBAC, is a mixture of alkylbenzyldimethylammonium chlorides of various even-numbered alkyl chain lengths. This product is a nitrogenous cationic surface-acting agent belonging to the quaternary ammonium group...

, cetylpyridinium chloride
Cetylpyridinium chloride
Cetylpyridinium chloride is a cationic quaternary ammonium compound in some types of mouthwashes, toothpastes, lozenges, throat sprays, breath sprays, and nasal sprays. It is an antiseptic that kills bacteria and other microorganisms. It has been shown to be effective in preventing dental plaque...

, methylparaben
Methylparaben
Methylparaben, also methyl paraben, one of the parabens, is a preservative with the chemical formula CH3. It is the methyl ester of p-hydroxybenzoic acid.-Occurrence:...

, hydrogen peroxide
Hydrogen peroxide
Hydrogen peroxide is the simplest peroxide and an oxidizer. Hydrogen peroxide is a clear liquid, slightly more viscous than water. In dilute solution, it appears colorless. With its oxidizing properties, hydrogen peroxide is often used as a bleach or cleaning agent...

, domiphen bromide and sometimes fluoride
Fluoride
Fluoride is the anion F−, the reduced form of fluorine when as an ion and when bonded to another element. Both organofluorine compounds and inorganic fluorine containing compounds are called fluorides. Fluoride, like other halides, is a monovalent ion . Its compounds often have properties that are...

, enzymes, and calcium
Calcium
Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...

. Ingredients also include water, sweeteners such as sorbitol
Sorbitol
Sorbitol, also known as glucitol, Sorbogem® and Sorbo®, is a sugar alcohol that the human body metabolizes slowly. It can be obtained by reduction of glucose, changing the aldehyde group to a hydroxyl group. Sorbitol is found in apples, pears, peaches, and prunes...

, sucralose
Sucralose
Sucralose is an artificial sweetener. The majority of ingested sucralose is not broken down by the body and therefore it is non-caloric. In the European Union, it is also known under the E number E955. Sucralose is approximately 600 times as sweet as sucrose , twice as sweet as saccharin, and 3.3...

, sodium saccharin
Saccharin
Saccharin is an artificial sweetener. The basic substance, benzoic sulfilimine, has effectively no food energy and is much sweeter than sucrose, but has a bitter or metallic aftertaste, especially at high concentrations...

, and xylitol
Xylitol
Xylitol is a sugar alcohol sweetener used as a naturally occurring sugar substitute. It is found in the fibers of many fruits and vegetables, and can be extracted from various berries, oats, and mushrooms, as well as fibrous material such as corn husks and sugar cane bagasse, and birch...

 (which doubles as a bacterial inhibitor).

Sometimes a significant amount of alcohol
Ethanol
Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...

 (up to 27% vol) is added, as a carrier for the flavor
Flavor
Flavor or flavour is the sensory impression of a food or other substance, and is determined mainly by the chemical senses of taste and smell. The "trigeminal senses", which detect chemical irritants in the mouth and throat as well as temperature and texture, are also very important to the overall...

, to provide "bite". Because of the alcohol content, it is possible to fail a breathalyzer
Breathalyzer
A breathalyzer or breathalyser is a device for estimating blood alcohol content from a breath sample...

 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. Commercial mouthwashes usually contain a preservative such as sodium benzoate
Sodium benzoate
Sodium benzoate has the chemical formula NaC6H5CO2; it is a widely used food preservative, with E number E211. It is the sodium salt of benzoic acid and exists in this form when dissolved in water. It can be produced by reacting sodium hydroxide with benzoic acid.-Uses:Sodium benzoate is a...

 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
Zinc
Zinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...

 ion
Ion
An ion is an atom or molecule in which the total number of electrons is not equal to the total number of protons, giving it a net positive or negative electrical charge. The name was given by physicist Michael Faraday for the substances that allow a current to pass between electrodes in a...

 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
Edible salt
Salt, also known as table salt, or rock salt, is a mineral that is composed primarily of sodium chloride , a chemical compound belonging to the larger class of ionic salts. It is essential for animal life in small quantities, but is harmful to animals and plants in excess...

 in a cup of warm water.

Vodka, gin and other hard liquors (with alcohol content of 35% or more) can be used as an alternative to Listerine, especially if one is looking for a mouthwash with only natural ingredients. Flavored spirits, such as London dry gin, work especially well as the flavorings can mask the alcohol smell. However, such use can be problematic in households with children.

Recently, the use of herbal mouthwashes such as persica
Salvadora persica
Salvadora persica , is a species of Salvadora....

 is increasing, due to the perceived discoloration effects and unpleasant taste of chlorhexidine. Research has also indicated that sesame and sunflower oils as cheap alternatives compared to chlorhexidine.

Other products like hydrogen peroxide
Hydrogen peroxide
Hydrogen peroxide is the simplest peroxide and an oxidizer. Hydrogen peroxide is a clear liquid, slightly more viscous than water. In dilute solution, it appears colorless. With its oxidizing properties, hydrogen peroxide is often used as a bleach or cleaning agent...

 have been tried out as stand-alone and in combination with chlorhexidine, due to some inconsistent results regarding its usefulness.

