Editing Mouthwash (section)

==<span class="anchor" id="Magic mouthwash"></span> 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 [[Dental plaque|bacterial plaque]] that causes [[Dental caries|cavities]], [[gingivitis]], and [[bad breath]]. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both [[toothbrush|brushing]] and [[flossing]].<ref name=pmid17138709>{{cite journal | vauthors = Gunsolley JC | title = A meta-analysis of six-month studies of antiplaque and antigingivitis agents | journal = Journal of the American Dental Association | volume = 137 | issue = 12 | pages = 1649–57 | date = December 2006 | pmid = 17138709 | doi = 10.14219/jada.archive.2006.0110 | s2cid = 9347082 }}</ref><ref name=pmid2366142>{{cite journal | vauthors = Tal H, Rosenberg M | title = Estimation of dental plaque levels and gingival inflammation using a simple oral rinse technique | journal = Journal of Periodontology | volume = 61 | issue = 6 | pages = 339–42 | date = June 1990 | pmid = 2366142 | doi = 10.1902/jop.1990.61.6.339 }}</ref><ref>{{cite news | url=http://www.nbcnews.com/id/6799764 | archive-url=https://web.archive.org/web/20141006203443/http://www.nbcnews.com/id/6799764 | url-status=dead | archive-date=6 October 2014 |title=Listerine no replacement for flossing?|work=NBC News | date=7 January 2005 | access-date=14 October 2013 }}</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>{{cite web | author = Jake | date = 1 April 2015 |title=Should I use Mouthwash |url=http://brushflossandmouthwash.com/should-i-be-using-mouthwash/ }}</ref>
For many patients, however, the mechanical methods could be tedious and time-consuming, and, additionally, some local conditions may render them especially difficult. Chemo{{shy}}thera{{shy}}peutic agents, including mouthwashes, could have a key role as adjuncts to daily home care, preventing and controlling supra{{shy}}gingival plaque, gingivitis and oral malodor.<ref>{{cite journal |doi=10.1590/S1806-83242007000500005 |title=The effect of mouthrinses against oral microorganisms |journal=Brazilian Oral Research |volume=21 |pages=23–8 |year=2007 | vauthors = Cortelli JR, Thénoux RE |doi-access=free }}</ref>

Minor and transient side effects of mouthwashes are very common, such as [[Dysgeusia|taste disturbance]], tooth staining, [[xerostomia|sensation of a dry mouth]], etc. Alcohol-containing mouthwashes may make dry mouth and halitosis worse, as they dry out the mouth.<ref>{{cite book | vauthors = Oneschuk D, Hagen N, MacDonald N |title=Palliative Medicine: A case-based manual|year=2012|publisher=Oxford University Press|isbn=9780191628733|page=126 | url = https://books.google.com/books?id=MJOE2MflzngC&q=non+alcoholic+mouthwash+halitosis&pg=PA126 |edition=3rd}}</ref><ref>{{cite web | vauthors = Philipp J | date = 16 July 2015 | work = azcentral.com |url=http://www.azcentral.com/story/entertainment/life/health/2015/07/16/medications-diseases-among-factors-dry-mouth-cbt/30270419/|title=Medications, diseases among factors for dry mouth}}</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 ulcer]]s, other [[oral ulcer]]s, and other mouth pain.<ref name="DetailDoc"/> "Magic mouthwashes" are prescription mouthwashes [[Compounding|compounded]] in a [[pharmacy]] from a list of ingredients specified by a doctor.<ref>{{cite web|url=http://www.drotterholt.com/magicmouthwash.html |title=Magic Mouthwash |access-date=2009-12-05 | vauthors = Otterholt R }}</ref><ref>{{cite web|url=http://www.pharmacistsletter.com/(S(4xxt15452khjdpbrnmrxdbfi))/pl/Browse.aspx?s=PL&dd=230703&cat=4313&pt=2 |title=Magic Mouthwash |access-date=2009-12-05 |work=Pharmacist's Letter |publisher=Therapeutic Research Center }}</ref> Despite a lack of evidence that prescription mouthwashes are more effective in decreasing the pain of oral [[lesion]]s, many patients and prescribers continue to use them. There has been only one [[Controlled experiment|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 (medicine)|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 microbiology|oral microbiome]] and interfere with the regulated production of [[Biological functions of nitric oxide|nitric oxide]] (NO), which in turn increase [[cardiovascular disease|cardiovascular]],<ref name="s998">{{cite journal | last=Blot | first=Stijn | title=Antiseptic mouthwash, the nitrate–nitrite–nitric oxide pathway, and hospital mortality: a hypothesis generating review | journal=Intensive Care Medicine | volume=47 | issue=1 | date=2021 | issn=0342-4642 | pmid=33067640 | pmc=7567004 | doi=10.1007/s00134-020-06276-z | doi-access=free | pages=28–38 | url=https://link.springer.com/content/pdf/10.1007/s00134-020-06276-z.pdf | access-date=2025-04-29}}</ref><ref name="p889">{{cite journal | last=Joshipura | first=Kaumudi | last2=Muñoz-Torres | first2=Francisco | last3=Fernández-Santiago | first3=Jeanpaul | last4=Patel | first4=Rakesh P. | last5=Lopez-Candales | first5=Angel | title=Over-the-counter mouthwash use, nitric oxide and hypertension risk | journal=Blood Pressure | volume=29 | issue=2 | date=2020-03-03 | issn=0803-7051 | pmid=31709856 | pmc=7125030 | doi=10.1080/08037051.2019.1680270 | doi-access=free | pages=103–112 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125030 | access-date=2025-04-29}}</ref> and [[Alzheimer's Disease]]<ref name="f234">{{cite journal | last=Boulares | first=Ayoub | last2=Jdidi | first2=Hela | last3=Bragazzi | first3=Nicola Luigi | title=Impact of Mouthwash-Induced Oral Microbiome Disruption on Alzheimer's Disease Risk: A Perspective Review | journal=International Dental Journal | volume=75 | issue=1 | date=2025 | pmid=39379282 | pmc=11806309 | doi=10.1016/j.identj.2024.07.005 | doi-access=free | pages=45–50}}</ref> health risks.