An Orthodontist’s Guide to Mouthwash

A proper mouth care routine is required for dental health. It should consist of two essentials: brushing and flossing. In some cases, you may need to use mouthwash. A common question, however, is whether or not everyone needs to use the product.

Contrary to popular belief, using mouthwash is not an absolute necessity. If you already brush your teeth at least twice daily and you floss every day as well, you can skip it. The purpose of the product is to give the mouth an overall clean and refreshed feeling. Many people use it to make sure their breath does not smell bad throughout the day.

In reality, mouthwash has benefits for oral health, but not everyone needs it. You can still use rinses if you wish to incorporate it into your routine. The important thing is you select the right one. Just like with other products, mouthwashes are not all the same. You have to be vigilant in choosing your mouth rinse product and be aware of certain ingredients to avoid.

Where Did Mouthwash Come From?

Mouth wash container close up.

It would seem like mouthwash is one of those products that suddenly existed. Not a lot of people were concerned about its humble beginning. But mouthwash does have an interesting (and disgusting) background.

Let us look at the timeline below:

Ancient Romans: It is unclear when mouthwash started exactly. Some say the Greek first used them, while others claim Chinese and even Egyptians. However, the most well-recorded history is that mouthwash came from ancient Rome. According to documents, the Romans used Portuguese urine for rinsing their mouth. They believed that the ammonia-rich urine could disinfect their mouths and even brighten their teeth.

Ayurveda: Rinsing the mouth was required to help treat gingivitis.

Hippocrates: The Greek physician recommended mixing salt, vinegar, and alum for washing the mouth.

More Oddities: As time passed, urine was not the only mouthwash used. Blood from poor tortoises was harvested to clean and disinfect people’s mouth. For a tastier mouthwash, ancient people used berries and mixed them with mint leaves and wine or sometimes, vinegar.

12th Century: Saint Hildegard von Bingen altered the way many people washed their mouths. He encouraged the use of cold water – no additives – to remove plaque and tartar.

18th Century: Antonie van Leeuwenhoek is considered the father of modern microbiology. One of his discoveries included oral bacteria. He tried different solutions to kill the bacteria and the most effective for him was ammonia. He claimed it could immobilise and eliminate bacteria. Antonie also said that alcohol was an excellent way to get rid of the microorganisms in the mouth. Until today, alcohol is one of the most common ingredients in mouthwash.

1865: The products that we know today started existing at this time. Alcohol replaced urine to fight germs and bacteria in the mouth. An English doctor named Joseph Lister was the first surgeon to work in a chamber sterilised with antiseptic. At that time, it was not a common practice. He found out that his practice helped reduce deaths and was later used to create a mouthwash product that still exists today.

So why do mouthwash products exist?

Mouthwash is used to have a clean and fresh feeling all over the mouth. You can become confident because you know your breath smells good.

Apart from the mentioned benefits, mouthwash can also reduce oral bacteria. Therefore, it helps lower the instance of dental plaque formation. Regularly taking care of your dental health by incorporating mouthwash into your routine can also prevent periodontal disease. Provided that you use the product correctly, it can also help reduce cavities when it contains fluoride.

Pros and Cons of Alcohol-Based Mouthwash

With many mouthwash products around, it can get confusing to choose the best one for you and your family. One of the most popular variant today comes with alcohol. Research has proven that the ingredient can indeed kill bacteria, but is it safe to use in your mouth?

Alcohol is an antiseptic, which means it can naturally eliminate bacteria. It also kills other microorganisms, such as viruses and fungi. However, it is not advisable for use on broken skin and children with fever. Some parents would even add alcohol to water when bathing. The body can absorb the chemical and may lead to toxicity.

Since alcohol is not an entirely safe compound, does it mean you should not put it in your mouth? Alcohol-based mouthwashes are all around us. These products are precisely what you think of them: they contain alcohol, which is one of their main ingredients.

