Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth. Usually mouthwashes are antiseptic solutions intended to reduce the microbial load in the mouth, although other mouthwashes might be given for other reasons such as for their analgesic, anti-inflammatory or anti-fungal action. Additionally, some rinses act as saliva substitutes to neutralize acid and keep the mouth moist in xerostomia (dry mouth). Cosmetic mouthrinses temporarily control or reduce bad breath and leave the mouth with a pleasant taste. Rinsing with water or mouthwash after brushing with a fluoride toothpaste can reduce the availability of salivary fluoride. This can lower the anti-cavity re-mineralization and antibacterial effects of fluoride. Fluoridated mouthwash may mitigate this effect or in high concentrations increase available fluoride, but is not as cost-effective as leaving the fluoride toothpaste on the teeth after brushing. A group of experts discussing post brushing rinsing in 2012 found that although there was clear guidance given in many public health advice publications to "spit, avoid rinsing with water/excessive rinsing with water" they believed there was a limited evidence base for best practice.
Use
Common use involves rinsing the mouth with about 20–50 ml (0.7–1.7 US fl oz) of mouthwash. The wash is typically swished or gargled for about half a minute and then spat out. Most companies suggest not drinking water immediately after using mouthwash. In some brands, the expectorate is stained, so that one can see the bacteria and debris. Mouthwash should not be used immediately after brushing the teeth so as not to wash away the beneficial fluoride residue left from the toothpaste. Similarly, the mouth should not be rinsed out with water after brushing. Patients were told to "spit don't rinse" after toothbrushing as part of a National Health Service campaign in the UK. A fluoride mouthrinse can be used at a different time of the day to brushing. Gargling is where the head is tilted back, allowing the mouthwash to sit in the back of the mouth while exhaling, causing the liquid to bubble. Gargling is practiced in Japan for perceived prevention of viral infection. One commonly used way is with infusions or tea. In some cultures, gargling is usually done in private, typically in a bathroom at a sink so the liquid can be rinsed away.
Serious harm and even death can quickly result from ingestion due to the high alcohol content and other substances harmful to ingestion present in some brands of mouthwash. Zero percent alcohol mouthwashes do exist, as well as many other formulations for different needs (covered in the following sections). These risks may be higher in toddlers and young children if they are allowed to use toothpaste and/or mouthwash unsupervised, where they may swallow it. Misuse in this way can be avoided with parental admission or supervision and by using child-safe forms or a children's brand of mouthwash. Surrogate alcohol use such as ingestion of mouthwash is a common cause of death among homeless due to the inclusion of toxic substances in these products.
Effects The most commonly used mouthwashes are commercial antiseptics, which are used at home as part of an oral hygiene routine. Mouthwashes combine ingredients to treat a variety of oral conditions. Variations are common, and mouthwash has no standard formulation, so its use and recommendation involves concerns about patient safety. Some manufacturers of mouthwash state that their antiseptic and antiplaque mouthwashes kill the bacterial plaque that causes cavities, gingivitis, and bad breath. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both brushing and flossing. The American Dental Association asserts that regular brushing and proper flossing are enough in most cases, in addition to regular dental check-ups, although they approve many mouthwashes. For many patients, however, the mechanical methods could be tedious and time-consuming, and, additionally, some local conditions may render them especially difficult. Chemotherapeutic agents, including mouthwashes, could have a key role as adjuncts to daily home care, preventing and controlling supragingival plaque, gingivitis and oral malodor. Minor and transient side effects of mouthwashes are very common, such as taste disturbance, tooth staining, sensation of a dry mouth, etc. Alcohol-containing mouthwashes may make dry mouth and halitosis worse, as they dry out the mouth. Soreness, ulceration and redness may sometimes occur (e.g., aphthous stomatitis or allergic contact stomatitis) if the person is allergic or sensitive to mouthwash ingredients, such as preservatives, coloring, flavors and fragrances. Such effects might be reduced or eliminated by diluting the mouthwash with water, using a different mouthwash (e.g. saltwater), or foregoing mouthwash entirely. Prescription mouthwashes are used prior to and after oral surgery procedures, such as tooth extraction, or to treat the pain associated with mucositis caused by radiation therapy or chemotherapy. They are also prescribed for aphthous ulcers, other oral ulcers, and other mouth pain. "Magic mouthwashes" are prescription mouthwashes compounded in a pharmacy from a list of ingredients specified by a doctor. Despite a lack of evidence that prescription mouthwashes are more effective in decreasing the pain of oral lesions, many patients and prescribers continue to use them. There has been only one controlled study to evaluate the efficacy of magic mouthwash; it shows no difference in efficacy between the most common magic-mouthwash formulation, on the one hand, and commercial mouthwashes (such as chlorhexidine) or a saline/baking soda solution, on the other. Current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief and in shortening the healing time of oral mucositis from cancer therapies. Beyond the sanitization effects, the use of antiseptic mouthwash can disrupt the oral microbiome and interfere with the regulated production of nitric oxide (NO), which in turn increase cardiovascular, and Alzheimer's disease health risks.
History
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