Another study has demonstrated that daily use of an alum
Alum
Alum is both a specific chemical compound and a class of chemical compounds. The specific compound is the hydrated potassium aluminium sulfate with the formula KAl2.12H2O. The wider class of compounds known as alums have the related empirical formula, AB2.12H2O.-Chemical properties:Alums are...

-containing mouthrinse was safe and produced a significant effect on plaque that supplemented the benefits of daily toothbrushing.

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
Magic mouthwash
Magic mouthwash and magic swizzle are terms referring to a number of different mouthwash formulations. Typically, a magic mouthwash is prescribed to treat the pain associated with mucositis caused by radiation therapy or chemotherapy...

" may be prescribed by dentists for post oral surgeries. Variations are common, and some are done with over-the-counter
Over-the-counter drug
Over-the-counter drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription...

 products.

Health risks

A literature review by Michael McCullough and Camile Farah, published in the Australian Dental Journal in 2008, focused on a possible connection between mouthwashes that contain alcohol, and an increased risk of oral cancer.

McCullough and Farah also state that the risk of acquiring 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). In addition, the authors highlight side effects from several mainstream mouthwashes that included dental erosion and accidental poisoning of children.

The review garnered media attention and conflicting opinions from other researchers. Yinka Ebo of Cancer Research UK
Cancer Research UK
Cancer Research UK is a cancer research and awareness charity in the United Kingdom, formed on 4 February 2002 by the merger of The Cancer Research Campaign and the Imperial Cancer Research Fund. Its aim is to reduce the number of deaths from cancer. As the world's largest independent cancer...

 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". Studies conducted in 1985, 1995, and 2003 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. 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".

Mouthwashes containing cetylpyridinium chloride
Cetylpyridinium chloride
Cetylpyridinium chloride is a cationic quaternary ammonium compound in some types of mouthwashes, toothpastes, lozenges, throat sprays, breath sprays, and nasal sprays. It is an antiseptic that kills bacteria and other microorganisms. It has been shown to be effective in preventing dental plaque...

 are also associated with loss of taste sensation and brown discolouration of the teeth.

Brands

  • Astring-O-Sol
    Astring-O-Sol
    Astring-O-Sol is a brand of mouth wash with active ingredients that include myrrh extract. Its flavor has been likened to that of root beer.Made famous by model Joey Eastwood who kissed over 20 girls in the kissing booth TV commercial...

  • Colgate
    Colgate (toothpaste)
    Colgate is an oral hygiene product line of toothpastes, toothbrushes, mouthwashes and dental floss.-Duraphat:Duraphat is a professional strength paste intended for the treatment and prevention of dental caries....

  • Corsodyl
  • Dentyl pH
    Dentyl pH
    Dentyl pH is a brand of mouthwash. Traditional mouthwash formulations use alcohol or other antimicrobial ingredients to kill bacteria in order to control halitosis...

  • Meridol
  • Listerine
  • Oral-B
    Oral-B
    Oral-B is a popular brand of oral hygiene products, including toothbrushes, toothpastes, mouthwashes and dental floss.It all started with a dentist, back in 1950, who created the first Oral-B toothbrush and its soft, end-rounded nylon bristles. Dr. Robert Hutson, a California periodontist, designed...

  • Sarakan
    Sarakan
    Sarakan is the brand name for a range of oral health products owned by G.R Lane Health Products Ltd.Sarakan oral health products contain the natural ingredient Salvadora Persica which is more commonly known as the toothbrush tree. It has been used for centuries in the Indian subcontinent in the...

  • Scope (mouthwash)
    Scope (mouthwash)
    Scope is a brand of mouthwash made by Procter & Gamble. It was introduced in 1966. Originally available only in mint flavor, Scope is still currently available in original mint , but also in a peppermint & new Scope White...

  • Tantum verde

See also

  • Kunzea ericoides
  • Leptospermum scoparium
    Leptospermum scoparium
    Leptospermum scoparium is a shrub or small tree native to New Zealand and southeast Australia. Evidence suggests that L. scoparium originated in Australia before the onset of the Miocene aridity and dispersed relatively recently from Eastern Australia to New Zealand. It is likely that on arrival...

  • Magic mouthwash
    Magic mouthwash
    Magic mouthwash and magic swizzle are terms referring to a number of different mouthwash formulations. Typically, a magic mouthwash is prescribed to treat the pain associated with mucositis caused by radiation therapy or chemotherapy...

  • Mucositis
    Mucositis
    Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. Mucositis can occur anywhere along the gastrointestinal tract, but oral mucositis refers to the particular...

  • Period-after-opening symbol
    Period-after-opening symbol
    The period-after-opening symbol or PAO symbol is a graphic symbol that identifies the useful lifetime of a cosmetics product after its package has been opened for the first time...

  • Sodium fluoride
    Sodium fluoride
    Sodium fluoride is an inorganic chemical compound with the formula NaF. A colorless solid, it is a source of the fluoride ion in diverse applications. Sodium fluoride is less expensive and less hygroscopic than the related salt potassium fluoride....

  • Sodium monofluorophosphate
    Sodium monofluorophosphate
    Sodium monofluorophosphate, commonly abbreviated MFP, is the inorganic compound with the formula Na2PO3F. Typical for a salt, MFP is odourless, colourless, and water-soluble. This salt is an ingredient in some toothpastes.-Uses of MFP:...


External links

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