Most of the time, you end up buying an alcohol-based mouthwash if you are not specific with the brand. The only exception is if you purchase a product specifically for kids.

Why do mouthwashes have alcohol?

One reason is that these products are easy to make.

When you rinse your mouth with mouthwash, you feel that “burn.” It instantly gives you a signal (or belief) that your mouth is thoroughly clean. In reality, however, it is not always a good thing.

Let us weigh the pros and cons of the product.

Here are the advantages first:

  • Freshens breath
  • Inexpensive
  • Contains germ-killing properties
  • Helps fight tooth decay
  • Prevents gum disease like gingivitis
  • Easy to buy since it does not require a doctor’s prescription
  • Many flavours available

Now onto the disadvantages:

  • Leaves a burning sensation in the mouth
  • May result in ulcers for some people with sensitive gums
  • Leaves an unpleasant taste, especially for those who plan to eat shortly after washing their mouth
  • Dries the mouth for about 30 to 60 minutes after use
  • May cause an unusual taste in the mouth after the effect dissipates
  • Not suitable for recovering alcoholics

Although alcohol-based mouthwashes have many benefits, they also come with several disadvantages. If that is the case, why is there alcohol in mouthwash products in the first place? There are two answers here.

  1. First, alcohol serves as a solvent that solubilises or dissolves the other ingredients. The second purpose is to deliver the active ingredients to the right places. At the same time, it promotes penetration of essential oils to bacterial communities in the mouth or the plaque biofilm.
  2. For numerous consumers, alcohol-based mouthwash is safe and effective. The product is known to fight bacteria, which is an effect that benefits people. If you find the mouthwash denaturing and causes dry mouth and other problems, an alcohol-free rinse is a much better option for you.

What about Other Ingredients?

A quick search online will take you to many horror stories about mouthwashes that contain alcohol. If your dentist tells you to switch to an alcohol-free product, it is always best to listen to the advice. More often than not, you should avoid alcohol-based when you suffer from mouth dryness, stained teeth, gum and tongue irritation, vomiting, and any allergic reaction.

The problem with alcohol-free products is that they are challenging to find. They are not as popular and usually do not sell as well as the alcohol-based ones. One reason is that they are more expensive than their counterpart.

Aside from alcohol, another controversial ingredient in mouthwash products is fluoride. This compound is in toothpaste as well. If you are already brushing twice a day with fluoride toothpaste, you do not have to rinse with this liquid. An exception is if your dentist tells you to use mouthwash. It may be due to an increased risk of developing cavities, which can be lessened with fluoride toothpaste and mouthwash.

Some studies support the use of fluoride mouthwash products, especially in places that do not have water with the mineral. The rinses can help strengthen the tooth enamel and protect the teeth from damage caused by acid.

The other components will depend on the brand.

Typically, however, the product has the following ingredients:

  • Benzydamine: This analgesic is for mouthwashes made for people with painful oral conditions, including aphthous stomatitis.
  • Benzoic acid: Companies add this ingredient as a buffer.
  • Cetylpyridinium chloride: Products with this ingredient is typically designed for those who suffer from bad breath or halitosis. One complaint about it may cause teeth stains and ulcers.
  • Chlorhexidine: Mouthwashes indicate that they have 0.12 to 0.2 per cent of this chemical antiseptic. However, there is no proof that higher amounts are more effective, especially in reducing the risk of gingivitis and dental plaque. The ingredient is known for its anti-fungal and anti-plaque characteristics and can help prevent Gram-negative rods.
  • Essential oils: Some examples include phenol, eugenol, and eucalyptol. They come from plants and may be more effective than other ingredients, especially for fighting gingivitis.
  • Flavour: Adding sweeteners to mouthwash may seem counterproductive, but they do exist, including sucralose, xylitol, and sorbitol.
  • Hydrogen peroxide: It helps clean the mouth and remove anaerobic bacteria.

