Smiling's never been so easy

We hear it all the time---you need to visit your dentist twice a year at a minimum, brush your teeth at least twice a day and that you have to floss daily. But have you ever wondered why we are very rarely reminded to diligently use mouthwash?

Anyone who has ever been to a dental appointment or has seen the advertisements of several mouthwash brands out in the market would already have a fair idea about what mouthwashes are and what they are for. Marketing ads tend to portray mouthwash as the best quick fix to bad breath before that all-important job interview or a first date. And we typically experience using mouthwash after tooth extraction or get prescribed the best mouthwash for receding gums. Other than that…is mouthwash necessary for our everyday life? It seems almost commonsensical, but could there be other mouthwash benefits besides a clean mouth and fresh breath?

In celebration of National Dental Hygiene Month this October, here are the top 5 reasons why antimicrobial mouthwash is a superhero that should be a part of your dental hygiene routine:

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Mouthwash reaches areas hardly reached by the toothbrush

Brushing will always be the number one dental hygiene must-do, no doubt about that. But did you know that only about 25% of the mouth is reached by the almighty toothbrush? Sure, flossing helps rid of food debris but using a mouth rinse, particularly an antimicrobial mouthwash might just be the key to true, whole-mouth clean that lasts for hours.

Many people doubt this and ask, is mouthwash necessary? The short of it is a yes and no. For certain oral or dental concerns (e.g. post-dental surgery, gum disease) it is deemed necessary and is prescribed by the dentist together with any antibiotic medicine to fight off infection. But for most of us, it is considered an additional step in the daily hygiene routine, albeit a very powerful one.

Using a mouthwash makes a world of difference, especially when it comes to those who wear braces, retainers, dental implants and dentures. Mouthwash loosens up food particles or debris that tend to get stuck or hidden in orthodontic devices which makes it easier to brush these away. Mouthwashes, especially the antimicrobial kind help inhibit the buildup of plaque that usually causes massive problems for wearers of dental implants. In the same manner, using mouthwash as the last step after brushing helps with any spots that the toothbrush might have missed and amplifies the fresher and cleaner mouth feeling.

Antimicrobial mouthwash is packed with active ingredients that do more than just make your mouth smell good and feel extra clean

Not all mouthwashes are created equal. In broad terms, there are two types of mouthwash: cosmetic mouthwash and therapeutic mouthwash. Cosmetic mouthwash, as the name suggests, is the kind that gives you temporary benefits such as a pleasant taste, clean mouth feel and fresh breath (for a limited time). On the other hand, therapeutic mouthwash such as the antimicrobial mouthwash is formulated with active ingredients that target specific oral conditions such as bad breath, tooth decay, plaque, gingivitis and many more.

Some of the active ingredients that may be included in therapeutic mouthwash are:

  • cetylpyridinium chloride – an antiseptic ingredient that targets bacteria and other microorganisms that cause bad breath
  • chlorhexidine gluconate – a germicidal component that helps control plaque and treat inflammation and bleeding from gingivitis
  • essential oils – may help with issues such as gingivitis and plaque; some examples of essential oils included in mouthwash are menthol, eucalyptol, thymol and methyl salicylate
  • fluoride – a well-researched ingredient that promotes remineralization and prevents tooth decay
  • peroxide – an antiseptic that helps to address irritations from mouth sores and minor cuts; also known to help whiten teeth
  • zinc salts, ketone, terpene and ionone – ingredients that inhibit the increase of odor-causing compounds
  • zinc lactate – when combined with cetylpyridinium chloride and chlorhexidine, may reduce bad breath and alleviate teeth stains
  • local topical anesthetics  – provides topical pain relief due to oral lesions, irritations and mouth ulcers; examples of these are lidocaine, benzocaine/ butamben/ tetracaine hydrochloride, dyclonine hydrochloride, phenol, sodium hyaluronate, polyvinylpyrrolidone and glycyrrhetinic acid

The combinations of these active ingredients affect the extent of the effects the mouthwash can have. While many antimicrobial mouthwashes have to be prescribed, there are over-the-counter antimicrobial rinses that can handle the mildest issues and reduce the amount of bacteria in the mouth. Some studies have also indicated that mouthwashes with chlorhexidine and antibiotics reduce the need for periodontal surgery for people with mild gum disease.

This article from the National Institute for Health Research explains this in more detail.

Antimicrobial mouthwash greatly helps in the healing and prevention of specific mouth diseases

For those times when you are in a hurry and need a quick breath freshener before a meeting, presentation or a big date, cosmetic mouthwash will obviously do the trick. However, for the prevention and treatment of irritation, inflammation or infection, antimicrobial mouthwash is a must.

