Mouthwash
Template:Short description Template:Other uses Template:Use dmy dates
Mouthwash, mouth rinse, oral rinse, or mouth bath<ref name=pmid12856008>Template:Cite journal</ref> 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).<ref name=wsj>Template:Cite web</ref><ref name=medX>Template:Cite web</ref> Cosmetic mouthrinses temporarily control or reduce bad breath and leave the mouth with a pleasant taste.<ref name=ada>Template:Cite web</ref>
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.<ref name=pmid21591596>Template:Cite journal</ref><ref name=pmid1423447>Template:Cite journal</ref><ref name=pmid18534177>Template:Cite journal</ref> 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.<ref name="pmid21591596"/> 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"<ref name=":0">Template:Cite web</ref> they believed there was a limited evidence base for best practice.<ref name=pmid22498529>Template:Cite journal</ref>
Use
[edit]Common use involves rinsing the mouth with about Template:Nowrap Template:Nowrap 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.<ref name=pmid8794967>Template:Cite journal</ref><ref name=pmid1552460>Template:Cite journal</ref><ref name=pmid2076696>Template:Cite journal</ref> 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.<ref>Template:Cite web</ref> A fluoride mouthrinse can be used at a different time of the day to brushing.<ref name=":0" />
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.<ref name="Pubchem">Template:Cite web</ref>
Dangerous misuse
[edit]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.<ref>Template:Cite web</ref> Zero percent alcohol mouthwashes do exist, as well as many other formulations for different needs (covered in the above 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 people during winter months, because a person can feel warmer after drinking it.<ref>Template:Cite web </ref>
Effects
[edit]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.<ref name=pmid17138709>Template:Cite journal</ref><ref name=pmid2366142>Template:Cite journal</ref><ref>Template:Cite news</ref> 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.<ref>Template:Cite web</ref> For many patients, however, the mechanical methods could be tedious and time-consuming, and, additionally, some local conditions may render them especially difficult. ChemoTemplate:ShytheraTemplate:Shypeutic agents, including mouthwashes, could have a key role as adjuncts to daily home care, preventing and controlling supraTemplate:Shygingival plaque, gingivitis and oral malodor.<ref>Template:Cite journal</ref>
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.<ref>Template:Cite book</ref><ref>Template:Cite web</ref> 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.<ref name="DetailDoc"/> "Magic mouthwashes" are prescription mouthwashes compounded in a pharmacy from a list of ingredients specified by a doctor.<ref>Template:Cite web</ref><ref>Template:Cite web</ref> 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.<ref name="DetailDoc"/>
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,<ref name="s998">Template:Cite journal</ref><ref name="p889">Template:Cite journal</ref> and Alzheimer's Disease<ref name="f234">Template:Cite journal</ref> health risks.
History
[edit]
The first known references to mouth rinsing is in Ayurveda<ref name=pmid21760690>Template:Cite journal</ref> for treatment of gingivitis.<ref>Template:Cite journal</ref> Later, in the Greek and Roman periods, mouth rinsing following mechanical cleansing became common among the upper classes, and Hippocrates recommended a mixture of salt, alum, and vinegar.<ref name=pmid9643227>Template:Cite journal</ref> The Jewish Talmud, dating back about 1,800 years, suggests a cure for gum ailments containing "dough water" and olive oil.<ref name=pmid12389360>Template:Cite journal</ref> The ancient Chinese had also gargled salt water, tea and wine as a form of mouthwash after meals, due to the antiseptic properties of those liquids.<ref>Template:Cite web</ref>
Before Europeans came to the Americas, Native North American and Mesoamerican cultures used mouthwashes, often made from plants such as Coptis trifolia.<ref name=Keoke2002 /> Peoples of the Americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as teething and mouth ulcers.<ref name=Keoke2002>Template:Cite book</ref>