If you do not suffer from any adverse effects, you can stick to your alcohol-based mouthwash. However, you should never give the same product to children, especially those below six years old. Younger kids tend to swallow the product, which can cause health issues

Typical ingredients for mouthwash based products.Natural Alternatives to Commercial Mouthwashes

If alcohol-free products do not interest you, you can always go the natural route. You can avoid the following ingredients:

  • Chlorine dioxide
  • Parabens
  • Chlorhexidine
  • Poloxamer 407
  • Saccharin
  • Formaldehyde
  • Cocamidopropyl betaine

Many “natural” products are around, but they are often expensive. You can, however, make your own mouthwash, which can be time-consuming. Some homemade rinses include mixes of the following:

  • Ginger, powdered turmeric, mint herb, and cinnamon
  • Coconut oil, Celtic sea salt or pink Himalayan salt, peppermint oil, and baking soda
  • Aloe vera juice, baking soda, Himalayan or Celtic sea salt, cinnamon oil, and peppermint oil

If you do want to create your own concoction, there are other substitutes in rinsing using mouthwash:

  • Swish warm water with table salt around your mouth.
  • Go for the Ayurvedic treatment known as oil pulling. You use a tablespoon of oil, preferably coconut, sesame, or olive oil around the mouth for about five to 20 minutes. Brush and floss after.
  • Combine water and baking soda in the right amounts. You can also add peppermint oil to enhance the flavour.

How to Use Mouthwash Correctly

If you do choose to use mouthwash, the proper way will depend on the type of product you have. For instance, you may have to be extra cautious when using fluoride mouthwashes. It is because you may already be brushing your teeth with fluoride toothpaste. Also, your water may contain the element.

Therefore, you must use the right amount. Talk to your dentist to find out the most suitable for you. In most cases, you can refer to the product label, which states how much to use. Also, you should only wash after you have thoroughly cleaned your teeth.

When you swish the product around, make sure to keep your mouth closed. It helps if you vigorously swish, especially if the label indicates so. You should watch the clock while using the product. Before swishing it around your mouth, be sure that you have already read the instructions. Most mouthwashes today require 30 seconds to a minute before you spit it out. The most important part is to spit the product thoroughly.

Never swallow the rinse. If it has fluoride, it can be toxic if you ingest enough of the liquid. Finally, you should wait for at least 30 minutes before you eat, drink, or smoke. This way, fluoride remains in your mouth and will provide the benefits you seek. You should not rinse with water after using mouthwash.

But how much mouthwash is too much? Some products are used as-is, so there is no need to add water. On the other hand, some brands should be mixed with water before swishing. Always read the label to make sure you do not burn your mouth with the product. Follow the instruction if it says dilution is not required, since the product may be less effective in killing ingredients when diluted.

Use the product intermittently. Long-term use is not advised. When using, it is best to rinse for 10 to 20 minutes after brushing.

Australian Government Regulations around Mouthwash Products

Just recently, several groups protested against the sale of household products, such as mouthwash, containing alcohol. The Northern Territory Government introduced the Liquor Bill 2019 last May. The bill includes police powers for searching and seizing alcohol-containing substances, including mouthwash.

To make sure that you remain on the safe side, you should only purchase brands that come with the Seal of Approval from the Australian Dental Association. Buying a product that has the seal gives you the confidence that dental professionals endorse it.

The approval seal is only given to products that have been tested and approved by expert dentists. It means that the manufacturer claims are valid, such as the product contains fluoride in the specified amount. They should also meet certain Australian standards, which include government-set criteria for safety and quality.

Under the Australian standards, mouthwashes are considered products for therapeutic use and belong to Class II medicines. An exception is when the product does not make any therapeutic claims. Products included are those that contain 220 mg/L (at the most) of fluoride ion that do not claim to provide healing benefits. They usually offer cosmetic changes, as well as prevention of caries and sometimes, plaque.

