Report: Mouthwash improving oral hygiene?

When the person you're talking to decides to chew on some gum or mints and offers you some, too, does she think her breath smells bad — or is she hinting yours does?

It is a vexing and often taboo topic. The market offers some solutions with mouthwashes offering new combinations of ingredients.

However, what's the truth about mouthwashes? Is the alcohol content in mouthwashes a cause for grave concern?

It is true that some mouthwashes will dry the mouth and that can eventually lead to even more bad breath, but consider this: a mouthwash, even if it has alcohol content, stays in the mouth for just about 5 seconds before being spit out. Compare this with the pints of alcohol consumed by people everyday who still live on for many years. Are the mouthwash health concerns then, really so valid?

Should one use mouthwash? And if yes then which one?

Mouthwashes come in many varieties. From simple breath fresheners to products that can really influence oral health—a

variety of mouthwashes are available in the market.

Mouthwashes fall into two basic categories: cosmetic and therapeutic.

The cosmetic rinses you find in the supermarket are usually

formulated to temporarily freshen breath. Although they can aid in removing food particles embedded in teeth, their primary purpose is to mask mouth odour.

How and when to use a mouthwash

• Only use if and as prescribed;

• Only use specific products which have been recommended by the doctor;

• Too much use is discouraged (be careful about how much you are using and how many times in a day);

• Discontinue after the specific problem is resolved;

• Use only under supervision of a doctor;

• Listerine is high in alcohol therefore its use tends to dry the mouth. If used long term it would aggravate the problem of bad breath;

• Use after brushing, last thing at night, if you want a fresh breath at waking, in the morning;

• Do not make the use of mouthwash a habit.

Types of mouth rinses

The fluoride mouth-rinses:Non-prescription therapeutic mouth rinses often contain fluoride for decay prevention or active ingredients to reduce dental plaque, tooth sensitivity or gingivitis, the early stage of gum disease. Most fluoride mouth rinses on the market contain sodium fluoride, which provides extra protection against dental decay.

Fluoride containing mouth rinses help to prevent dental decay. They may be recommended for:

• Children having orthodontic treatment,

• Children with high caries risk. A.M.-P.M. Junior (Elder) mouthwash contains 0.03% Triclosan and 0.05% Sodium Fluoride,

• Patients suffering from dry mouth specially—seniors;

• Patients who have undergone radiation therapy.

However, children who can't spit out mouthwashes should never be given the mouthwash as fluoride ingestion is harmful.

Chlorhexidine mouthwash:Chlorhexidine is an active ingredient in some mouthwashes that has an antimicrobial effect and may prevent gingivitis. However, long-term use of chlorhexidine may stain teeth, alter taste sensation and cause recurrent ulceration of the oral tissues.

• Chlorhexidine mouthwash has an unpleasant taste,

• It alters taste sensation,

• Produces brown stains on teeth, which are very difficult to remove. This can also affect the mucous membranes and tongue and may be related to the precipitation of chromogenic dietary factors onto the teeth and mucous membranes. Due to this reason, it is important for patients using Chlorhexidine mouthwash to avoid the intake of tea, coffee and red wine during the duration of its use.

Anti-microbial mouthwash:an antibiotic mouthwash can be used after brushing and flossing to reduce bacteria in the mouth.

Desensitising mouth rinses:contain active ingredients such as potassium nitrate to reduce tooth sensitivity.

Benzydamine mouthwash:may be helpful as a local anaesthetic and can ease the discomfort caused by inflammation of the mouth lining resulting from chemotherapy.

For more information about which mouthwash is right for you it is best to seek a dentist's advice.

Antiplaque or anti-microbial mouthwash:Used to inhibit bacterial plaque formation and prevent or resolve chronic gingivitis. They can affect only supra gingival plaque. So they have no role in the treatment of existing periodontal disease, since they cannot either reach the sub gingival environment or penetrate thick layers of established plaque. In these situations, they are used after supra and sub gingival scaling has been done, rendering the tooth surfaces clean, in order to maintain this situation for a short period when the soreness of the gingiva may prevent effective mechanical plaque control.

When to use antiplaque mouthwashes

Antiplaque mouthwashes are used to replace mechanical tooth brushing when this is not possible in the following situations:

• In cases of acute oral mucosal and gingival infections,

• After periodontal or oral surgery and during the healing period,

• After cosmetic jaw surgery or intermaxillary fixation used to treat jaw fractures,

• For mentally and physically handicapped patients,

• As an adjunct to normal mechanical brushing in situations where this may be compromised by discomfort or inadequacies.

Types of antiplaque mouthwashes

•Mouth washes containing essential oils:Listerine (Parke Davis), one of the oldest mouth washes available, is an essential oil/phenolic mouth wash. It has been shown to have moderate plaque inhibitory effect and some anti-gingivitis effect. Its lack of profound plaque inhibitory effect is because it has poor oral retention.

