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Oral Rinses: Mouth Rinses and Mouthwashes

An oral rinse (mouth rinse or mouthwash) is a liquid solution that you swish around your entire mouth – teeth, gums and tongue – to help promote oral hygiene, reduce oral discomfort, provide moisture to oral tissues or help with bad breath. Oral rinses may be purchased over-the-counter (OTC) or via prescription, and can be categorized as cosmetic, therapeutic or a combination of the two.

Your dentist may recommend or prescribe certain types of oral rinses if you are at high risk of tooth decay, gum inflammation, dry mouth (xerostomia, a lack of saliva that can cause an increased risk of tooth decay) or gum disease. An oral rinse also may be prescribed following oral surgery or periodontal treatments (such as scaling or root planing) in order to promote healing, reduce microbial load and help with discomfort. Additionally, many therapeutic oral rinses are strongly recommended for people who cannot brush due to physical impairments or medical conditions.

Cosmetic Oral Rinses

Cosmetic oral rinses, available as commercial, OTC solutions, may temporarily control or reduce bad breath (halitosis), rinse away oral debris, diminish bacteria in your mouth and leave it with a pleasant, refreshing taste. Some oral rinses contain whiteners to help whiten the teeth. Whitening your teeth may improve your appearance, but it will not provide oral health benefits.

Some cosmetic oral rinses are available without alcohol, but many contain high concentrations of alcohol ranging from 18 to 26 percent – more than the percentage found in some alcoholic beverages. Most cosmetic oral rinses also contain a flavoring agent, such as saccharin to provide a pleasant taste, and astringents like zinc chloride to constrict pores, and may create a protective layer of firm tissue between the under layers of tissue and the elements.

Cosmetic oral rinses mask rather than eliminate bad breath. Their odor-masking effects typically last no more than three hours. If you have persistent bad breath, contact your dentist or doctor, as this may be a sign of an oral infection or a medical condition such as diabetes or a respiratory tract infection.

Cosmetic oral rinses that contain some of the active ingredients found in rinses designed to treat oral health conditions (i.e., fluoride to help strengthen teeth and prevent cavities) also double as therapeutic rinses.

Therapeutic Oral Rinses

Offering the same benefits as cosmetic oral rinses, therapeutic oral rinses – available in non-prescription and prescription formulations – contain added active ingredients to help prevent or treat various oral health conditions and diseases. Therapeutic oral rinses are regulated by the Food and Drug Administration (FDA) and are voluntarily approved by the American Dental Association (ADA).

Therapeutic oral rinses usually fall into one of the following categories:

  • Anti-plaque/anti-gingivitis: This type of therapeutic rinse has been shown to control bacterial plaque and reduce and inhibit gingivitis, a form of gum (periodontal) disease. Many of these rinses contain chlorhexidine gluconate, the most effective plaque-fighting drug yet tested, and are available by prescription only. They may have an unpleasant taste or leave a bitter aftertaste in your mouth. These solutions usually include alcohol, although they may be available without alcohol. They are recommended for short-term use of six months or less.
  • Anti-cavity: This type of therapeutic oral rinse or mouthwash contains fluoride, which helps strengthen teeth and prevent decay. Anti-cavity rinses are available OTC and by prescription (offering a higher-concentration of fluoride). If you are at high risk of tooth decay or wear an orthodontic appliance (such as dental braces or Invisalign), your dentist may recommend that you regularly use an anti-cavity rinse in addition to your daily oral hygiene regimen.
  • Anti-tartar: Containing agents such as zinc citrate, these therapeutic oral rinses reduce the buildup of tartar, the hard, sticky buildup of food and bacteria that can form on your teeth.
  • Antibacterial/antimicrobial/antibiotic mouth rinses or chemotherapeutic mouthwashes: These types of oral rinses reduce bacterial count and inhibit the bacterial activity that can cause gum disease.

Other types of therapeutic oral rinses may provide relief from oral pain. In addition, topical antibiotic rinses, enzyme rinses and artificial saliva rinses are also available by prescription.

Natural/Herbal Oral Rinses

If you prefer natural/herbal products, there are numerous options from which to choose, including those offered by The Natural Dentist and Tom’s of Maine. Soothing and mild yet effective, natural oral rinses do not contain alcohol, harsh chemicals, dyes or preservatives. They often contain herbs with beneficial properties and alternative ingredients.

For instance, Xylitol, a natural sweetener derived from the fibrous parts of plants, has a sweet taste similar to sugar, but is low in calories and has a low glycemic index (GI) of seven (as opposed to sugar’s 83). Foods with low GI carbohydrates – the ones that cause only minor fluctuations in your glucose and insulin levels – help decrease your chance of developing heart disease and diabetes, as they help maintain your weight loss. Additionally, clinical and laboratory studies indicate that Xylitol helps reduce the risk of tooth decay and promotes oral health. Recently several chewing gums have entered the marketplace that contain Xylitol and are promoted as reducing decay.

How Effective are Oral Rinses?