 

The logo for the Australian Dental Association.

True or False: Busting Myths about Mouthwashes

Here are some of the most popular beliefs about mouthwashes. Which among them is real and which are not?

Mouthwash works on its own

False!

Mouthwash helps fight bacteria and can give you fresher breath as well. However, it should not be used as a replacement for brushing and flossing. Instead, you can use it in combination with your daily oral care routine.

Mouthwashes can cure a sore throat

Not true.

Your mouthwash will not relieve your sore throat. However, it can benefit you if you suffer from the infection since the product kills bacteria that could be irritating your throat. An alternative is to use warm salt water, which has been proven to relieve sore throat problems.

Regular mouthwash use can cause cancer

This one requires more studies at the moment.

The story behind the relationship between regular mouthwash use and oral cancer has been around since the early 80s. This 1983 study tried to examine the possibility of developing cancer due to daily mouthwash use. The researchers found there was a high risk but only in females while males have no excess chance.

However, in 2008, an update to the study showed that epidemiological evidence does not support the link between the product and oral cancers.

Mouthwash can whiten teeth

Yes, but not all.

It should be noted though that these mouthwashes are specifically designed to whiten teeth. They contain ingredients, such as hydrogen peroxide, which are known to provide the whitening effect. Another catch here is that it does not happen overnight.

Some manufacturers claim that their products take about 12 weeks for the results to be visible. Often, the instructions involve swishing the liquid around in the mouth for about a minute twice daily. The products are typically used before you even brush your teeth.

Some experts, however, say that these rinses are less effective than other whitening products that you can purchase over-the-counter. Compared to whitening strips that should be on the teeth for about 30 minutes, mouthwashes come in contact with the teeth for two minutes in one day of use.

Mouthwash can prevent gum disease

Yes.

However, it will not work alone. You still have to brush and floss at least twice daily. Gum disease starts with gingivitis, which is due to the build-up of harmful bacteria in the mouth and teeth. Most people can prevent gingivitis by practising good oral care routine daily.

Mouthwash is not effective in eliminating bad breath

Surprisingly, this one is true.

When you rinse with your mouthwash, the bad odour is replaced by fresher breath. However, it does not last long. If you have a severe case of halitosis, using mouthwash will simply mask the smell. Treatment for this condition involves knowing the underlying cause. In other words, you should not use mouthwash products to cure bad breath.

What Do Orthodontists Say About Mouthwash?

Most dentists allow using mouthwash. Some would even encourage people to use the product twice a day – in the morning and at night – while others say it is unnecessary. However, it will not hurt if you decide to add mouthwash to your routine.

Different types of mouthwash are widely available. Therefore, the product you should buy depends on what you need it for and your current condition. For instance, you have a dry mouth; your mouthwash will vary from those with sensitive teeth and people with mouth sores. If you have had any recent dental surgery, you should also pick the suitable one for you.

Your dentist will give you recommendations on the product that you should choose. Often, mouthwashes with fluoride are the top option, especially for those who require added benefits for their teeth.

For many orthodontists, the consensus is that mouthwashes are useful products that can kill bacteria and freshen breath. However, they simply remove the microorganisms on the surface of your teeth and mouth. They are not standalone products that can also address the underlying causes of your dental issues and halitosis.

People with braces should know the ingredients in the product before using it. Make sure you have talked to your orthodontist. They will often suggest that you use an ADA-accepted mouthwash designed for orthodontic patients. More often than not, the product is alcohol-free to prevent the burning sensation in the mouth.

Another prerequisite is for the product to have 0.044% sodium fluoride, which effectively combats cavities. This advanced formula can also benefit patients since the ingredient can reduce white spot formation on braces.

Mouthwash is simply a finishing rinse and should not replace brushing and flossing. You should never expect it to cure your oral health problems.

As with brushing and flossing, regular visits to the dentist should be part of your oral health care routine as well.