Anton van Leeuwenhoek, the famous 17th century microscopist, discovered living organisms (living, because they were mobile) in deposits on the teeth (what we now call dental plaque). He also found organisms in water from the canal next to his home in Delft. He experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. Next he tried rinsing the mouth of himself and somebody else with a mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. He concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms.<ref>Template:Cite book</ref> In 1892, German Richard Seifert invented mouthwash product Odol, which was produced by company founder Karl August Lingner (1861–1916) in Dresden.<ref>Lingner-Archiv (German)</ref>
That remained the state of affairs until the late 1960s when Harald Loe (at the time a professor at the Royal Dental College in Aarhus, Denmark) demonstrated that a chlorhexidine compound could prevent the build-up of dental plaque. The reason for chlorhexidine's effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours.<ref name=pmid4575037>Template:Cite journal</ref>
Since then commercial interest in mouthwashes has been intense and several newer products claim effectiveness in reducing the build-up in dental plaque and the associated severity of gingivitis, in addition to fighting bad breath. Many of these solutions aim to control the volatile sulfur compound–creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste.<ref name=pmid1552460/><ref name=pmid8794967/><ref name=pmid8133414>Template:Cite journal</ref><ref name=pmid12013345>Template:Cite journal</ref><ref name=pmid1499240>Template:Cite journal</ref> For example, the number of mouthwash variants in the United States of America has grown from 15 (1970) to 66 (1998) to 113 (2012).<ref>Template:Cite journal</ref>
Research
[edit]Research in the field of microbiotas shows that only a limited set of microbes cause tooth decay, with most of the bacteria in the human mouth being harmless. Focused attention on cavity-causing bacteria such as Streptococcus mutans has led research into new mouthwash treatments that prevent these bacteria from initially growing. While current mouthwash treatments must be used with a degree of frequency to prevent this bacteria from regrowing, future treatments could provide a viable long-term solution.<ref>Template:Cite web</ref>
A clinical trial and laboratory studies have shown that alcohol-containing mouthwash could reduce the growth of Neisseria gonorrhoeae in the pharynx.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> However, subsequent trials have found that there was no difference in gonorrhoea cases among men using daily mouthwash compared to those who did not use mouthwash for 12 weeks.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Template:Clear
Ingredients
[edit]Alcohol
[edit]
Alcohol is added to mouthwash not to destroy bacteria but to act as a carrier agent for essential active ingredients such as menthol, eucalyptol and thymol, which help to penetrate plaque.<ref name="cleef"/> Sometimes a significant amount of alcohol (up to 27% vol) is added,<ref name="Mildau">Template:Cite journal</ref> as a carrier for the flavor, to provide "bite".<ref name="Pader">Template:Cite journal</ref>Template:Unreliable medical source Because of the alcohol content, it is possible to fail a breathalyzer test after rinsing, although breath alcohol levels return to normal after 10 minutes.<ref>Template:Cite web</ref> In addition, alcohol is a drying agent, which encourages bacterial activity in the mouth, releasing more malodorous volatile sulfur compounds. Therefore, alcohol-containing mouthwash may temporarily worsen halitosis in those who already have it, or, indeed, be the sole cause of halitosis in other individuals.<ref name=":1" /> Alcohol in mouthwashes may act as a carcinogen (cancer-inducing agent) in some cases Template:Xref.<ref name=":19">Template:Cite journal</ref> Many newer brands of mouthwash are alcohol-free, not just in response to consumer concerns about oral cancer, but also to cater for religious groups who abstain from alcohol consumption.
Benzydamine (analgesic)
[edit]In painful oral conditions such as aphthous stomatitis, analgesic mouthrinses (e.g. benzydamine mouthwash, or "Difflam") are sometimes used to ease pain, commonly used before meals to reduce discomfort while eating.