Dental experts differ on the effectiveness of oral rinses for improving oral health. Most dental organizations – including the ADA and the Academy of General Dentistry (AGD) – concur that the benefits of oral rinses depend on the type of rinse used. For instance, both groups agree that fluoride rinses reduce bacteria that cause cavities and that use of a cosmetic oral rinse will freshen breath for several hours. However, some oral rinses can stain or cause discoloration to teeth.

Also, while some anti-cavity rinses have been clinically proven to fight up to 50 percent more cavity-causing bacteria, initial studies have demonstrated that most OTC anti-plaque rinses and antiseptics are not much more effective against plaque and gum disease than simply rinsing with water. The ADA emphasizes that cosmetic oral rinses merely mask – not eliminate – bad breath for a few hours. Many dental experts consider the use of fluoride toothpastes as sufficient anti-cavity protection for most individuals.

Despite such statements, many dentists recommend that their patients use an oral rinse as part of their regular oral health regimen. Just keep in mind that an oral rinse is intended to be a supplement to, not a replacement for, daily tooth brushing and flossing.

Since there are many oral rinse products on the market claiming various actions and abilities, check for the ADA seal of acceptance. The ADA seal vouches that the oral rinse product has been evaluated by an independent body of scientific experts (the ADA Council on Scientific Affairs) for safety and effectiveness according to objective guidelines. The ADA seal statement on product packaging or bottling tells you why the ADA has given its seal to this product. All claims on labeling have been reviewed and approved by the ADA; the list of ingredients have likewise been reviewed and approved for safety and effectiveness. Products with the ADA seal must say what they do and their ingredients must live up to those claims.

How to Rinse Properly

According to the ADA, the order in which you brush, floss and rinse does not make a big difference. Most people, though, prefer to brush and floss teeth before using an oral rinse. Teeth should be as clean as possible before applying an anti-cavity oral rinse in order to get the full preventative benefits.

  • Check the oral rinse’s label for recommendations on how and when to use the product, and look for products that have the ADA’s seal of acceptance.
  • Measure the proper amount of rinse recommended on the bottle or by your dentist. Do not dilute.
  • Close lips and, keeping your teeth slightly apart, swish the liquid around your mouth. Make sure to swish vigorously and thoroughly so that the rinse reaches the front and sides of your mouth equally.
  • Being careful not to swallow, gargle by raising your chin and saying “aahh” while holding the rinse in your mouth. This is especially good for reaching the back of your tongue, where bacteria may accumulate.
  • Continue rinsing for about 30 seconds, then completely spit the rinse from your mouth.
  • Avoid rinsing, eating or smoking for 30 minutes after using an oral rinse, as this will lessen its effectiveness.

Are Oral Rinses Safe?

Oral rinses are typically safe, but they may cause certain side effects. These are more likely to occur with prescription-strength rinses, but they may also occur with OTC products.

If you or your child experiences any adverse reactions to an oral rinse, stop using it immediately and consult your dentist. He/she may be able to recommend alternative treatments based on your particular dental needs. Serious side effects can require immediate emergency medical treatment. Side effects include:

  • Staining of teeth and/or dental restorations
  • Changes in taste sensation
  • Tartar buildup on the teeth
  • Burning sensation in the cheeks, teeth and gums
  • Drying of mouth tissue
  • Mouth and tongue irritation, numbness or soreness
  • Mucosal erosions
  • Sodium retention
  • Swollen glands on the side of the face or neck
  • Sensitivity of tooth roots
  • Mouth ulcers

Most commercial oral rinses contain alcohol, which may be lethal when swallowed in large quantities by children. Anti-cavity rinses with sodium fluoride can lead to fluoride toxicity when taken excessively or swallowed. Since children tend to accidentally swallow oral rinses, children 12 years and younger should not use them. Ask your child’s dentist or pediatrician to recommend some oral rinses specifically formulated for children.

Symptoms of an oral rinse overdose include:

  • Breathing problems, such as deep breathing, rapid shallow breathing, slowed breathing or breathing stoppage
  • Gastrointestinal problems, such as abdominal pain, diarrhea, nausea and vomiting
  • Nervous system problems, such as coma, dizziness or drowsiness
  • Bluish skin, particularly lips and fingernails
  • Collapse
  • Convulsions
  • Decreased blood pressure (hypotension)
  • Less-frequent urination
  • Excessive sweating and thirstiness
  • Trouble walking normally
  • Slurred speech

There have been some concerns that the essential oils in oral rinses may damage dental restorations, such as braces, dentures or dental fillings, but studies have shown this concern to be unfounded. Concerns also have been raised about the risk of oral cancer due to the alcohol content in oral rinses. According to the ADA, oral rinses “containing more than 25 percent alcohol could increase the risk of oral and pharyngeal cancers by about 50 percent,” but more clinical evidence is required to substantiate this claim. Regardless of cancer concerns, oral rinses containing alcohol should be avoided by people with voice problems, dry mouth, women who are pregnant, individuals with porcelain restorations (since it causes a breakdown of the restoration’s glossy finish) and children.