Best Types of Mouthwash

It’s probably the most common question I get as a dentist: "which mouthwash should I be using?" Or, "is this mouthwash good?"

The answer often depends on what your needs are. People look to mouthwash as a breath freshener or to stop bad breath, but mouthwash is also used to stop bleeding gums, tooth decay, and some are used for teeth whitening.

One big misconception is that mouthwash can remove plaque from your teeth and gums. Swishing a mouthwash may have antibacterial action, but won’t remove plaque itself, so it should never replace brushing and flossing.

Before using any mouthwash you should go through these steps:

1. Determine the primary reason for using mouthwash. Is it to treat a condition or simply to prevent dental disease?
2. Consult your dentist. You should first gain a diagnosis of your problem and get your healthcare provider's recommendation before using a mouthwash.
3. Read the label carefully: be judicious in understanding what is in the product.
4. Follow the directions.

The health claims and benefits of mouthwash vary quite a bit, so let’s see which contains what and if they live up to their claims.

Mouthwashes With Alcohol

Alcohol is one of the most common mouthwash ingredients. The thought is that alcohol kills bacteria that cause diseases in the mouth, but alcohol in mouthwash isn’t the active ingredient. Alcohol is present to help diffuse other active ingredients, like essential oils.

Most alcohol mouthwashes are used to freshen breath and fight bleeding gums or gum disease.

Bleeding gums and bad breath are due to the presence of certain types of bacteria in the mouth. The problem is that little is known about the specific mode of action alcohol has against them. Generally, it’s believed that alcohol destroys bacterial cell walls, but it’s not known whether it is effective against those that cause gum disease and bad breath.

Alcohol mouthwash has drawn widespread concern regarding alcoholic content being a risk factor for oral cancer. There is research to show that alcohol makes the mouth's cells more vulnerable to cancer-causing agents. When alcohol is broken down, the product is acetaldehyde, a known human carcinogen.

There can be temporary side effects of alcoholic mouthwash, such as:

• Taste disturbances
• Tooth staining
• The sensation of a dry mouth
• Worsening bad breath: Alcohol-containing mouthwashes may make dry mouth and halitosis worse since they dry the mouth out more. Soreness, ulcerations, and redness may sometimes occur.

Do your best to avoid alcoholic mouthwashes. They aren't particularly effective against gum disease or bad breath and may increase the risk of oral cancer.

Chlorhexidine Mouthwash

Chlorhexidine is an antibacterial used as an active ingredient in certain mouthwash brands. It is a broad spectrum antimicrobial with particular use against bacteria that cause gum disease.

Dentists do sometimes employ chlorhexidine mouthwash to treat patients with gum disease. Studies have shown it can reduce inflammation caused by periodontal bacteria.

One concern is that chlorhexidine may not be that effective against the particular bacteria known to cause bad breath.

Long-term use of chlorhexidine mouthwash is known to cause tooth and tongue swelling. It can also alter or decrease taste and cause dry mouth. In some patients, it can increase the build-up of dental tartar. This may be due to shifts in oral bacteria. It may also interact with toothpaste ingredients, so should always be used separately.

Some people experience rash or burning sensations, in which case use should be ceased immediately.

Chlorhexidine mouthwash may be helpful in treating gum disease, however, it is not effective for bad breath. It should always be used under guidance from your dental professional.

Fluoride Mouthwash

Many types of mouthwash contain fluoride to help prevent tooth decay.

Fluoride has been shown to be effective in preventing tooth decay, with five to 50 percent less dental decay. However, it should only be used in high-risk cases. 

Situations where fluoride rinses may be effective are:

• For orthodontic patients: this is a good alternative (or supplement) to foam tray applications if you are having orthodontic treatment.
• Moderate to high caries risk, including for elderly patients and early enamel caries
• Partial dentures
• Patients with xerostomia

It’s important that you don’t accidentally swallow fluoride-containing mouthwash, as it can be toxic. Fluoride mouthwash should be avoided in children under seven because the chance is too high that they will swallow it. The daily rinses are probably the most effective and contain about 0.05 percent fluoride. Weekly or fortnightly mouth rinses at 0.2 percent are also available.

