♿ Mouthwashes And its Uses
Mouthwashes are a very popular additional oral hygiene element and there are plenty of individual products, whose compositions are in a state of flux. The aim of our study was to investigate the compositions of mouthwashes and their functions, as well as to discuss their effectiveness in preventing and curing oral diseases and side effects. We searched for mouthwashes available on the market in Poland. We identified 241 individual mouthwash products. The extraction of compositions was performed and functions of the ingredients were assessed. Then, analysis was performed. The evaluation revealed that there are plenty of ingredients, but a typical mouthwash is a water–glycerine mixture and consists of additional sweetener, surfactant, preservative, and some colourant and flavouring agent, as well as usually having two oral health substances, anticaries sodium fluoride and antimicrobial essential oils. The effectiveness or side effects of several substances of mouthwashes were thoroughly discussed. We recommend not multiplying individual mouthwash products and their ingredients beyond medical or pharmaceutical necessity, especially without scientific proof.
What type of mouthwash should you be using? After brushing and flossing, using mouthwash can give your mouth a nice, clean finish. But not all rinses are made the same. Depending on their ingredients, some are more effective than others for taking care of certain oral hygiene problems. There is a wide range of over-the-counter and prescription mouthwashes to choose from; your prosthodontist will help you to pick the right one for your dental needs.
1. COSMETIC MOUTHWASH
When you’re simply looking for something to make your breath smell fresher, cosmetic mouthwash is what you need. When used right after brushing, cosmetic mouthwash is great for rinsing away loose food particles, but it doesn’t have any actual germ-killing properties.
2. FLUORIDE MOUTHWASH
Sodium fluoride is a chemical that helps to fight tooth decay, toughening teeth in the process. Fluoride mouthwash has this chemical as part of its formula, with the aim of helping to keep teeth healthy. The problem with this product is that it’s possible to have too much fluoride. With community water being fluoridated and many toothpaste formulas including it as well, it’s very easy to ingest more than the recommended amount. Too much fluoride can lead to brittle bones and increased fractures, encourage certain thyroid problems and even cause pregnant women to give birth to children with lower IQ scores. A little bit goes a long way with fluoride.
3. ANTISEPTIC MOUTHWASH
For people with halitosis or certain types of mouth infections, antiseptic mouthwashes containing chlorhexidine gluconate can help. This chemical prevents the growth of bacteria in the mouth. Antiseptic mouthwash can help to heal mouth sores and make your breath smell better, but it’s best used for only short lengths of time. Extended use can cause discolored teeth. If this happens, it can be reversed in your dentist’s office.
4. NATURAL MOUTHWASH
Many people have difficulties with alcohol or object to using chemicals in their daily lives. Natural mouthwash formulas are made without the use of alcohol or fluoride but can have the same benefits of those that do. Most commercial natural mouthwash formulas include essential oils, salt, herbs such as echinacea and calendula, mint and aloe vera. Another option for gentler mouthwash is to make your own at home. Mix distilled water and baking soda and use this to rinse your mouth after brushing. If you feel a need for more mineralizing properties, stir in a bit of sea salt.
5. PRESCRIPTION MOUTHWASH
For patients with gum disease, mouthwash can be serious medicine, not just a quick way to freshen the breath. Prescription strength mouthwash contains chlorhexidine in a prescription dosage. It’s meant to fight gingivitis, help inflamed gums to heal and reduce swelling and bleeding.
Prescription strength mouthwash isn’t useful for fighting periodontitis, a more severe form of gum disease. During this advanced stage, patients experience receding gums, loose teeth, pus and infection and tooth sensitivity.
In the early stages of gum disease, though, prescription strength mouthwash can destroy harmful bacteria in the mouth. After using it for six months, patients have been tested and found that the level of bacteria in their mouth had been reduced by up to 97 percent. In addition, some mouthwash remains in the mouth after rinsing, so it continues to work for a time after the original use.
