What is mouthwash and what does it do?
A mouthwash is a liquid that is held in the mouth and moved around vigorously in order to provide a healthier feeling in your mouth and also to reduce the bacteria in the oral cavity.
A mouthwash is not designed to be swallowed however after you have used the mouthwash it is best to spit out but not to rinse out with water afterwards so that remnants of the mouthwash can carry on working after you have eliminated the mouthwash by spitting out. The best time to use a mouthwash is therefore at night-time when you are not going to be eating or drinking again for another 6 to 8 hours and also during the night, the mouth becomes dry which causes the proliferation of bacteria so a mouthwash will help to put a lid on this.
Most mouthwashes go a little further and provide extra benefits:
Most mouthwashes have more than one function so for example a particular mouthwash may be used for bad breath but also to prevent tooth decay.
Mouthwashes are made from different ingredients and some of these ingredients will be the active ingredients. As well as medicated ingredients other ingredients are needed to make the mouthwash stabilise itself such as preservatives. The exact combination and flavour and the purpose of the mouthwash will vary from Brand to brand. So at one time there were very few mouthwashes however nowadays there is a huge range of mouthwashes and whole shelves are dedicated in shops chemists in supermarkets just for mouthwashes. There are even alcohol-free versions and versions for vegetarians.
The most important information to take with you is that mouthwash is not a replacement to regular brushing. I will repeat that because it is so important. A mouthwash is definitely not a replacement to brushing and flossing. No matter how good a mouthwash is claiming to be, it will never ever replace regular brushing. This means you still need to concentrate mainly on brushing twice a day for at least 2 minutes 4 minutes and also to use floss or use interdental brushes once a day as well. The whole point of brushing your teeth is to physically remove the plaque and bacteria which grows on your teeth and your fillings and your crowns and even your dental implants. Only a toothbrush gets under the gums where plaque builds up to cause gum problems. The plaque or bacteria is Sticky and therefore it cannot be removed by swishing a liquid around your mouth in order to get rid of it. Even the mouthwashes that work against gingivitis and periodontitis, they still do not remove plaque. It is important to know that brushing your teeth will clean about 70% of your tooth surface and the other 30% is therefore cleaned using interdental cleaning or dental floss. The mouthwash is therefore an adjunctive to brushing and flossing which is the most important in the very first place.
History of mouthwash
The very earliest form of mouthwash was the most simplest and easily available mouthwash. This mouthwash is of course cold water. Water was used by the Stone Age and Bronze age and Iron Age eras to get rid of food particles after eating.
Eventually people started to add ingredients which claimed had beneficial effects in preserving your gums and your teeth. We do have evidence that the ancient Egyptians, Greeks, Roman and Chinese cultures used to use charcoal, herbs and dried flowers as ingredients all mixed together to produce a mouthwash. It was really at the beginning of the 1900s when oral Healthcare started to take a commercial step forward because this is when toothpaste was first becoming more common and therefore mouthwash was also being produced. Back then and even now, alcohol was the ingredient that was used to stabilize the mouthwash. You didn't want to buy a mouthwash only to find that within a few days it had gone off, so alcohol is added in order to preserve the mouthwash so that it does last a lot longer. Today there are other ingredients that can be used instead of alcohol and these are called alcohol-free mouthwashes. Another reason for using alcohol-free mouthwashes is that some people have a dry mouth found that the alcohol can make the mouthwash get more dry mouth. The amount of alcohol is important to know, is extremely tiny and you certainly can't become drunk on it however much you swallow. The type of alcohol is called ethanol. There are religious objections to using alcohol in mouthwash and therefore alcohol-free mouthwashes contain ingredients such as Cetylpyridinium Chloride abbreviated as CPC.
Early evidence reports that Hippocrates recommended a mixture of salt and vinegar together with Alum in order to create a compound which could be used as a mouthwash. Later on other people then started to add different ingredients to this basic formula such as leaves, milk, wine, different oils and even peels from fruit. An interesting fact is that even urine was used as a key ingredient and this is because urine contains ammonia which helps to kill the bacteria which produce sulphur and which are responsible for bad breath. It was also recommended to use urine from a child as that was more effective as a mouthwash. Eventually as mouthwashes became a bit more sophisticated the common ingredients used to contain clove oil and essential oil such as peppermint or tea tree.
