CHOOSING dental products is often a frustrating, confusing and exhausting experience.
The process is typically time-consuming and expensive, leading many people to abandon efforts to improve their oral hygiene before they even begin.
If selecting a simple toothbrush can be daunting, the task becomes even more overwhelming when considering more specialised products like mouthwashes or water flossers.
Regrettably, a significant portion of the population wishes to integrate these modern tools into their routine, but feels helpless, unsure of where to start.
This confusion persists especially around mouthwashes, with common questions concerning which type to choose, which brands are trustworthy and what specific factors should guide a purchase.
The history of mouthwash dates back to the 1800s, with Listerine being the first commercially available product.
Interestingly, its initial purpose was not for daily oral care, but as a surgical antiseptic for cleaning the mouth before operation and even as a floor cleaner, leveraging on its high alcohol content to kill bacteria.
For many years, alcohol-based formulas were the only option until the 1900s, when manufacturers began shifting away from these harsher ingredients towards safer and more effective alternatives.
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Modern research supports this shift, indicating that long-term use of alcohol-based mouthwashes is not advisable due to a potential association with oral cancer.
Mouthwashes are broadly categorised into two types: cosmetic and therapeutic.
Cosmetic mouthwashes primarily function to mask bad breath temporarily, providing a fresher sensation and pleasant taste.
However, they do not get rid of the underlying causes of oral health issues, such as plaque, gum disease or tooth decay.
In contrast, therapeutic mouthwashes are designed to actively maintain oral health through mechanical and chemical control.
They can be antiplaque or antigingivitis agents, working to prevent the initial stage of harmful biofilm formation bacterial adhesion.
By interrupting this process, therapeutic mouthwashes help to prevent the development of gum disease and decay.
Key ingredients and their functions
Understanding the active components in mouthwashes is crucial for making an informed choice.
Hydrogen peroxide: This ingredient is valued for its oxygenating and cleansing action, often used to alleviate minor gingivitis and soreness from dentures or orthodontic appliances.
As a bleaching agent with strong oxidising properties, it works by releasing oxygen to loosen debris, remove light stains, and kill anaerobic bacteria.
Some formulations include ethanol as well.
Hydrogen peroxide is considered a broad-spectrum antimicrobial and has been shown to reduce gingivitis.
It is often recommended for treating acute ulcerative conditions, reducing inflammation before certain dental procedures, aiding those with limited manual dexterity and for denture cleaning.
Povidone-Iodine: This is an iodophore, where iodine is bound to povidone, allowing it to target bacterial cell membranes directly.
It has a broad spectrum of activity against bacteria, fungi, protozoa and viruses. Studies indicate it is effective in reducing plaque and gingivitis, making it a useful supplement to standard oral hygiene.
It is also beneficial in reducing the symptoms of radiation mucositis.
While there is a theoretical concern about iodine absorption affecting thyroid function, this is generally not a risk for individuals without pre-existing thyroid conditions, provided the solution is not swallowed.
Enzyme-based systems: Some mouthwashes contain a combination of enzymes like lysozyme, lactoferrin, glucose oxidase and lactoperoxidase.
These are designed to mimic and restore saliva’s natural antimicrobial activity.
They are particularly marketed for relieving dry mouth (xerostomia), gingivitis, minor gum irritation and halitosis.
While these formulas are typically free of alcohol and detergents, they often have a low pH, which could pose a risk of dental erosion with prolonged use.
Sodium bicarbonate (baking soda): A simple and gentle mouthwash can be made by dissolving a teaspoon of sodium bicarbonate in water.
It is recommended for patients with xerostomia or erosion risk because it helps to raise salivary pH and suppress acid-producing bacteria like Streptococcus mutans.
It neutralises acids, helps to improve taste and is bland enough not to irritate sensitive oral tissues or ulcers.
The concern with alcohol
Ethanol in mouthwashes serves as a solvent, preservative and antiseptic.
It works by denaturing proteins and dissolving lipids, granting it antimicrobial properties against a wide range of bacteria, fungi and viruses.
However, research indicates that mouthwashes with high alcohol concentrations (above 20%) can cause adverse oral effects, including epithelial detachment, keratosis, mucosal ulceration, gingivitis and pain.
More significantly, accumulating evidence suggests a possible direct relationship between the alcohol content in mouthwashes and an increased risk of oral cancer.
The risk appears amplified in smokers and those who consume alcoholic beverages, but some studies indicate an elevated risk even for individuals who neither smoke nor drink.
Consequently, recent scientific reviews advise against recommending the long-term use of alcohol-containing mouthwashes.
Guidance for selection
Patients and dental professionals are confronted with an overwhelming array of mouthwash products containing various active and inactive ingredients.
Determining the most suitable product for an individual’s specific needs is a complex task.
While many popular mouthwashes can aid in controlling plaque and gingivitis, they should be viewed strictly as a short-term adjunct to not a replacement for fundamental oral hygiene practices like proper brushing and flossing.
Given the potential risks, the long-term use of ethanol-containing mouthwashes should be discouraged.
For patients at a high risk of developing cavities, fluoride-containing therapeutic mouthwashes are a valuable and recommended option.
Ultimately, navigating the mouthwash aisle requires a focus on therapeutic benefits for specific conditions, a cautious approach to ingredients like alcohol and the understanding that these products are merely one part of a comprehensive oral health regimen.