The mouthwashes were selected according to the following inclusion criteria:
- Intended to prevent and cure oral conditions and maintain oral health;
- Over-the-counter;
- In one of the following forms:
- An aqueous solution;
- A concentrate to be diluted with water;
- A tablet or powder to be dissolved in water.
The exclusion criteria were as follows:
- Full composition not available;
- Saliva substitutes;
- Not recognised as cosmetic;
- Containing antibiotics, antimycotics, steroids, parasympathomimetic saliva stimulants, topical local anaesthetics and other prescription drugs;
- Orally taken, but not intended for oral health (e.g.,nitroglycerine)
- Toothpastes, gels, powders, foams and similar;
- With majority of coconut oil or other oils;
- Homeopathics;
- Tablets for chewing;
- Intended to cure tonsillitis, pharyngitis and other conditions of the respiratory tract.A dental care routine that includes brushing only does not eliminate all germs that can accumulate on the surface of the teeth, gums and other non-dental surfaces and therefore will not guarantee giving your mouth the required hygiene. Food debris can also get stuck between the teeth and cause many problems and would not be removed by a brush.
You need to follow a routine of daily cleaning of three steps to maintain the health of your teeth and avoid problems and diseases that can affect the gums and teeth such as gingivitis, plaque and other problems that cause weak teeth and bad breath. The three steps a proper daily routine consists of are: brushing, flossing, and mouth washing.
You might know that not all types of mouthwash are the same, there are many types of mouthwash that can have different effects according to the active ingredients they contain. This article will walk you through the types of mouthwash available, their benefits and their uses, so you can choose the one that suits you the best.
Uses of Mouthwash
Some types of mouthwash are used to help eliminate issues that affect the mouth and teeth such as reducing plaque, gingivitis, tooth decay and bad breath. These types of mouthwash are considered to be therapeutic and they help solve these problems with the active ingredients they contain. While other mouthwashes are made to merely give you fresh breath without having any anti-bacterial or properties.
Most therapeutic mouthwashes can be obtained without a prescription, but some require a prescription according to the ingredients they contain.
Active ingredients used in mouthwashes
There are many active ingredients used in various types of mouthwash, each with its own effects and benefits. They include1
Cetylpyridinium chloride: It is added to mouthwash to reduce bad breath.
Chlorhexidine: It can be used to help control plaque and gingivitis and generally can’t be bought without a prescription.
Essential oils: Helps control plaque and gingivitis
Fluoride: It is used to help prevent tooth decay
Peroxide: Helps teeth whitening
Sodium Fluoride: used for preventing tooth decay and helping decrease teeth sensitivity.
Eucalyptus: help prevent plaque and gingivitis2
- Hydrogen peroxide: used for teeth whitening and is highly effective in penetrating the hard tissues of the teeth3
mouthwash – to rinse or not to rinse?
A common question that dentists are asked is whether there is any benefit to using a mouthwash as part of a daily oral hygiene programme.
As a general rule, it is fair to say the for the removal of plaque bacteria (the cause of tooth decay and gum disease) is achieved most effectively by brushing and flossing your teeth daily and by seeing a dental hygienist at least twice a year.
There is no scientific evidence that the use of a general (non-specific) mouthwash significantly reduces plaque bacteria over and above good brushing and flossing techniques.
Some mouthwashes contain the chemical Chlorhexidine Gluconate. These are strong anti-bacterial formulas that may be prescribed by your dentist when it is not possible to brush your teeth for a short period of time, for instance following surgery in the mouth. Some companies market these as long term daily oral hygiene products but they should not be used as such. Chlorhexidine Gluconate can stain teeth and affect your taste buds when used for long periods.
If you have suffered from thinned or weak enamel, or if you happen to have a high decay rate, your dentist may recommend using a mouthwash with high levels of fluoride. Fluoride can attach to the molecules of your tooth enamel and strengthen it, making it harder for sugars and acids to break down the enamel molecules. It is important not to swallow these products in significant levels and it is therefore only recommended for children over the age of seven and adults.