A big breakthrough came in 1960 when ICI demonstrated that chlorhexidine which is a chemical, could prevent plaque building up in the very first place. So this is when chlorhexidine started to become widely available in order to reduce plaque which helps to fight gingivitis bad breath and periodontitis. More recently the tide has turned slightly in that natural ingredient are becoming more prevalent in mouthwashes and there is a lot of debate as to which is better, a synthetic ingredient or a natural ingredient in the fight against gum disease. Chlorhexidine molecules attach onto oral tissues and this prevents oral bacteria from binding.
However about 50 years prior to this in the early 1900s two scientists named Joseph Lawrence and Jordan Wheat Lambert produced a popular mouthwash and they named it Listerine. Listerine contains 4 oils which are menthol, eucalyptus, eucalyptus and thymol. Initially this formula was used as a general antiseptic however it soon became discovered that they also eradicated germs in the mouth. Listerine is still one of the most widely used mouthwashes for gum disease, ulcers and bad breath.
What do mouthwashes contain?
Chlorhexidine also known as Corsodyl
Chlorhexidine is an antimicrobial agent. It is effective against both gram-positive and gram-negative bacteria. It is active against both anaerobic and aerobic bacteria. In addition it will attack fungi, yeasts and some viruses. It is therefore extremely useful as a mouthwash. An important feature of chlorhexidine is that it inhibits the formation of plaque on tooth surfaces in the first place. It is important to realise that it does not kill the bacteria in plaque but it prevents the formation of plaque in the very first place. Chlorhexidine also known as corsodyl is therefore best used after brushing especially at night when you won't be having anything else to eat or drink for another 8 hours.
Chlorhexidine has a good safety record in that it is very safe and has low toxicity. Chlorhexidine however does have certain disadvantages and side effects.
Benzydamine hydrochloride This is also known as Difflam mouthwash and it is extremely useful in that it numbs certain areas of the mouth up. This means it is good at sore throats or if you have pain or ulceration in your mouth because it has the anaesthetic and analgesic properties. In addition it is also anti-inflammatory and antibacterial. It does not have any significant side effects.
Essential oils
Essential oils in many mouthwashes are based on essential oils which contain ingredients such as thymol, menthol and eucalyptus oil. The solvent is usually alcohol. Essential oils have a broad spectrum of antibacterial activity and therefore they stop bacteria from multiplying. They also destroy the bacterial cell walls and the bacterial enzymes themselves. Mouthwashes which contain essential oils are primarily used to reduce bad breath and to combat gingivitis bacteria. They have very little side effects however you should not swallow significant quantities of this mouthwash and also the ethanol can cause irritation and dryness in some patients.
Cetylpyridinium Chloride
Cetylpyridinium Chloride also has the effect of reducing plaque formation in the very first place in the same manner as chlorhexidine. However it's plaque inhibit reaction is short-lived in comparison to chlorhexidine and this is because the molecule starts to breakdown and therefore becomes less active as time goes on. It also weakens the plaque attachment which can then be easily removed by toothbrushing. This means if your tooth brushing is not as effective as it should be this mouthwash will help to reduce the amount of plaque forming and also help to keep the plaque off your teeth in the first place.
Triclosan
Triclosan has a number of properties which are useful in mouthwashes. Experiments have shown that it is anti-inflammatory and therefore gingivitis and gum disease which produces inflammation can therefore be inhibited by this ingredient. Triclosan also causes the mouthwash to stick better to the gums and hold on closer and therefore it increases its activity for a longer period of time. Triclosan also has an effect against mouth ulcers in that it reduces the pain and the healing times.
Hydrogen Peroxide Mouthwashes
Hydrogen peroxide works by releasing oxygen molecules. These oxygen molecules help to kill bacteria called anaerobic bacteria which don't require oxygen to survive. In fact the oxygen helps to kill anaerobic bacteria. Anaerobic bacteria are strongly implicated in gingivitis and periodontitis. The hydrogen peroxide mouthwash has an effect when the oxygen is released so that it starts to loosen any debris or staining and as well as killing the bacteria. It is therefore recommended for conditions such as ulcers or pain caused by dentures and also for teeth whitening.
