We all heard some of these iconic phrases: mouthwash kills germs that cause bad breath. Mouthwash can reach areas that your toothbrush can’t. Written by Sarie Liebenberg, dental hygienist & lecturer.
What do we really know about mouth rinses? Does it live up to the expectation and trust we put into it?
The marketing tactics of mouth rinse and mouthwash have been very effective without having to produce any scientific results. Professional studies don’t attribute much value to mouthwash in preventing disease, yet we often claim it as the must have in our dental cleaning routine. Did the manufacturers succeed in making us feel guilty for not using their products without producing the science to support their claims?
Let me attempt to answer some commonly asked questions regarding mouth rinses.
Is mouthwash and mouth rinse the same?
A mouthwash only temporarily freshens your breath, but does not clean your teeth.
- Mouthwash is not a replacement for your oral cleaning routine. It simply helps to wash away left over food particles and some bacteria.
- It typically contains mint flavouring breath-freshening ingredients, leaving behind a pleasant taste. As the pleasant minty taste diminishes, the evidence of bad odour will increase.
- It has no chemical or biological application beyond their temporary benefit.
- It does not have the ability to remove plaque from the teeth. Plaque is sticky and needs mechanical removal with a toothbrush and floss and/or interdental brushes.
By contrast, a mouth rinse is therapeutic and have active ingredients intended to help control or reduce conditions associated with gingivitis (gum disease), plaque, bad breath, tooth decay and demineralization of enamel to name a few.
Active ingredients that may be used in therapeutic mouth rinses include: cetylpyridinium chloride, chlorhexidine, essential oils, fluoride, and peroxide. These rinses are available either over the counter or by prescription, depending on the formulation.
What about the claims made by manufacturers about mouth rinse and mouth wash?
Let us look at the claims manufacturers made regarding their products.
Reducing bacteria
Oral rinses contain active ingredients, such as antiseptics and antimicrobial agents, which help reduce the bacterial load responsible for plaque and gum diseases, but no rinse can remove bacteria from the tooth surface.
Freshening breath
Essential oils like menthol, eucalyptol and thymol assist in giving you a pleasant taste in your mouth, but only masking bad breath. No rinse can eliminate bad breath. You need to have a professional plaque removal to eliminate the reason for bad breath – remove plaque, reduce inflammation, clear up bleeding gums, and then maintain good oral hygiene to prevent reoccurrence.
Prevent tooth decay
Some oral rinses contain fluoride, which helps strengthen the enamel to prevent tooth decay.
Gum health
Rinses formulated with anti-inflammatory ingredients can aid in reducing gum inflammation and promoting healthier gums if used after a professional dental cleaning was performed.
Can I use a mouth rinse instead of flossing my teeth?
NO!!! No mouth rinse is a substitute for brushing or flossing. Rinsing is a chemical adjunct with the aim to reduce the number of bacteria. To effectively remove bacteria, mechanical means like brushing and flossing is needed to physically disturb the bacterial matrix.
Who needs to use a fluoride mouth rinse and why?
A fluoride mouth rinse doesn’t remove plaque or doesn’t kill bacteria. It aids in cavity prevention by protecting your teeth from acids produced by the bacterial plaque. The fluoride is a mineral that helps to strengthen the enamel and make the tooth hard and therefore resistant to the acid forming bacteria.
The fluoride coats the teeth with fluoride ions, which is absorbed by the enamel. The harder the tooth enamel, the more difficult it is for the acid of the bacteria to cause decalcification of the enamel and to form a cavity. It is important to understand that plaque removal is crucial in preventing tooth decay.
First and foremost, trying to remove as much bacteria as possible, before replying on a rinse to aid in strengthening the enamel. This needs to be done by mechanical removal of plaque with a toothbrush and floss and/or interdental brushes.
Anyone prone to cavities or someone having demineralized enamel will greatly benefit from a fluoride rinse. Fluoride is naturally found in many water sources and foods such as fish, tea, and cereal. Using a fluoride-containing mouthwash provides an additional layer of protection after plaque is mechanically removed. Tooth enamel can demineralize due to a combination of dietary sugars and acid produced by bacteria. Fluoride helps reverse this process by promoting remineralization. Minerals like calcium and phosphate found in fluoride, are redeposited into the enamel, making it stronger and less susceptible to cavities.
Can a mouth rinse cure bad breath?
NO!!! If bad breath is a temporary condition caused by plaque, dehydration or diet, a mouth rinse might assist you in temporary relief from the bad taste or smell in your mouth. When bad breath is caused by gum diseases like gingivitis and periodontitis it will not reduce bad breath. When you have gum disease, the plaque build-up, calculus, and bleeding gums, will be the reason for bad breath, and need to be addressed and eliminated before the bad breath will improve and eventually clear.