Benzoic acid
[edit]Benzoic acid acts as a buffer.<ref name="cleef"/>
Betamethasone
[edit]Betamethasone is sometimes used as an anti-inflammatory, corticosteroid mouthwash. It may be used for severe inflammatory conditions of the oral mucosa such as the severe forms of aphthous stomatitis.<ref name=Cawson2002 />Template:Rp
Cetylpyridinium chloride (antiseptic, antimalodor)
[edit]Cetylpyridinium chloride containing mouthwash (e.g. 0.05%) is used in some specialized mouthwashes for halitosis.<ref name="pmid27228022">Template:Cite journal</ref> Cetylpyridinium chloride mouthwash has less anti-plaque effect than chlorhexidine and may cause staining of teeth, or sometimes an oral burning sensation or ulceration.<ref name=Scully2013 />
Chlorhexidine digluconate and hexetidine (antiseptic)
[edit]Chlorhexidine digluconate is a chemical antiseptic and is used in a 0.05–0.2% solution as a mouthwash.<ref>Template:Cite journal</ref><ref name=pmid1552460/><ref name="cleef">Template:Citation</ref><ref name=pmid17391828>Template:Cite journal</ref> There is no evidence to support that higher concentrations are more effective in controlling dental plaque and gingivitis.<ref name="pmid28362061">Template:Cite journal</ref> A randomized clinical trial conducted in Rabat University in Morocco found better results in plaque inhibition when chlorohexidine with alcohol base 0.12% was used, when compared to an alcohol-free 0.1% chlorhexidine mouthrinse.<ref>Template:Cite journal</ref>
Chlorhexidine has good substantivity (the ability of a mouthwash to bind to hard and soft tissues in the mouth).<ref name=Scully2013 /> It has anti-plaque action, and also some anti-fungal action.<ref name=Scully2013 /> It is especially effective against Gram-negative rods.<ref name=Scully2013>Template:Cite book</ref> The proportion of Gram-negative rods increase as gingivitis develops, so it is also used to reduce gingivitis.<ref name=pmid28362061/><ref>Template:Cite journal</ref> It is sometimes used as an adjunct to prevent dental caries and to treat periodontal disease,<ref name=Scully2013 /> although it does not penetrate into periodontal pockets well.<ref name=BNF>Template:Cite web</ref> Chlorhexidine mouthwash alone is unable to prevent plaque, so it is not a substitute for regular toothbrushing and flossing.<ref name=BNF /> Instead, chlorhexidine mouthwash is more effective when used as an adjunctive treatment with toothbrushing and flossing.<ref name=pmid28362061/> In the short term, if toothbrushing is impossible due to pain, as may occur in primary herpetic gingivostomatitis, chlorhexidine mouthwash is used as a temporary substitute for other oral hygiene measures.<ref name=BNF /> It is not suited for use in acute necrotizing ulcerative gingivitis, however.<ref name=BNF /> Rinsing with chlorhexidine mouthwash before and after a tooth extraction may reduce the risk of a dry socket.<ref name=CochraneChlorhex>Template:Cite journal</ref> Other uses of chlorhexidine mouthwash include prevention of oral candidiasis in immunocompromised persons,<ref name=BNF /> treatment of denture-related stomatitis, mucosal ulceration/erosions and oral mucosal lesions, general burning sensation<ref name=pmid28362061/> and many other uses.<ref name=BNF />
Chlorhexidine mouthwash is known to have minor adverse effects.<ref name=CochraneChlorhex/> Chlorhexidine binds to tannins, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth.<ref name=Scully2013 /> A systematic review of commercial chlorhexidine products with anti-discoloration systems (ADSs) found that the ADSs were able to reduce tooth staining without affecting the beneficial effects of chlorhexidine.<ref>Template:Cite journal</ref> Chlorhexidine mouthwash can also cause taste disturbance or alteration.<ref name=pmid28362061/> Chlorhexidine is rarely associated with other issues like overgrowth of enterobacteria in persons with leukemia, desquamation, irritation, and stomatitis of oral mucosa,<ref name=Scully2013 /><ref name=CochraneChlorhex/> salivary gland pain and swelling, and hypersensitivity reactions including anaphylaxis.<ref name=Scully2013 />