Povidone-Iodine mouthwashes
Povidone-iodine mouthwashes are not very common but they do have a good broad-spectrum antibacterial activity against bacteria, fungi and viruses. The iodine causes damage to the bacterial cell membrane and therefore these mouthwashes reduce plaque formation and reduce the severity of inflammation caused by gingivitis.
Antibacterial Peroxidase mouthwashes
Antibacterial peroxidase mouthwash contains certain enzymes. These enzymes are lysozyme, lactoferrin, lactoperoxidase and glucose oxidase. These enzymes act against the peroxidase in bacteria. They are therefore useful in conditions of dry mouth, ulcers and bad breath or halitosis.
Fluoride mouthwashes
Nearly all mouthwashes available nowadays contain a certain concentration of the chemical called fluoride. Fluoride is the chemical that makes the enamel off your teeth hard and therefore less likely to become decayed or attacked by acids in the mouth. The fluoride is in different forms such as sodium fluoride or acidulated phosphate fluoride. When your tooth enamel becomes attacked by acid, the acid weakens the enamel but a fluoride mouthwash will actually help to remineralize the enamel surface. The remineralization of the enamel surface is better than the natural enamel because it contains fluoroapatite and fluoro hydroxyapatite which makes the enamel more difficult to acid attack. The disadvantage of fluoride however is that it should not be ingested especially by children as you can get fluoride toxicity over a long period of time.
Sodium Bicarbonate
Sodium bicarbonate has a high pH and is therefore alkaline. It therefore increases the pH of saliva and this reduces the growth of bacteria especially those which thrive in a low pH environment. Sodium bicarbonate mouthwash is advocated and recommended for patients who have dry mouth and also for those who suffer from tooth wear called erosion.
Alcohol in mouthwashes
Most mouthwashes contain a certain percentage of alcohol in the form of ethanol. The ethanol acts as a preservative and solvent for the various ingredients in the mouthwash. The concentration of alcohol ranges from 5% to about 27%. As well as being a preservative and solvent, the alcohol has broad antibacterial activity against bacteria, viruses and fungi.
One study suggested there may be a direct Association between the alcohol content of mouthwashes and the risk of developing mouth cancer. There are been more detailed studies to see if there is a risk of alcohol in mouthwashes and oral cancer. We know for a fact that the risk of developing mouth or throat cancer is 9 times greater in smokers. In addition it is 5 times more greater than those who drink alcohol. Overall the studies show that there is no strong correlation between the use of alcohol mouthwash and the risk of developing mouth cancer. However mouthwashes containing alcohol have a number of disadvantages.
Mouthwashes for bad breath and Halitosis
Nearly everyone will suffer from bad breath also called halitosis. Over 90% of bad breath is caused by conditions in the mouth itself rather than systemic conditions. Within the mouth it is the tongue and the tongue coating that harbours bacteria which are responsible for the bad breath. In addition, the presence of gum disease or decayed teeth including dry mouth are responsible for the other percentage which cannot be attributed directly to bacterial coatings on the tongue.
Mouthwashes are mainly used to combat bad breath.
The main active ingredients in the mouthwashes are usually antibacterial agents such as chlorhexidine, set up iridium chloride, chlorine dioxide, hydrogen peroxide, essential oils and triclosan.
Unfortunately, mouthwashes for bad breath are only a very temporary measure and the mouthwash effect will only last 1 or 2 hours at a maximum. It is therefore important that you see a dentist who can find out the exact cause of your bad breath and give appropriate advice and treatments. This advice may be the treatment for gum disease or treatment of a cavity that is collecting bacteria and food and causing the bad breath.
References:
.
A mouthwash is a liquid that is held in the mouth and moved around vigorously in order to provide a healthier feeling in your mouth and also to reduce the bacteria in the oral cavity.
A mouthwash is not designed to be swallowed however after you have used the mouthwash it is best to spit out but not to rinse out with water afterwards so that remnants of the mouthwash can carry on working after you have eliminated the mouthwash by spitting out. The best time to use a mouthwash is therefore at night-time when you are not going to be eating or drinking again for another 6 to 8 hours and also during the night, the mouth becomes dry which causes the proliferation of bacteria so a mouthwash will help to put a lid on this.
Most mouthwashes go a little further and provide extra benefits:
- Halitosis or bad breath.
- Mouth sores and ulcers.
- After dental treatment.
