When should I use mouthwash, how and what to use?

Daily use of mouthwash is commonplace for many and there are multiple types of mouthwash available in the market. And these are some of the questions about mouthwash which are commonly asked:

1. Should I use mouthwash daily?
2. How should I use mouthwash properly?
3. How to choose the best mouthwash for myself?

So, here are the answers for the questions!

When Should You Use Mouthwash?

Mouthwash is effective in reducing dental plaque and gum inflammation. It can be used to supplement the usual ways of teeth cleaning which are brushing and cleaning [1].

However, rinsing with mouthwash cannot replace daily brushing and flossing [2]. The need for using mouthwash every day is questionable. In fact, it is recommended only in certain conditions like bad breath, gum disease, high risk of getting tooth decay and for other therapeutic purposes (eg. postsurgery, denture stomatitis and oral mucositis).

According to American Dental Association (ADA), children younger than the age of 6 should not use mouthwash as they may swallow large amount of liquid unintentionally, unless directed by a dentist.

Due to the alcohol content in some mouthwash, swallowing large amount of the liquid can result in adverse health concerns such as dizziness, nausea, vomiting or even coma.

Rinse before or after brushing? 

Mouthwash can be used before or after brushing based on personal preference or manufacturer’s instruction [2]. 

However, certain mouthwash like Chlorhexidine gluconate mouthwash should be used after brushing to maintain their effectiveness for a longer period [3]. 

If mouthwash is used after brushing, you should wait for at least 30 minutes before you rinse with mouthwash. This is to keep the fluoride from the toothpaste for some time inside the mouth before it is rinsed off by the mouthwash. [4]. The exception to this is when you use fluoride mouthwash containing at least 100ppm fluoride. This can be used even soon after brushing [5]. 

Using mouthwash during pregnancy

The pregnant woman can use mouthwash upon the dentist’s recommendation. 

It is suggested to use the neutral sodium fluoride, alcohol-free mouthwash to strengthen the enamel and to reduce the risk of tooth decay in the pregnant woman [6].

Using mouthwash when wearing braces?

White spots (sign of early tooth decay) may appear on teeth during braces treatment. This is because of the difficulty in keeping the area around the braces attachments clean.

Thus, daily use of 0.05% sodium fluoride mouthwash is good for people with fixed braces to reduce the occurrence and severity of white spot lesions [7]. 

Using Mouthwash Properly

If you are using mouthwash every day, are you using it correctly and effectively? Let’s get started with using mouthwash correctly from today onwards by knowing the proper way!

How frequent should you use mouthwash?

It depends on the types of mouthwash used and the manufacturer’s instructions. 

Generally, the frequency of using fluoride mouthwash (for preventing tooth decay) is based on its fluoride concentration. Using mouthwash which contains 230ppm of fluoride daily OR 900ppm of fluoride weekly is efficacious in reducing tooth decay [8].

For a 0.12% Chlorhexidine gluconate mouthwash (for treating gum disease), rinse it twice a day with a 12-hour interval. This time interval was recommended because studies have proved that it could stay in the mouth sufficiently for this amount of time [9].

How long should you rinse?

You should always follow the manufacturer’s instruction. Generally, the duration of rinsing is 30 second to 1 minute.

Eat immediately after using mouthwash?

It is recommended not to rinse, eat or drink anything for 30-45 minutes after rinsing to avoid washing out the active ingredients.

Choosing the Best Mouthwash for Yourself

There are countless brands of mouthwash available in the market. Because of the marketing and the advertisement, we are prone to selecting mouthwash based on the brands we are familiar to. However, we should select the mouthwash based on the purpose of using it. There are two ways of doing this. One is to look for the effect claimed by the manufacturer on the package. Another one is to know the active ingredients and then choose the one which is suitable for your condition.

In the following sections, I will explain to you some active ingredients present in the common mouthwash and the use of mouthwash for each condition in the tables below.

If you are buying the products over-the-counter, it is suggested to look for mouthwashes that have the ADA Seal of Acceptance which shows that the product is effective and safe.

American Dental Association (ADA)

Types of mouthwash

Generally, there are 2 types of mouthwash: cosmetic and therapeutic [2]. 

Cosmetic mouthwash only temporarily controls bad breath, and the effect does not persist due to the lack of antimicrobial property. On the other hand, the therapeutic mouthwash can help to reduce bad breath, dental plaque, gum disease and tooth decay due to the presence of certain active ingredients.

Active ingredients in ‘therapeutic’ mouthwash

Different active ingredients may be present in different types of therapeutic mouthwash to serve their specific purposes. The following table lists down the active ingredients commonly used in mouthwash with their effects and advantages [3].

Mouthwash for your condition

The type of mouthwash suggested is based on your mouth condition. Let’s have a look at the following table which shows the most common conditions that you may encounter and the recommended mouthwash for each of them [2-3].

Is alcohol-containing mouthwash dangerous?

Alcohol intake has been associated with several types of cancers [9]. Thus, concern arises about whether the use of alcohol-containing mouthwash increases risk of head and neck cancer. Currently, there is no strong evidence that shows alcohol-containing mouthwash can cause mouth cancer. Anyways, the alcohol component of mouthwash may not provide more benefit when compared to other active ingredients in terms of plaque and gingivitis control [10].

Side Effects of Mouthwash

Certain active ingredients in mouthwash may cause some unwanted effects, as shown in the following table. Thus, it is imperative to consult your dentist for the suitable type of mouthwash for you and the period of use.

Conclusion

Remember, the best mouthwash for others may not be the best for you. There are many brands out there in the market. They can have different functions, duration and methods of use along with different side effects. What is really important is to understand your own condition, know the active ingredients you need, and then choose the mouthwash accordingly, so that you can achieve the results that you want.

Reference

1. Prasad M, Patthi B, Singla A, Gupta R, Jankiram C, Kumar JK, Vashishtha V, Malhi R. The clinical effectiveness of post-brushing rinsing in reducing plaque and gingivitis: a systematic review. Journal of clinical and diagnostic research: JCDR. 2016 May;10(5):ZE01.
2. Mouthwash (Mouthrinse) [Internet]. American Dental Association. 2021 [cited 26 March 2021]. Available from: https://www.ada.org/en/member-center/oral-health-topics/mouthrinse.
3. Parashar A. Mouthwashes and their use in different oral conditions. Scholars Journal of Dental Sciences. 2015;2(2B):186-91.
4. How to keep your teeth clean [Internet]. National Health Service. 2018 [cited 27 March 2021]. Available from: https://www.nhs.uk/live-well/healthy-body/how-to-keep-your-teeth-clean/
5. Pitts N, Duckworth RM, Marsh P, Mutti B, Parnell C, Zero D. Post-brushing rinsing for the control of dental caries: exploration of the available evidence to establish what advice we should give our patients. British Dental Journal. 2012 Apr;212(7):315-20.
6. American Academy of Pediatric Dentistry. Oral health care for the pregnant adolescent. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2020:267-74.
7. Benson PE, Parkin N, Dyer F, Millett DT, Furness S, Germain P. Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. Cochrane Database of Systematic Reviews. 2013(12).
8. Marinho VC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2016(7).
9. Alcohol and Cancer Risk [Internet]. National Cancer Institute. 2018 [cited 21 June 2021]. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet
10. Werner CD, Seymour RA. Are alcohol containing mouthwashes safe? British dental journal. 2009 Nov;207(10):E19-.