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While mouthwash should not replace your daily brushing and flossing routine, it can be a valuable addition to your oral hygiene regimen. Mouthwash, also known as mouthrinse, can reach areas that are challenging to access with a toothbrush, making it a helpful tool for some individuals. The decision of whether to use mouthwash before or after brushing may depend on personal preference, but it's important to consider product-specific recommendations, especially regarding ingredient interactions.
It's essential to note that mouthwash is not suitable for children under the age of 6. Young children may not have fully developed swallowing reflexes, leading to potential issues such as nausea, vomiting, or alcohol intoxication if they swallow large quantities of mouthwash containing alcohol. Always check the product label for specific precautions and age recommendations.
There are two primary categories of mouthwash: cosmetic and therapeutic. Cosmetic mouthwash provides temporary relief from bad breath and leaves a pleasant taste in the mouth. However, it lacks active ingredients to address specific oral conditions. In contrast, therapeutic mouthwash contains active components designed to control or mitigate issues like bad breath, gingivitis, plaque buildup, and tooth decay.
Various active ingredients serve different purposes in therapeutic mouthwash:
Therapeutic mouthwash is available both over-the-counter and by prescription, depending on the formulation. Custom-made mouthwashes, such as those containing chlorhexidine, require a prescription, while others are readily available for purchase.
Antimicrobial ingredients like cetylpyridinium, chlorhexidine, and essential oils, when used in mouthwashes along with daily brushing and flossing, have been shown to reduce plaque and gingivitis. Some studies suggest that chlorhexidine is more effective at controlling plaque than essential oils, but there is no significant difference in gingivitis control. It's worth noting that both cetylpyridinium and chlorhexidine may cause brown staining of teeth, tongue, and restorations.
Fluoride-containing mouthwash can provide fluoride ions, which promote remineralization and help prevent tooth decay. Research has shown that regular use of fluoride mouthwash reduces tooth decay in children, regardless of their exposure to other sources of fluoride, such as fluoridated water or fluoride toothpaste.
Mouthwashes that offer pain relief typically contain topical local anesthetics such as lidocaine, benzocaine, butamin, tetracaine hydrochloride, dyclonine hydrochloride, or phenol. In addition, some mouthwashes use ingredients like sodium hyaluronate, polyvinylpyrrolidine, and glycyrrhetinic acid to create a barrier that relieves pain caused by oral lesions, including aphthous ulcers.
Mouthwash can contribute to reducing extrinsic stains when it contains active ingredients like carbamide peroxide or hydrogen peroxide. Products containing carbamide peroxide are usually dispensed by dentists for at-home use and typically contain a specific percentage of carbamide peroxide. Some mouthwashes that claim to whiten teeth may contain 1.5 to 2 percent hydrogen peroxide. Research has shown that mouthwash containing hydrogen peroxide in this concentration range can achieve similar color changes as 10 percent carbamide peroxide whitening gel in a shorter timeframe.
Xerostomia, or dry mouth, occurs when there is a reduction in saliva production. Since decreased saliva flow increases the risk of cavities, a fluoride-containing mouthwash can be beneficial for those managing this condition. Opting for an alcohol-free mouthwash may be wise, as alcohol can exacerbate dry mouth symptoms. Additionally, some mouthwashes contain enzymes, cellulose derivatives, and animal mucins to mimic saliva's composition and provide relief from dry mouth symptoms.
Alcohol consumption and tobacco use are known risk factors for head and neck cancers. This has raised questions about whether alcohol-containing mouthwash increases the risk of these cancers. A recent systematic review and meta-analysis found no association between mouthwash use, alcohol-containing mouthwash, mouthwash dose response, and the development of oral cancer.