- After a tooth extraction.
- Tooth decay.
- Gum disease. Gingivitis and periodontitis.
- Teeth sensitivity.
- For Dry Mouth
- Tooth whitening
Most mouthwashes have more than one function so for example a particular mouthwash may be used for bad breath but also to prevent tooth decay.
Mouthwashes are made from different ingredients and some of these ingredients will be the active ingredients. As well as medicated ingredients other ingredients are needed to make the mouthwash stabilise itself such as preservatives. The exact combination and flavour and the purpose of the mouthwash will vary from Brand to brand. So at one time there were very few mouthwashes however nowadays there is a huge range of mouthwashes and whole shelves are dedicated in shops chemists in supermarkets just for mouthwashes. There are even alcohol-free versions and versions for vegetarians.
The most important information to take with you is that mouthwash is not a replacement to regular brushing. I will repeat that because it is so important. A mouthwash is definitely not a replacement to brushing and flossing. No matter how good a mouthwash is claiming to be, it will never ever replace regular brushing. This means you still need to concentrate mainly on brushing twice a day for at least 2 minutes 4 minutes and also to use floss or use interdental brushes once a day as well. The whole point of brushing your teeth is to physically remove the plaque and bacteria which grows on your teeth and your fillings and your crowns and even your dental implants. Only a toothbrush gets under the gums where plaque builds up to cause gum problems. The plaque or bacteria is Sticky and therefore it cannot be removed by swishing a liquid around your mouth in order to get rid of it. Even the mouthwashes that work against gingivitis and periodontitis, they still do not remove plaque. It is important to know that brushing your teeth will clean about 70% of your tooth surface and the other 30% is therefore cleaned using interdental cleaning or dental floss. The mouthwash is therefore an adjunctive to brushing and flossing which is the most important in the very first place.
History of mouthwash
The very earliest form of mouthwash was the most simplest and easily available mouthwash. This mouthwash is of course cold water. Water was used by the Stone Age and Bronze age and Iron Age eras to get rid of food particles after eating.
Eventually people started to add ingredients which claimed had beneficial effects in preserving your gums and your teeth. We do have evidence that the ancient Egyptians, Greeks, Roman and Chinese cultures used to use charcoal, herbs and dried flowers as ingredients all mixed together to produce a mouthwash. It was really at the beginning of the 1900s when oral Healthcare started to take a commercial step forward because this is when toothpaste was first becoming more common and therefore mouthwash was also being produced. Back then and even now, alcohol was the ingredient that was used to stabilize the mouthwash. You didn't want to buy a mouthwash only to find that within a few days it had gone off, so alcohol is added in order to preserve the mouthwash so that it does last a lot longer. Today there are other ingredients that can be used instead of alcohol and these are called alcohol-free mouthwashes. Another reason for using alcohol-free mouthwashes is that some people have a dry mouth found that the alcohol can make the mouthwash get more dry mouth. The amount of alcohol is important to know, is extremely tiny and you certainly can't become drunk on it however much you swallow. The type of alcohol is called ethanol. There are religious objections to using alcohol in mouthwash and therefore alcohol-free mouthwashes contain ingredients such as Cetylpyridinium Chloride abbreviated as CPC.
Early evidence reports that Hippocrates recommended a mixture of salt and vinegar together with Alum in order to create a compound which could be used as a mouthwash. Later on other people then started to add different ingredients to this basic formula such as leaves, milk, wine, different oils and even peels from fruit. An interesting fact is that even urine was used as a key ingredient and this is because urine contains ammonia which helps to kill the bacteria which produce sulphur and which are responsible for bad breath. It was also recommended to use urine from a child as that was more effective as a mouthwash. Eventually as mouthwashes became a bit more sophisticated the common ingredients used to contain clove oil and essential oil such as peppermint or tea tree.
A big breakthrough came in 1960 when ICI demonstrated that chlorhexidine which is a chemical, could prevent plaque building up in the very first place. So this is when chlorhexidine started to become widely available in order to reduce plaque which helps to fight gingivitis bad breath and periodontitis. More recently the tide has turned slightly in that natural ingredient are becoming more prevalent in mouthwashes and there is a lot of debate as to which is better, a synthetic ingredient or a natural ingredient in the fight against gum disease. Chlorhexidine molecules attach onto oral tissues and this prevents oral bacteria from binding.