Hexetidine<ref name="cleef"/> also has anti-plaque, analgesic, astringent and anti-malodor properties, but is considered an inferior alternative to chlorhexidine.<ref>Template:Cite web</ref>
Chlorine dioxide
[edit]In dilute concentrations, chlorine dioxide is an ingredient that acts as an antiseptic agent in some mouthwashes.<ref name="pmid32410557">Template:Cite journal</ref><ref name="pmid36634129">Template:Cite journal</ref>
Edible oils
[edit]In traditional Ayurvedic medicine, the use of oil mouthwashes is called "Kavala" ("oil swishing") or "Gandusha",<ref name=pmid21760690/><ref name="Beck2014"/> and this practice has more recently been re-marketed by the complementary and alternative medicine industry as "oil pulling".<ref name="pmid21760690"/> Its promoters claim it works by "pulling out" "toxins", which are known as ama in Ayurvedic medicine, and thereby reducing inflammation.<ref>Template:Cite web</ref> Ayurvedic literature claims that oil pulling is capable of improving oral and systemic health, including a benefit in conditions such as headaches, migraines, diabetes mellitus, asthma,<ref name="pmid21760690"/> and acne, as well as whitening teeth.<ref name="Butler2014"/>
Oil pulling has received little study and there is little evidence to support claims made by the technique's advocates.<ref name="Beck2014"/> When compared with chlorhexidine in one small study, it was found to be less effective at reducing oral bacterial load,<ref name=pmid19336860>Template:Cite journal</ref><ref>Template:Cite web</ref> and the other health claims of oil pulling have failed scientific verification<ref name="Beck2014"/> or have not been investigated.<ref name="Beck2014"/> There is a report of lipid pneumonia caused by accidental inhalation of the oil during oil pulling.<ref name=pmid24429325>Template:Cite journal</ref><ref name="oil pulling leg">Template:Cite web</ref><ref>Template:Cite news</ref>
The mouth is rinsed with approximately one tablespoon of oil for 10–20 minutes then spat out.<ref name="Beck2014">Template:Cite news</ref><ref name="Butler2014">Template:Cite news</ref> Sesame oil, coconut oil and ghee are traditionally used,<ref name="Butler2014"/> but newer oils such as sunflower oil are also used.<ref name="Butler2014"/>
Essential oils
[edit]Phenolic compounds and monoterpenes include essential oil constituents that have some antibacterial properties,<ref name="cleef"/><ref name=pmid17608576/> such as eucalyptol,<ref name="Pubchem" /> eugenol,<ref name="cleef"/> hinokitiol,<ref>Template:Cite journal</ref> menthol,<ref>Template:Cite journal</ref> phenol,<ref name="cleef"/> or thymol.<ref name="cleef"/> Essential oils are oils which have been extracted from plants. Mouthwashes based on essential oils could be more effective than traditional mouthcare as anti-gingival treatments.<ref name=pmid17608576>Template:Cite journal</ref><ref name="pmid21043801">Template:Cite journal</ref> They have been found effective in reducing halitosis, and are being used in several commercial mouthwashes.
Fluoride (anticavity)
[edit]Anti-cavity mouthwashes contain fluoride compounds (such as sodium fluoride, stannous fluoride, or sodium monofluorophosphate) to protect against tooth decay.<ref name="pmid37709645">Template:Cite journal</ref><ref>Template:Cite journal</ref> Fluoride-containing mouthwashes are used as prevention for dental caries for individuals who are considered at higher risk for tooth decay, whether due to xerostomia related to salivary dysfunction or side effects of medication, to not drinking fluoridated water, or to being physically unable to care for their oral needs (brushing and flossing), and as treatment for those with dentinal hypersensitivity, gingival recession/ root exposure.