• Oxygenating agents like Hydrogen peroxide, buffered Sodium peroxyborate and Peroxy carbonate in mouth washes have a beneficial effect on acute ulcerative gingivitis, probably by inhibiting anaerobic bacteria. However mouthwashes containing hydrogen peroxide are not recommended now based on the fact that they produce nascent oxygen and thus free radicals that can be carcinogenic.

• Chlorhexidine molecule gets absorbed onto the oral surfaces and gets released at bactericidal level over prolonged periods. Due to this process, Chlorhexidine has antiplaque properties unsurpassed by other agents.

Different brands of Chlorhexidine available in the market are Rexidin (Warren), Clohex (Group) and A.M.-P.M (Elder).

Povidone Iodine

Povidone Iodine appears to have no significant plaque inhibitory activity when used as 1% mouthwash and the absorption of significant levels of iodine through the oral mucosal may make this compound unacceptable for prolonged use in the oral cavity. It could cause problem of iodine sensitivity in sensitised individuals.

Piodin (Glaxo Wellcome), Povidine Gargle (Stadmed) are povidone iodine mouth washes available in the market.

Risks from alcohol in mouthwash

Most mouthwashes contain pharmaceutical grade alcohol, as a preservative and as a semi-active ingredient. Significant amounts of alcohol contained in many mouthwashes can lead to certain disadvantages. Care should be taken that they are not accidentally swallowed, especially by children, to avoid toxicity. Small children should not be advised mouth washes, because they are not able to spit it out properly. More over, most children have good gingival health.

Because of known links between alcohol consumption plus tobacco smoking and oral and pharyngeal cancer, it has been suggested that the frequent use of alcohol containing mouth washes might increase the incidence of this form of cancer.

Lastly, alcohol-containing mouthwashes have been shown to reduce the hardness of composite and hybrid resin restorations.

Lately, there have been fears of mouthwashes being the cause of oral cancer. The alcohol content in mouthwashes have been linked to increased risk of developing of cancers of the mouth. When the mouthwash is swished around in the mouth, some of its carcinogenic content can remain in the mouth, accumulate in oral cavity and cause oral cancer, reports point out.

"Top-selling mouthwashes can cause oral cancer and should be pulled from supermarket shelves immediately"

Australia's leading independent experts have issued this strong warning after investigating latest scientific evidence linking alcohol-containing mouthwashes to the deadly disease.

Their review, published in the Dental Journal of Australia, concludes there is now "sufficient evidence'' that "alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer''.

The ethanol in mouthwash is thought to allow cancer-causing substances to permeate the lining of the mouth more easily and cause harm.

Acetaldehyde, a toxic by-product of alcohol that may accumulate in the oral cavity when swished around the mouth, is also believed to be carcinogenic.

Listerine, the nation's biggest-selling mouthwash and a brand endorsed by the Australian Dental Association (ADA), contains as much as 26 per cent alcohol.

A Brazilian study has also found regular mouthwash use is associated with oral cancer regardless of alcohol or tobacco consumption. They said the role of ethanol in causing DNA damage needed to be explored further. A review in the Journal of Occupational Medicine and Toxicology last year said it would be "prudent, precautionary public-health policy to generally refrain from using ethanol in (mouthwash) products'' because of  "doubts about the safety of alcohol-containing oral products''.

In another study, researchers from the Bahrain Ministry of Health reviewed results from five studies with participants who were randomly given mouthwashes or placebo; 293 people in Thailand, the U.S, the Netherlands, Spain, and Israel took part.

According to background information provided by the researchers, halitosis is widespread around the world: Up to half of people in the U.S. say they have bad breath, 50-60% of people in France complain of it, and 24% of Japanese say it's a problem.

The participants in the data review were adults over 18 years old who did not have any serious chronic gum or mouth diseases or other conditions such as diabetes, which can bring on bad breath.

The studies were two, four, or six weeks long.

What researchers found when they compared data is that the type of mouthwash can make a difference in either masking or eliminating bad breath.

"We found that antibacterial mouth rinses, as well as those containing chemicals that neutralise odours, are actually very good at controlling bad breath," the study researcher said.

Researchers also found:

Mouthwash containing antibacterial ingredients such as chlorhexidine and cetylpyridinium did the job of getting rid of bad breath better than a placebo. This is likely due to decreasing the amount of bacteria in the mouth responsible for bad breath.

Mouthwash with chlorine dioxide and zinc helped to wipe out bad smells by neutralising them.

Bad breath is caused by bacteria and traces of food that collect in the back of and creases of the tongue. Researchers write that these particles and bacteria then "break down into volatile sulphur compounds," which are responsible for the smell.

Mouthwashes: prices at a glance

Brand

Quantity

Price

Per ml cost

Cool Mint Listerine

250 ml

Rs 85

0.34 paise

Senquel AD(Desensitising mouthwash)

200 ml

Rs 50.50

0.24 paise

Hexidine Antispetic/Antiplaque

(Chlorhexidine mouthwash)

160 ml

Rs 49.75

0.31 paise

Tantum Oral Rinse

(Benzydamine mouthwash)

120 ml

Rs 49

0.40 paise

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