Why should I consider an alcohol-free mouthwash?
Most mouthwashes typically contain around 20-30% of alcohol. Other types of rinses contain peroxide. Both types of rinses can cause dryness and irritation of the soft tissue of the mouth. These rinses often cause a burning sensation and makes it very uncomfortable to use. Recovering alcoholics are worried that the alcohol content might trigger a relapse. You can find alcohol-free mouthwash that provides similar oral health benefits to a typical alcohol-containing mouthwash. Consider a mouthwash with CPC (cetylpyridinium chloride). When CPC is used as one of the ingredients of a mouth rinse, it binds to the surface of the germs and causes them to burst, which helps reduce their buildup on the teeth.
How can I get rid of all the bacteria in my mouth?
You can’t. Bacteria is naturally found in the oral cavity and a rinse can’t eradicate bacteria completely. Nothing can make the oral cavity completely sterile. When the claim states: The rinse will kill the bacteria that is responsible for bad breath, this simply means: Some bacteria will be killed when the rinse is used, but in about 20 min, the remaining bacteria will have multiplied again. To put this in perspective:
Let’s say, as claimed by the manufacturer, the rinse kills 99.99% of bacteria. It is estimated that there are around 800 different types of bacteria in your mouth, and around 6 billion of them. That is 6 000 000 000 bacteria. One hit of mouth rinse would leave 600 000 behind. If they double every 30 minutes, within 24 hours there would be more than 16000000000000000000 bacteria. Researchers concluded that some bacteria could double in number as much as 5 times in 24 hours. Some species of bacteria can double their numbers every 20 minutes.
Something else to consider: Biologically speaking, minutes after bushing our teeth, a biofilm, called the pellicle, is formed on the enamel surface of the tooth. The enamel surface attracts glycoproteins and calcium phosphates found in saliva and other bacterial products. These glycoproteins include proline rich protein that allows bacteria to stick to the teeth. Plaque, composed of several different kinds of bacteria and their products, develop and adhere to the pellicle. The plaque will cause the surrounding environment to become acidic if not removed. This adherent biofilm can’t be removed chemically only (using a mouth rinse). It must be mechanically removed by using a toothbrush and dental floss and/or interdental brushes. After 24 hours of plaque formation, it would be difficult even for a mechanical removal method, to get rid of the bacterial plaque. (Hence, we always advice to mechanically clean your teeth every 12 hours.)
This illustrates why it is so important to understand that a mouth rinse should never be used in isolation, but always as part of your dental cleaning routine together with brushing and flossing and/or interdental brushes. Every effort should be made to reduce the number of bacteria daily. It is an ongoing process.
ALSO VISIT: What if I can’t afford to take my child to the dentist?
What is a good alternative if you don’t want to use a commercial rinse:
Rinsing your mouth with warm salt water has a whole host of benefits. It’s almost like nature’s own antibiotic:
- It restores your oral pH
Rinsing regularly with warm saltwater balances the pH (acidity level) of your mouth. Bad bacteria don’t like a healthy pH balance. Bacteria use the sugars in food to create an acid, and in this acidic environment cavities can form.
- Decrease the risk of bad breath
Accumulation of food particles and bacteria are 2 factors contributing to bad breath. By rinsing with salt water, food particles and some bacteria get washed away and risk of bad breath gets reduced.
- Help treat bleeding gums
If your gums are bleeding when you brush and floss, you guessed right: Accumulation of bad bacteria are to blame for causing the gums to bleed, leading to bad breath. After having a professional dental cleaning, rinsing with warm salt water can improve your overall oral hygiene by speeding up the healing process.
- Reduce respiratory infections
Gargling with warm salt water significantly reduce your chances of contracting common respiratory tract and sinus infections such as the cold and flu.
What is the best oral cleansing routine?
The best oral care routine is to always brush and floss or use interdental brushes to mechanically remove the plaque sticking to the teeth. Only then it is advisable to enhance your oral cleansing routine with a mouth rinse. Consult with your dentist or dental hygienist to find out if you need to use a specialised rinse to assist your unique oral health condition.
What is Chlorhexidine mouth rinse?
Chlorhexidine mouth rinse is an antiseptic oral rinse that contains the active ingredient chlorhexidine gluconate. It is a chemical compound known for its strong antimicrobial properties, making it effective at killing a wide range of bacteria and microorganisms in the mouth. It is commonly recommended in the following situations:
- Gum disease treatment and prevention – helping to reduce the number of bacteria, thereby reducing inflammation and promoting gum healing.