Flavoring agents and xylitol
[edit]Flavoring agents include sweeteners such as sorbitol, sucralose, sodium saccharin, and xylitol, which stimulate salivary function due to their sweetness and taste and helps restore the mouth to a neutral level of acidity.<ref name=wsj/>
Xylitol rinses double as a bacterial inhibitor,<ref name=pmid9831777>Template:Cite journal</ref> and have been used as substitute for alcohol to avoid dryness of mouth associated with alcohol.<ref name=wsj/>
Hydrogen peroxide
[edit]Hydrogen peroxide can be used as an oxidizing mouthwash (e.g. Peroxyl, 1.5%).<ref name=BNF /><ref name=pmid379049>Template:Cite journal</ref> It kills anaerobic bacteria, and also has a mechanical cleansing action when it froths as it comes into contact with debris in mouth.<ref name=BNF /> It is often used in the short term to treat acute necrotising ulcerative gingivitis.<ref name=BNF /> Side effects can occur with prolonged use, including hypertrophy of the lingual papillae.<ref name=BNF />
Lactoperoxidase (saliva substitute)
[edit]Enzymes and non-enzymatic proteins, such as lactoperoxidase, lysozyme, and lactoferrin, have been used in mouthwashes (e.g., Biotene) to reduce levels of oral bacteria, and, hence, of the acids produced by these bacteria.<ref name="Hoogedoorn_1985">Template:Cite book</ref>
Lidocaine/xylocaine
[edit]Oral lidocaine is useful for the treatment of mucositis symptoms (inflammation of mucous membranes) induced by radiation or chemotherapy.<ref>Template:Cite journal</ref> There is evidence that lidocaine anesthetic mouthwash has the potential to be systemically absorbed, when it was tested in patients with oral mucositis who underwent a bone marrow transplant.<ref>Template:Cite journal</ref>
Methyl salicylate
[edit]Methyl salicylate functions as an antiseptic, antiinflammatory, and analgesic agent, a flavoring, and a fragrance.<ref name=":1">Template:Cite news</ref> Methyl salicylate has some anti-plaque action, but less than chlorhexidine.<ref name=Scully2013 /> Methyl salicylate does not stain teeth.<ref name=Scully2013 />
Nystatin
[edit]Nystatin suspension is an antifungal ingredient used for the treatment of oral candidiasis.<ref name="Nystatin PI">Template:Cite web</ref>
Potassium oxalate
[edit]A randomized clinical trial found promising results in controlling and reducing dentine hypersensitivity when potassium oxalate mouthwash was used in conjugation with toothbrushing.<ref>Template:Cite journal</ref>
Povidone/iodine (PVP-I)
[edit]A 2005 study found that gargling three times a day with simple water or with a povidone-iodine solution was effective in preventing upper respiratory infection and decreasing the severity of symptoms if contracted.<ref name=pmid16242593>Template:Cite journal</ref> Other sources attribute the benefit to a simple placebo effect.<ref>To gargle or not to gargle? Japan Times, 15 December 2009</ref>
PVP-I in general covers "a wider virucidal spectrum, covering both enveloped and nonenveloped viruses, than the other commercially available antiseptics",<ref>Template:Cite journal</ref> which also includes the novel SARS-CoV-2 virus.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite web</ref>
Sanguinarine
[edit]Sanguinarine-containing mouthwashes are marketed as anti-plaque and anti-malodor treatments.<ref name=Scully2013 /> Sanguinarine is a toxic alkaloid herbal extract, obtained from plants such as Sanguinaria canadensis (bloodroot), Argemone mexicana (Mexican prickly poppy), and others.<ref name=Scully2013 /> However, its use is strongly associated with the development of leukoplakia (a white patch in the mouth), usually in the buccal sulcus.<ref name=Scully2013 /><ref>Leukoplakia Template:Webarchive, (pdf format) hosted by the American Academy of Oral and Maxillofacial Pathology. Page accessed on 19 December 2006.</ref> This type of leukoplakia has been termed "sanguinaria-associated keratosis", and more than 80% of people with leukoplakia in the vestibule of the mouth have used this substance. Upon stopping contact with the causative substance, the lesions may persist for years. Although this type of leukoplakia may show dysplasia, the potential for malignant transformation is unknown.<ref name=Neville2002>Template:Cite book</ref> Ironically, elements within the complementary and alternative medicine industry promote the use of sanguinaria as a therapy for cancer.