However about 50 years prior to this in the early 1900s two scientists named Joseph Lawrence and Jordan Wheat Lambert produced a popular mouthwash and they named it Listerine. Listerine contains 4 oils which are menthol, eucalyptus, eucalyptus and thymol. Initially this formula was used as a general antiseptic however it soon became discovered that they also eradicated germs in the mouth. Listerine is still one of the most widely used mouthwashes for gum disease, ulcers and bad breath.
What do mouthwashes contain?
Chlorhexidine also known as Corsodyl
Chlorhexidine is an antimicrobial agent. It is effective against both gram-positive and gram-negative bacteria. It is active against both anaerobic and aerobic bacteria. In addition it will attack fungi, yeasts and some viruses. It is therefore extremely useful as a mouthwash. An important feature of chlorhexidine is that it inhibits the formation of plaque on tooth surfaces in the first place. It is important to realise that it does not kill the bacteria in plaque but it prevents the formation of plaque in the very first place. Chlorhexidine also known as corsodyl is therefore best used after brushing especially at night when you won't be having anything else to eat or drink for another 8 hours.
Chlorhexidine has a good safety record in that it is very safe and has low toxicity. Chlorhexidine however does have certain disadvantages and side effects.
- It causes a brown discoloration of the teeth including onto fillings and the tongue.
- It alters the taste Sensation so foods and drinks may not taste the same after you have used chlorhexidine.
- if you have an ulcer it can sometimes irritate the ulcer.
- it tastes quite strong and may not be agreeable to everyone.
Benzydamine hydrochloride This is also known as Difflam mouthwash and it is extremely useful in that it numbs certain areas of the mouth up. This means it is good at sore throats or if you have pain or ulceration in your mouth because it has the anaesthetic and analgesic properties. In addition it is also anti-inflammatory and antibacterial. It does not have any significant side effects.
Essential oils
Essential oils in many mouthwashes are based on essential oils which contain ingredients such as thymol, menthol and eucalyptus oil. The solvent is usually alcohol. Essential oils have a broad spectrum of antibacterial activity and therefore they stop bacteria from multiplying. They also destroy the bacterial cell walls and the bacterial enzymes themselves. Mouthwashes which contain essential oils are primarily used to reduce bad breath and to combat gingivitis bacteria. They have very little side effects however you should not swallow significant quantities of this mouthwash and also the ethanol can cause irritation and dryness in some patients.
Cetylpyridinium Chloride
Cetylpyridinium Chloride also has the effect of reducing plaque formation in the very first place in the same manner as chlorhexidine. However it's plaque inhibit reaction is short-lived in comparison to chlorhexidine and this is because the molecule starts to breakdown and therefore becomes less active as time goes on. It also weakens the plaque attachment which can then be easily removed by toothbrushing. This means if your tooth brushing is not as effective as it should be this mouthwash will help to reduce the amount of plaque forming and also help to keep the plaque off your teeth in the first place.
Triclosan
Triclosan has a number of properties which are useful in mouthwashes. Experiments have shown that it is anti-inflammatory and therefore gingivitis and gum disease which produces inflammation can therefore be inhibited by this ingredient. Triclosan also causes the mouthwash to stick better to the gums and hold on closer and therefore it increases its activity for a longer period of time. Triclosan also has an effect against mouth ulcers in that it reduces the pain and the healing times.
Hydrogen Peroxide Mouthwashes
Hydrogen peroxide works by releasing oxygen molecules. These oxygen molecules help to kill bacteria called anaerobic bacteria which don't require oxygen to survive. In fact the oxygen helps to kill anaerobic bacteria. Anaerobic bacteria are strongly implicated in gingivitis and periodontitis. The hydrogen peroxide mouthwash has an effect when the oxygen is released so that it starts to loosen any debris or staining and as well as killing the bacteria. It is therefore recommended for conditions such as ulcers or pain caused by dentures and also for teeth whitening.
Povidone-Iodine mouthwashes
Povidone-iodine mouthwashes are not very common but they do have a good broad-spectrum antibacterial activity against bacteria, fungi and viruses. The iodine causes damage to the bacterial cell membrane and therefore these mouthwashes reduce plaque formation and reduce the severity of inflammation caused by gingivitis.