- Post surgical care – after procedures like dental implants or tooth extractions or periodontal surgeries, it will help prevent post-operative infection and aid in the healing process.
- Oral infections or ulcers – conditions where bacterial control is important, chlorhexidine can help keep the oral environment clean and promote healing.
Factors to remember when using chlorhexidine mouth rinse:
- There is a possibility, with long-term use, that bacteria can build up resistance, and the effectiveness might diminish.
- With long-term use, chlorhexidine will cause staining of teeth and dental restorations.
- Extended use can lead to changes in taste sensation.
Is mouth rinse bad for you?
When using as part of a comprehensive oral hygiene routine, mouthwash is considered safe and beneficial for maintaining oral health. Keep in mind, that antiseptic and antimicrobial properties kill indiscriminately – killing good and bad bacteria. Good bacteria act as a natural defence to fight pathogens. This could reduce the effectiveness of your natural ability to fight pathogens and lessen your immunity.
Can I be allergic to mouth rinse?
Some individuals might be sensitive or allergic to certain ingredients in mouthwash. If you experience any adverse reaction, such as irritation, swelling or rash, consult with your dentist or hygienist.
Can any mouth rinse be used in conjunction with any toothpaste?
To maximize the benefit from the oral care products used, manufacturers may recommend a specific order for their use, depending on ingredients. For example, some toothpaste ingredients like calcium hydroxide or aluminium hydroxide, can form a complex with fluoride ions and reduce a mouth rinse’s effectiveness. Therefore, vigorous rinsing with water may be recommended after brushing and before rinsing if these ingredients are present.
Can I just buy any over the counter rinse, or do I need a prescription?
If you have specific dental conditions, such as gum disease, tooth sensitivity or a history of cavities, it is a good idea to consult with our dental team before incorporating a mouth rinse or mouthwash into your routine. They will provide you with personalised recommendations based on your personal oral health needs.
Does whitening rinses really change the colour of my teeth?
Although some manufacturers claim that the active ingredients in whitening rinses, carbamide peroxide or hydrogen peroxide will cause an improvement of the colour of your teeth, it is important to understand that such an improvement will not happen overnight. The percentage of peroxide is an important factor as to how quickly a change will be seen, but it would be realistic to anticipate that such change will only be seen when the whitening rinse is used for about 12 weeks.
The claim for success of these whitening rinses, is the fact that it forms a layer over the teeth and protect the teeth from stains from food and drink. This is also often true with whitening toothpastes. Some toothpaste forms a protective layer over the teeth, preventing the teeth from gaining stains. Other toothpastes are more abrasive, and therefore effective in removing such stains, rather than altering the colour of the teeth. Change in colour of the teeth, needs to take place within the dentine – the layer underneath the enamel (outer layer of the teeth). Such change does not take place in the enamel. Because of the abrasiveness of these whitening toothpastes, this can often lead to tooth sensitivity.
Do you get a mouth rinse for xerostomia (dry mouth)?
Yes. Dry mouth is a reduction in the amount of saliva bathing the oral mucous membranes. A lack of saliva increases the risk of decay (saliva has antibacterial properties and it help in washing away plaque and food particles. Saliva also restores the pH of the mouth). When xerostomia is present (sometimes because of a side effect of chronic medication, systemic conditions, diet or dehydration) it is advisable to use a fluoride containing mouth rinse to give you extra protection against the acid of the bacteria.
Since alcohol can be dehydrating, it might not be a good idea to use a mouth rinse containing alcohol when you suffer from xerostomia. Furthermore, mouth rinses containing enzymes, cellulose derivatives and/or animal mucins can mimic the composition and feel of saliva and may provide additional relief from symptoms associated with xerostomia.
Can mouth rinse treat dental hypersensitivity?
Tooth sensitivity can occur when the dentin, the underlying layer of the teeth, becomes exposed. Gum tissue convers and protects the tooth roots but receding gum tissue exposes the dentine. Tiny tubules in your dentin lead to the centre of the tooth where the nerve is located, known as the pulp. Exposed tubules allow for stimuli like hot or cold food and drink to reach the pulp of the tooth, which can lead to tooth sensitivity or pain. Some key ingredients in mouth rinse to treat dental sensitivity are potassium citrate, potassium nitrate and sodium fluoride.
In conclusion:
While mouthwash and mouth rinse can be a valuable addition to your oral health routine, it cannot replace regular brushing, flossing and the use of interdental brushes. Proper brushing, flossing and professional dental cleanings remain the foundation of maintaining good oral health.
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