Fluoride rinses probably only have a significant effect if you are at an increased risk of dental caries and certainly should not be used as a substitute for brushing with a fluoride toothpaste—you need to do both. Fluoride-containing mouthwash should only be used for patients with high-risk tooth decay. It should be taken under direction from your dental professional.

Hydrogen Peroxide Mouthwash

Hydrogen peroxide is the active ingredient found in most household cleaning products. It has wide anti-microbial properties due to its oxidizing chemical action. Oxidation acts to damage and kill bacterial cells.

It has been proven safe at one to three percent concentrations. The problem is that people have very different reactions to hydrogen peroxide and safe use depends on proper dilution. Studies suggest that there may be a slight decrease in gum inflammation. There also may be a slight teeth whitening effect.

Hydrogen peroxide is known to cause damage to the cells of the dental pulp. It can cause the tooth nerves to become infected and eventually die (called pulpitis). Do your best to avoid hydrogen peroxide mouthwash. There doesn’t seem to be enough research on the benefits to balance the risks that hydrogen peroxide mouthwash has.

Essential Oils

Essential oils are extracted from plants that are known to have aromatic or healing properties. Some mouthwashes do have essential oils added to their ingredients. However, you can make your own by adding drops of essential oils to the water.

Essential oils contain the "essence of" the plant's fragrance—which is characteristic of the plant from which it is derived. Their properties include antioxidant, antimicrobial, and anti-inflammatory actions. These healing oils are rapidly growing in popularity because they act as natural medicine without any side effects.

Generally, these mouthwashes are considered as safe as they are natural products. Some essential oils have been found to have particular antibacterial properties that may make them useful as a mouthwash. These include:

• Peppermint oil
• Spearmint oil
• Clove oil
• Eucalyptus oil

Essential oils mouthwash may be a good breath freshener. You shouldn’t solely rely on essential oil mouthwash ahead of oral hygiene practice, though.

Salt Water Mouthwash

Salt water is an isotonic solution, which means it contains the same salts and minerals as our body fluids and won’t irritate your gums.

Salt water is commonly used and recommended after dental extraction. The anti-bacterial properties seem to decrease dental infections and gum inflammation, as well as a dry socket. Warm salt water is known to help with sore throats and tonsils. It also can alleviate mouth sores or ulcers.

As it has a low pH, salt water may help to treat bad breath. Bacteria that cause bad breath require a high pH in the mouth in order to thrive. You can make a mixture at home by adding ½ a teaspoon of salt to a cup of warm water. You can do this two to three times and repeat up to four times a day. Salt water is a good DIY option for keeping your mouth feeling fresh and clean.

Other Considerations When Using Mouthwash

Other Ingredients: Most mouthwashes contain other chemicals that help to increase shelf life or give it a desirable color. You should read the label carefully to make sure you know all of the ingredients in the type you are using. If you have an adverse reaction it could be due to one of these substances.

Detergents: Water-soluble cleansing agent combines with impurities and dirt to make them more soluble. It’s stated that they loosen residue that has accumulated on teeth; however, this claim isn’t heavily supported. Common detergents are listed on labels as sodium benzoate and sodium lauryl sulfate. There are concerns about the safety of consuming these chemicals and some people do report adverse reactions.

Flavors: Artificial flavoring will give the mouthwash it’s color and taste. They don’t contribute to its action or effectiveness and may have adverse reactions.

Preservatives: These prevent the growth of bacteria in the mouthwash. Common preservatives are sodium benzoate or methylparaben. They don't contribute to the action of the mouthwash.

Water: Water is used to dissolve and carry the other ingredients.

Do Benefits Outweigh the Cost?

If you are brushing and flossing regularly to maintain your dental health, outside of treating harmful disease the benefits of mouthwash don’t seem to be particularly helpful. People who use mouthwash for bad breath, in particular, don’t see much benefit in their condition. They also may be worsening their bad breath. Unfortunately, for the most part, mouthwashes don’t live up to the advertised hype.

When used in conjunction with a treatment plan with your dentist, some may be effective, otherwise, stick to a good diet, brush your teeth, and floss to keep your teeth healthy.