Antibacterial Peroxidase mouthwashes
Antibacterial peroxidase mouthwash contains certain enzymes. These enzymes are lysozyme, lactoferrin, lactoperoxidase and glucose oxidase. These enzymes act against the peroxidase in bacteria. They are therefore useful in conditions of dry mouth, ulcers and bad breath or halitosis.
Fluoride mouthwashes
Nearly all mouthwashes available nowadays contain a certain concentration of the chemical called fluoride. Fluoride is the chemical that makes the enamel off your teeth hard and therefore less likely to become decayed or attacked by acids in the mouth. The fluoride is in different forms such as sodium fluoride or acidulated phosphate fluoride. When your tooth enamel becomes attacked by acid, the acid weakens the enamel but a fluoride mouthwash will actually help to remineralize the enamel surface. The remineralization of the enamel surface is better than the natural enamel because it contains fluoroapatite and fluoro hydroxyapatite which makes the enamel more difficult to acid attack. The disadvantage of fluoride however is that it should not be ingested especially by children as you can get fluoride toxicity over a long period of time.
Sodium Bicarbonate
Sodium bicarbonate has a high pH and is therefore alkaline. It therefore increases the pH of saliva and this reduces the growth of bacteria especially those which thrive in a low pH environment. Sodium bicarbonate mouthwash is advocated and recommended for patients who have dry mouth and also for those who suffer from tooth wear called erosion.
Alcohol in mouthwashes
Most mouthwashes contain a certain percentage of alcohol in the form of ethanol. The ethanol acts as a preservative and solvent for the various ingredients in the mouthwash. The concentration of alcohol ranges from 5% to about 27%. As well as being a preservative and solvent, the alcohol has broad antibacterial activity against bacteria, viruses and fungi.
One study suggested there may be a direct Association between the alcohol content of mouthwashes and the risk of developing mouth cancer. There are been more detailed studies to see if there is a risk of alcohol in mouthwashes and oral cancer. We know for a fact that the risk of developing mouth or throat cancer is 9 times greater in smokers. In addition it is 5 times more greater than those who drink alcohol. Overall the studies show that there is no strong correlation between the use of alcohol mouthwash and the risk of developing mouth cancer. However mouthwashes containing alcohol have a number of disadvantages.
- They should not be accidentally swallowed by young children.
- the alcohol content can form on the breath and therefore it could change the readings of a breath test.
- The alcohol in the mouthwash has been shown to reduce the hardened hardness of a filling that is used commonly in the mouth by dentists called composite and resin Restorations. The alcohol may also alter the colour of the composite fillings.
- The alcohol can also be a disadvantage for religious reasons.
Mouthwashes for bad breath and Halitosis
Nearly everyone will suffer from bad breath also called halitosis. Over 90% of bad breath is caused by conditions in the mouth itself rather than systemic conditions. Within the mouth it is the tongue and the tongue coating that harbours bacteria which are responsible for the bad breath. In addition, the presence of gum disease or decayed teeth including dry mouth are responsible for the other percentage which cannot be attributed directly to bacterial coatings on the tongue.
Mouthwashes are mainly used to combat bad breath.
The main active ingredients in the mouthwashes are usually antibacterial agents such as chlorhexidine, set up iridium chloride, chlorine dioxide, hydrogen peroxide, essential oils and triclosan.
Unfortunately, mouthwashes for bad breath are only a very temporary measure and the mouthwash effect will only last 1 or 2 hours at a maximum. It is therefore important that you see a dentist who can find out the exact cause of your bad breath and give appropriate advice and treatments. This advice may be the treatment for gum disease or treatment of a cavity that is collecting bacteria and food and causing the bad breath.
References:
- https://www.pharmaceutical-journal.com/The-Pharmaceutical-Journal/8.issue
- https://www.sciencedirect.com/science/article/pii/S1013905217301025
- https://www.sciencedirect.com/journal/the-journal-of-the-american-dental-association/vol/146/issue/8
- https://www.sciencedirect.com/journal/journal-of-evidence-based-dental-practice
- https://www.sciencedirect.com/journal/dental-clinics-of-north-america/vol/59/issue/4
- http://www.contempclindent.org/article.asp?issn=0976-237X;year=2015;volume=6;issue=4;spage=505;epage=509;aulast=Priya
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