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Paging Dr. Frischer - Mouthwash
WRITTEN BY :   Dr. Alan Frischer

Many of us use mouthwash. Is it safe? Does it help? Is one really any different from another?
Mouthwash is most commonly used as a breath freshener. However, manufacturers claim that it can be used as an anti-plaque mouth rinse that kills bacteria, which could lead to cavities, gingivitis (gum inflammation), periodontitis (gum disease), as well as bad breath. Some also use fluoride to protect against tooth decay. Mouthwash, of course, doesn’t replace brushing and flossing. The American Dental Association states that regular brushing and proper flossing are sufficient for most of us, although it has given its approval for many non-alcohol containing mouthwashes.
As far back as around 2700 BCE, Ayurvedic and Chinese medicine refer to mouthwash as a treatment for gingivitis. Much later, the upper class ancient Greeks and Romans used it (Hippocrates recommended a mixture of salt, alum, and vinegar), and still later, in about the year 300, the Jewish Talmud suggested a cure for gum ailments containing dough water and olive oil.
The science of mouthwash took a leap ahead in the 17th century, when Anton van Leeuwenhoek used a microscope to discover living organisms on teeth (dental plaque). He also found living organisms in water from the canal near his home in Delft. When he added vinegar or brandy to the infected water, it resulted in the immediate death of the organisms. However, when he rinsed his own mouth with a solution containing vinegar and brandy, he found that the living organisms survived. His conclusion was that his mouthwash either did not reach or was not present long enough to kill the plaque organisms.
In the late 1960’s, a professor at the Royal Dental College in Denmark demonstrated that chlorhexidine, a compound that strongly adheres to surfaces in the mouth, prevents the build-up of dental plaque. An explosion in the use of mouthwash followed, and today there are a number of products that appear to be effective in reducing the build-up of plaque, and in improving bad breath as well.
Listerine was the very first mouthwash sold over-the-counter, marketed in the 1920’s as a cure for bad breath. It also claimed in its ads that users had half as many colds as non-users. It wasn’t until 1976 that the Federal Trade Commission ruled that this was not true; it was not effective for sore throat relief or cold prevention. Listerine was ordered to stop making these claims, and to include in the next $10.2 million dollars of ads the statement: “contrary to prior advertising, Listerine will not help prevent colds or sore throats or lessen their severity.”
Most mouthwash is colored, which masks the bacteria and debris that is spit out! Each mouthwash differs slightly, but most contain alcohol, chlorhexidine gluconate, hydrogen peroxide, fluoride, enzymes, calcium, as well as other chemicals. Most are sweetened with sorbitol, sucralose, and/or xylitol. Some contain as much as 26% alcohol – note that this is enough to cause one to fail a breathalyzer test. Also note that alcohol is a drying agent, so it may even make bad breath worse. Many brands are now alcohol-free.
Does mouthwash come with health risks? Swallowing mouthwash (as opposed to gargling and spitting) is not recommended, due to the alcohol, artificial colors, sugars, fluoride and other chemicals. As mentioned above, it may contain as much as 26% alcohol, and smoking and alcohol are well-established risk factors for oral cancers. A recent review in the Dental Journal of Australia concluded that there is a connection between mouthwash with alcohol, and an increased risk of oral cancers.However, at this time, the American Dental Association (ADA) has not issued a specific opinion one way or the other.
While mouthwashes containing alcohol have been shown to be effective in reducing plaque and oral bacteria, they are likely no better than those that do not contain alcohol. Also, given the potential risks, a number of natural alternative mouthwash products have been developed. Herbal products with persica, home remedies with salt and hydrogen peroxide, baking soda, and natural products including Tom’s of Maine are available.
So where does this leave us? As usual, my answer is to use moderation and common sense. Until there is conclusive evidence either way, choose alcohol-free mouthwash, use as directed by your dentist, and be on the lookout for more information.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Published: Aug. 22, 2013 – Volume 12 – Issue 19

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