Here is a quick rundown of other specific concerns that antimicrobial mouthwash can to address:

  1. Pericoronitis, aphthous ulcers, pain and irritation from braces – those who wear braces, retainers or other orthodontic devices are more prone to infection and irritation because the inside of the mouth can get scraped by the wires. Peroxide in mouthwash can help heal minor cuts on the insides of the cheeks, irritation of the gums and prevent further infections
  2. Halitosis or bad breath, also known as oral malodor, can be caused by a lot of things but the biggest causal factor is something called volatile sulfur compounds (VSCs) which can come from the normal breakdown of food, dental plaque and oral bacteria. Average cosmetic breath fresheners and mouthwashes can mask the bad odor and give a pleasant flavor on the mouth but do not address the root cause which is the bacteria or VSCs -- only antimicrobial mouthwash can address this.
  3. Alveolar Osteitis (AO) – commonly called dry socket, this is a condition that some may experience after dental extraction, especially the extraction of the third molar. It is theorized that bacteria causes fibrin clot decomposition, which is why it becomes unstable and dislodged. Dry socket brings about intense pain in the area of extraction for around 2-3 days post operation.  A 2018 study available in the National Center for Biotechnology Information (NCBI) of the US National Library of Medicine found that the use of chlorhexidine is effective to prevent AO, even without the use of antibiotics.
  4. Xerostomia – decrease in the amount of saliva which increases the possibility for the development of caries or dental cavities. For this concern, dentists recommend mouthwash with fluoride or those that contain cellulose derivatives or enzymes that relieve symptoms. Alcohol-free mouth rinses are also highly encouraged since alcohol tends to be drying.
  5. Whitening – aside from getting rid of bacteria present in the mouth, antimicrobial mouthwashes may also aid in the reduction of stains on the teeth, especially when active ingredients like carbamide peroxide or hydrogen peroxide are present. Dentists could prescribe mouthwashes with 10% carbamide peroxide or 1.5 to 2 % hydrogen peroxide.

Another study done in 2015, also available in the NCBI found that using mouthwash with hydrogen peroxide for 12 weeks saw color changes over time. You may view the article here.

It does not take much effort for a mouthwash to be effective

When used as a part of daily oral hygiene routine, it only takes about 30 to 60 seconds of rinsing—it really is that quick! So if it is really that quick and easy, why isn't it used by everyone? Well, maybe because most of us still have questions about its effectiveness and use.

One of the most asked questions about mouthwashes is if is supposed to be used before or after brushing your teeth. Some people will say that it does not really matter while others will point out that there is a recommended sequence which can better maximize the effectiveness of the active ingredients present in the mouthwash.

So, should mouthwash be used before OR after brushing your teeth? The simple answer to that question is it depends on what you are trying to achieve or address.

For specific concerns, dentists may recommend definitive regimens based on the severity and any factors affecting the disease. For example, for people with gum diseases such as periodontitis, it is recommended to use the mouthwash with chlorhexidine at night as a final rinse. That means no more eating, drinking or brushing after the mouthwash. Why the strict ruling? This is because the active ingredient chlorhexidine works most effectively when left in contact with the gums overnight.

Here is a quick look at the pros and cons of swishing before or after brushing your teeth:

Using mouthwash BEFORE brushing your teeth

Pro: Using mouthwash as a pre-rinse before brushing gives a better chance of breaking down food particles left in the mouth, therefore making it easier for the toothbrush to scrub away plaque and reach harder spots. You may think of it kind of like how you would pre-soak or pre-rinse dirty dishes or dirty laundry before putting them in their respective washers.

Con: Brushing your teeth after using mouthwash may cancel out the effects of the active ingredients present in it.

Using mouthwash AFTER brushing your teeth

Pro:  Using mouthwash as a final rinse helps to make sure that all the residue will be cleaned out and that the areas possibly missed by your toothbrush will be reached. Swishing after brushing also helps disinfect the mouth, and in a way keeping it germ-free for a much longer period of time.

Con: If the mouthwash you are using has alcohol, swishing after brushing may leave the mouth dry or with a stinging sensation.

Some people decide to use mouthwash both before and after brushing, in hopes of getting as much of the particles out and killing as much nasty bacteria as possible. There is really no absolute right or wrong as long as you use mouthwash together with regular brushing and flossing.

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There are a lot of mouthwash brands to choose from

The consumer market today offers so many choices when it comes to products specifically for dental and oral hygiene, sometimes maybe even TOO many! When you visit drug stores or supermarkets, what you see is a wide aisle of dental hygiene products, from toothpaste to floss to even teeth whitening devices! This fact could not be truer for mouthwashes. There are a lot of brands for you to choose from that it is no surprise if you end up trying one after the other.

While there is not much harm in doing so, it would be beneficial to know just what kind of mouthwash you actually need to be able to address the current dental issues you have. It would be best to check with your dentist for guidance before even trying a newly marketed mouthwash.

A good basis of this is a 2015 research published in the Iranian Journal of Public Health tried several types of mouthwash brands with different active ingredients. Researchers compared three (3) different types of mouthwashes available for consumers. These are 0.2% chlorhexidine (CHX), Listerine®, and Persica (PM). It was found that both CHX based mouthwash and Listerine® have significantly reduced the bacterial counts within one (1) and four (4) hours after dental volunteers.

Simply put, the results revealed that mouthwashes are effective in reducing and maintaining low bacterial counts in the mouth. While all three (3) mouthwash types might decrease the number of bacteria in the oral cavity, it still needs to be said that the presence of commensal bacteria in the oral cavity is also important. So the constant need to maintain very low bacterial counts in the mouth is still under debate. You can find the full text of the research in this NCBI link.