Sodium bicarbonate (baking soda)
[edit]Sodium bicarbonate is sometimes combined with salt to make a simple homemade mouthwash, indicated for any of the reasons that a saltwater mouthwash might be used. Pre-mixed mouthwashes of 1% sodium bicarbonate and 1.5% sodium chloride in aqueous solution are marketed, although pharmacists will easily be able to produce such a formulation from the base ingredients when required. Sodium bicarbonate mouthwash is sometimes used to remove viscous saliva and to aid visualization of the oral tissues during examination of the mouth.<ref name=Cawson2002>Template:Cite book</ref>Template:Rp
Sodium chloride (salt)
[edit]Template:Main Template:See also
Saline has a mechanical cleansing action and an antiseptic action, as it is a hypertonic solution in relation to bacteria, which undergo lysis. The heat of the solution produces a therapeutic increase in blood flow (hyperemia)<ref name=BNF /> to the surgical site, promoting healing.<ref name=pmid12856008/> Hot saltwater mouthwashes also encourage the draining of pus from dental abscesses.<ref>Template:Cite book</ref> In contrast, if heat is applied on the side of the face (e.g., hot water bottle) rather than inside the mouth, it may cause a dental abscess to drain extra-orally, which is later associated with an area of fibrosis on the face Template:Xref.<ref name=Wray2003 />
Saltwater mouthwashes are also routinely used after oral surgery, to keep food debris out of healing wounds and to prevent infection. Some oral surgeons consider saltwater mouthwashes the mainstay of wound cleanliness after surgery.<ref name=Wray2003>Template:Cite book</ref> In dental extractions, hot saltwater mouthbaths should start about 24 hours after a dental extraction.<ref name=Wray2003 /> The term mouth bath implies that the liquid is passively held in the mouth, rather than vigorously swilled around (which could dislodge a blood clot). Once the blood clot has stabilized, the mouthwash can be used more vigorously.<ref name=Wray2003 /> These mouthwashes tend to be advised for use about 6 times per day, especially after meals (to remove food from the socket).<ref name=Wray2003 />
Sodium lauryl sulfate (foaming agent)
[edit]Sodium lauryl sulfate (SLS) is used as a foaming agent in many oral hygiene products, including many mouthwashes. Some may suggest that it is probably advisable to use mouthwash at least an hour after brushing with toothpaste when the toothpaste contains SLS, since the anionic compounds in the SLS toothpaste can deactivate cationic agents present in the mouthwash.<ref name=pmid11905111>Template:Cite journal</ref>
Sucralfate
[edit]Sucralfate is a mucosal coating agent, composed of an aluminum salt of sulfated sucrose.<ref name="Saunders et al">Template:Cite journal</ref> It is not recommended for use in the prevention of oral mucositis in head and neck cancer patients receiving radiotherapy or chemoradiation, due to a lack of efficacy found in a well-designed, randomized controlled trial.<ref name="Saunders et al" />
Tetracycline (antibiotic)
[edit]Tetracycline is an antibiotic which may sometimes be used as a mouthwash in adults (it causes red staining of teeth in children). It is sometimes use for herpetiforme ulceration (an uncommon type of aphthous stomatitis), but prolonged use may lead to oral candidiasis, as the fungal population of the mouth overgrows in the absence of enough competing bacteria.<ref name=Cawson2002 />Template:Rp Similarly, minocycline mouthwashes of 0.5% concentrations can relieve symptoms of recurrent aphthous stomatitis.<ref>Template:Cite journal</ref> Erythromycin is similar.<ref name="DetailDoc">Template:Cite journal</ref>
Tranexamic acid
[edit]A 4.8% tranexamic acid solution is sometimes used as an antifibrinolytic mouthwash to prevent bleeding during and after oral surgery in persons with coagulopathies (clotting disorders) or who are taking anticoagulants (blood thinners such as warfarin).<ref name=Glick2003>Template:Cite book</ref>Template:Rp
Triclosan
[edit]Triclosan is a non-ionic chlorinate bisphenol antiseptic found in some mouthwashes.<ref>Template:Cite web</ref> When used in mouthwash (e.g. 0.03%), there is moderate substantivity, broad spectrum anti-bacterial action, some anti-fungal action, and significant anti-plaque effect, especially when combined with a copolymer or zinc citrate.<ref name=Scully2013 /> Triclosan does not cause staining of the teeth.<ref name=Scully2013 /> The safety of triclosan has been questioned.<ref>Template:Cite web</ref>
Zinc
[edit]Astringents like zinc chloride provide a pleasant-tasting sensation and shrink tissues.<ref name=GentleDENTALcare>Template:Cite web</ref> Zinc, when used in combination with other antiseptic agents, can limit the buildup of tartar.<ref>Template:Cite news</ref>
See also
[edit]References
[edit]External links
[edit]- Article on Bad-Breath Prevention Products – from MSNBC
- Mayo Clinic Q&A on Magic Mouthwash for chemotherapy sores
- American Dental Association article on mouthwash
Template:Periodontology Template:Throat preparations Template:Dosage forms Template:Authority control