Tuesday, December 22, 2009

Mouthwashes: Are they for regular use?

One of my friend was concerned about the regular use of mouth washes. Being a dentist it is my duty to help people realise the benefits and side effects of such things. So I did a small research about mouthwashes and have compiled the evidence.

Halitosis is an unpleasant or offensive odour, emanating from the oral cavity. In approximately 80% of all cases, halitosis is caused by microbial degradation of oral organic substrates. Major degradation products are volatile sulphur-containing compounds.

Undoubtedly, the basic management is mechanically reducing the amount of micro-organisms and substrates in the oral cavity. This includes the use of toothbrushes, flossing and rinsing yor mouth.

Masking products such as mouthrinses/mouthwashes are not, and antimicrobial ingredients in oral healthcare products are only temporary effective in reducing micro-organisms or their substrates.

Good short-term results were reported with chlorhexidine. Triclosan seems less effective, essential oils and cetylpyridinium chloride are only effective up to 2 or 3 h. Metal ions and oxidizing agents, such as hydrogen peroxide, chlorine dioxide and iminium are active in neutralizing volatile sulphur-containing compounds. Zinc seems to be an effective safe metal at concentrations of at least 1%.

The effectiveness of active ingredients in oral healthcare products is dependent on their concentration and above a certain concentration the ingredients can have unpleasant side effects. (1)

Antimicrobial mouthrinses are generally considered safe and effective in reducing plaque and gingivitis, and should be part of a comprehensive oral health care regimen that includes brushing, flossing and rinsing to prevent or minimize periodontal disease. (2)

One concern with the regular use of alcohol-containing mouthwash was oral cancer, and the occurrence of oral cancers is not supported by epidemiological evidence. (3)
One of the major drawbacks of mouthwashes containing products such as chlorhexidine is the occurrence of stains on long term use. (4)

So, the final verdict?

Daily use of mouthwashes are safe, provided mechanical methods of cleaning are being effectively used to keep the teeth clear of plaque and other debris.
Keep a watch on the colour of the teeth; if they seem to be getting discolored, it’s time to stop using the mouthwash. Occasional use of mouthwash is preferable to daily use. Rinsing your mouth with water at regular intervals can be preferred instead of repeated mouthwash use.

If you notice bad breath, deposits on the teeth, or bleeding from gums, it is always better to consult a dentist to get your teeth cleaned and know more about oral hygiene.

(1) van den Broek AM, Feenstra L, de Baat C. A review of the current literature on management of halitosis. Oral Dis. 2008 Jan;14(1):30-9.
(2) Lemos CA Jr, Villoria GE. Reviewed evidence about the safety of the daily use of alcohol-based mouthrinses. Braz Oral Res. 2008;22 Suppl 1:24-31.
(3) La Vecchia C. Mouthwash and oral cancer risk: an update. Oral Oncol. 2009 Mar;45(3):198-200. Epub 2008 Oct 25.
(4) Adams D, Addy M. Mouthrinses. Adv Dent Res. 1994 Jul;8(2):291-301.

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