But even with helpful research such as the above, the following questions still remain:

  • Should I get an antimicrobial mouth rinse?
  • How can I choose a mouthwash that is just right for me?
  • When will i be able to see results?

Let us try to answer these questions one by one.

Should i get an antimicrobial mouth rinse?

Yes, Chlorhexidine and any antimibrobial mouthwash will be very beneficial to you, especially if your recent dentist appointment involves deep cleaning (i.e. scaling and root planing) or if your dentist just gave you a diagnosis of moderate to severe periodontal disease (e.g. gingivitis, periodontitis).

How can I choose a mouthwash that is just right for me?

Just like any other personal care product, it is often difficult to find that one product that ticks all the boxes. The rule of thumb here is to select a mouth rinse based on the biggest issue that needs treatment.

Rule number one is to only buy products with the American Dental Association (ADA) seal on its label. ADA only awards this recognition to companies that have thoroughly researched and provided scientific basis that their products actually work as intended.

If you prefer natural or organic products, there are also some mouth rinses that are ADA recognized. Some generic or drug store brands also have the ADA seal so best watch out for this when you are out shopping for your toiletries.

To provide you with an even better idea when it comes to choosing the right mouthwash for your dental and oral health, here are a few tips:

  • You can get a hold of therapeutic or antimicrobial mouthwash both over-the-counter and by prescription, depending on the specific formulation. For example, you can most likely find a mouthwash with essential oils in regular stores while mouthwash containing active ingredients such as chlorhexidine may only be bought with a dentist’s prescription.
  • The power of an antimicrobial mouth rinse is intense as compared to over-the-counter cosmetic mouthwash in a sense that it can reduce certain types of gum-disease causing bacteria to a level that’s almost undetectable. Chlorhexidine is most commonly prescribed by dentists, but should be guided by careful instruction on how to integrate it in an oral health treatment plan.
  • A mouth rinse that contains alcohol tend to be more drying. The secret to using this is to dilute the solution with water at a 70 to 20 ratio of mouthwash to water. This way, you still get the effectiveness of the product while lessening the drying effect of the incorporated alcohol content.
  • Your preferred schedule of using a mouth rinse would still be up to you. Just follow the all important rules in the product labels such as not swallowing the solution after swishing.
  • Aside from having clean teeth, mouthwash can also be used to clean your aligners. To do this, soak your aligners for a few minutes then rinse them under cold water then brush off remaining residue with your toothbrush. You might want to use clear mouthwash though, because colored ones have the tendency to stain the aligners, which you wouldn't really want.

When will I be able to see results?

The important thing to remember when it comes to results is to always consider the severity of the condition you are looking to treat. If your condition is simply temporary like bad breath due to eating spicy food then a quick swish of a cosmetic mouthwash can give instant results.

But if you are looking to treat a more serious condition like tonsil stones, gingivitis or even periodontitis, then it might take a few days to a couple of weeks to show results. If your goal is to whiten your teeth or prevent bleeding gums, waiting a few weeks with constant use is for the best. Remember that severe gum diseases and serious mouth conditions may require further treatment to be able to fully recover.

So in conclusion, we have established that antimicrobial mouthwashes are indeed the superheroes of dental and oral hygiene. Scientists and product experts have formulated these to ensure we get the best results and get the most out of what we paid for.

Once again, here are the top 5 reasons why antimicrobial mouthwash is a superhero in dental hygiene:

It can go to hard to reach areas of the mouth

It is packed with active ingredients that do far more than freshen your breath

It aids in healing mouth conditions while preventing further complications

Little effort is required from you for a mouthwash to work its magic

You will never run out of options when it comes to mouthwash

As a final note, while there are many benefits to using mouthwash, there are also precautions to be observed. Here are a few reminders from the American Dental Association:

  • Children below six (6) years of age are not recommended to use mouthwash. Very young children are still developing their swallowing reflex, so they are more prone to swallowing the mouthwash which may cause intoxication, vomiting and nausea.
  • An antimicrobial mouthwash should not be used as a replacement for brushing your teeth and flossing daily.
  • Prescription types of mouthwash should be used only as directed by your trusted dentist. Missing a dose, altering the frequency, amount or rinse time of the prescription could also affect the expected outcomes.
  • When choosing from several mouthwash brands it pays to look for the American Dental Association (ADA) Seal of Acceptance, which indicates that the product has been tested for safety and effectivity of its claims.

Dental and oral hygiene plays a widely important role in your overall body health. Keep in mind that what can start out as a simple mouth irritation or sore gums could escalate to more serious health problems like periodontitis that can further lead to or affect any chronic illness (i.e. diabetes). So it is best to prevent them with proper oral hygiene with the winning combination of brushing, flossing and rinsing with a mouthwash.

So why not include a rinse with an antimicrobial mouthwash as a part of your daily routine?  You might be surprised at how big a world of difference it can make not just on your overall body health but also to your confidence and better overall disposition.

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