If you want to use a mouthwash in conjunction with a good brushing and flossing regime (you may simply like the feeling that it gives you), it is very important to make sure that the mouthwash is water based and does not contain acohol. Traditionally many mouthwashes contained alcohol to act as a preservative but some studies have suggested that long term use of alcohol on the oral tissues could increase the risk of oral disease. Thankfully, many mouthwashes have dispensed with the use as alcohol as a preservative but some still exist and it is worth checking.
Pre-treatment mouthwash to reduce patient to dentist infections
A range of dental procedures particularly those using high-speed hand pieces and ultrasonic scalers as well as coughing sneezing and breathing lead to the production of aerosols. As a large number of microbial species including SARS-CoV-2 are present these aerosols may be contaminated. With dental treatment involving close contact between dental professionals and the patients there is the potential for cross-infection. Studies have demonstrated that mouthwash may reduce bacterial contamination and viral load but the impact on infection in dental professionals is unclear.
The aim of this Cochrane review was to assess the effects of preprocedural mouthwash used in dental clinics to minimise incidence of infection in dental healthcare providers and reduce or neutralise contamination in aerosols.
Methods
Searches were conducted in the Cochrane Oral Health’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, World Health Organization COVID-19 Global Literature on Coronavirus Disease Database (search.bvsalud.org/ global-literature-on-novel-coronavirus-2019-ncov) Cochrane COVID-19 Study Register (covid-19.cochrane.org/), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry databases. The primary outcome was the incidence of infection of dental healthcare providers with reduction in the level of contamination, cost, change in patient’s oral microbiota and as adverse events secondary outcomes. Parallel arm or cluster randomised controlled trials (RCTs) were considered for the primary outcome with cross- over designs for secondary objectives with the intention of using first- period data from cross-over trials as parallel-arm studies. Quasi-RCTs, split-mouth studies, controlled clinical trials and experimental studies conducted in a laboratory environment were excluded. Standard Cochrane data extraction and analyses procedures were followed.
Results
- 17 RCTs involving 830 participants were included
- 3 RCTs were at high risk of bias, 2 at low risk and 12 had an unclear risk of bias.
- 11 RCTs were from India, 3 from the USA, 2 from Brazil and one from Puerto Rico.
- Sample sizes ranged from 18 – 185.
- None of the studies measured the incidence of infection in dental healthcare providers.
- The studies measured reduction in the level of bacterial contamination measured in colony-forming units (CFUs) at different distances. It is unclear what size of CFU reduction represents a clinically significant amount.
- There is low- to very low-certainty evidence that chlorhexidine (CHX) may reduce bacterial contamination (CFUs), compared with no rinsing or rinsing with water.
- Similar results were seen comparing cetylpyridinium chloride (CPC) with no rinsing and when comparing CPC, essential oils/herbal mouthwashes or boric acid with water.
- There is very low-certainty evidence that tempered mouth rinses may provide a greater reduction in CFUs than cold mouth rinses.
- There is low-certainty evidence that CHX may reduce CFUs more than essential oils/herbal mouthwashes.
- The evidence for other head-to-head comparisons was limited and inconsistent.
- No information on costs, change in micro-organisms in the patient’s mouth or adverse events was provided in the studies.
- Patients’ acceptability or feasibility of implementation was not assessed.
Conclusions
The authors concluded: –
None of the included studies measured the incidence of infection among dental healthcare providers. The studies measured only reduction in level of bacterial contamination in aerosols. None of the studies evaluated viral or fungal contamination. We have only low to very low certainty for all findings. We are unable to draw conclusions regarding whether there is a role for preprocedural mouth rinses in reducing infection risk or the possible superiority of one preprocedural rinse over another. Studies are needed that measure the effect of rinses on infectious disease risk among dental healthcare providers and on contaminated aerosols at larger distances with standardised outcome measurement.
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