With numerous prescription and OTC mouthwash options out there, this guide helps to explain why they’re suggested by dentists and which one you should buy.
Who doesn’t want a healthy mouth?
Of the numerous ways to describe a healthy mouth, the most important is getting rid of the thousands of microflorae in the oral cavity – which may cause concerns like cavities, gum disease, bad breath and bleeding. Many patients already recognize that brushing their teeth twice daily may help promote oral wellness.
However, dental professionals may sometimes recommend additional steps to help patients achieve their oral health goals. A daily mouthwash may be recommended for patients based on their recent oral health status at their biannual dental check-up.
Because there are numerous prescriptions and over-the-counter mouthwashes for consumers, it might help to get some guidance on purchasing one. This guide helps to explain what mouthwash is, why it’s suggested, and which one you should buy based on your specific oral health needs.
What is mouthwash?
The oral cavity is home to thousands of bacteria, viruses, and fungi. This collection of microflorae lives everywhere, including our tongue, gums, teeth, tonsillar area, and roof and floor of the mouth. The microflorae are constantly changing and adapting to live in our mouths.
Each of these pathogens is unique in the harm they may cause in the mouth, including bleeding tissues, cavities, fungal infections, viral infections, bad breath (halitosis), and gum disease.
Because so many unique microorganisms live in the mouth, research has shown that a person must make an ongoing daily regimen to disrupt the bacteria or biofilm. Sometimes, a person’s best oral homecare efforts are limited due to the inability to hold a toothbrush, mouth shape, and oral anatomy. Mouthwashes, also called oral or mouth rinses 1 , were designed due to their ability to flow in the most challenging spaces and disrupt biofilm, regardless of anatomical or dexterity limitations.
Therapeutic vs. cosmetic mouthwashes
Mouthwashes may be divided into two basic categories: therapeutic and cosmetic2 . Cosmetic mouthwashes may only contain a few ingredients because they are meant to freshen your breath temporarily. The therapeutic style of mouthwashes is designed to address more issues than just bad breath. 3
Therapeutic mouthwashes may be broken even further into whether they are bacteriostatic, bactericidal, antiviral, antifungal, or antimicrobial 3. Most people accept using mouthwash in their oral care routine because it is an easy habit to adopt 2. Mouthwashes contain various ingredients, depending on whether they are cosmetic or therapeutic. The most common ingredients include water, alcohol, flavoring ingredients, coloring agents, and essential oils 2. Therapeutic mouthwashes may contain any of the following: chlorhexidine gluconate, cetylpyridium chloride, fluoride, hydrogen peroxide, povidone iodine, and triclosan 3.
Natural mouthwashes contain more organic ingredients, and a list of these ingredients includes sorbitol, aloe vera, turmeric, table salt, algae, witch hazel, pomegranate, green tea, propolis, charcoal, coconut oil, and baking soda 4.
Mouthwashes typically have instructions printed on the side of the bottle about how much liquid a patient should be swishing vigorously around their mouth. It is not recommended for anyone to swallow or drink any mouthwash. Children may use mouthwash, but they need to follow instructions, such as swishing and not swallowing the mouthwash 1.
Which mouthwash should I choose?
Selecting the correct daily mouthwash for your oral care routine is an important decision that can significantly impact your dental health. When choosing a mouthwash, consider your specific needs, such as cavity prevention, gum health, breath freshening, or teeth whitening.
- Various types of mouthwash are available, including
- Fluoride-based for cavity protection
- Antiseptic for fighting bacteria
- Cosmetic for temporary breath freshening
- Whitening formulas
- Natural options
Factors to keep in mind include alcohol content, sensitivity, taste preference, and any specific dental issues you may have. While mouthwash is a valuable addition to your oral hygiene regimen, it’s meant to complement, not replace, regular brushing and flossing.
For personalized advice, consult your dentist to determine the most suitable mouthwash for your oral health needs.
Best Mouthwash for Gingivitis
Gingivitis is defined as inflammation of the gingival tissue characterized by redness and bleeding 6. Gingivitis results from bacteria being left on the teeth and gums from either poor oral hygiene habits or difficult-to-reach areas 6. Dental professionals recommend improving oral hygiene habits to treat gingivitis, since gingivitis may be treated at home with improved oral home care.
A mouthwash may help reduce the plaque from collecting on the teeth and gums by dislodging it or killing the bacteria. Suggested oral mouthwashes to treat gingivitis include those that contain antimicrobial properties such as essential oils, chlorhexidine, and cetylpyridium chloride 1.
In addition, other anti-gingivitis mouthwashes may also be designed to be antibacterial, so they contain ingredients like alcohols, tetrasodium edta, sodium bicarbonate, sodium chlorite, and sodium benzoate 8. Suggested over-the-counter mouthwashes include Therabreath©, Listerine© (either with or without alcohol), and Colgate Total Pro Shield©.
Best Mouthwash for Cavities
Cavities are a common concern for the public. Many dental patients are quick to want to reduce their chance of dental decay because they are trying to preserve their teeth and reduce the number of dentist visits and any potential costs spent on dental restorations.
A dental cavity is caused by specific oral bacteria breaking down enamel from sugar and acid 6. To repair the bacteria’s breakdown of enamel, it is recommended that a patient use a repairing fluoridated mouthwash 1.
Fluoride mouthwash may have fewer ingredients listed on the bottle than other mouthwash, as the fluoride ion is the main ingredient 4. The Act© mouthwash brand is a common fluoride mouthwash sold in various retail stores.
Best Natural Mouthwash
Many dental patients choose to switch to a more holistic and natural lifestyle. In fact, studies show that consumers now pay more attention to the ingredients in their dental products and even to the packaging around them 5.
As a result, more oral care products are being marketed toward a natural lifestyle. These natural mouthwashes are still being closely monitored by the Food and Drug Administration and the American Dental Association to decide whether they are as effective as they claim 2. Natural mouthwashes are designed to help promote a healthy mouth, and some of these ingredients are effective against malodor, cavities, and gum disease 4.
Best Mouthwash for Dry Mouth
Dry mouth, or xerostomia as it’s professionally known, is a problem that affects many adults as they age 6. Dry mouth is a concern because it may cause plaque, food debris, and oral tissues to stick to one another. In addition, xerostomia causes dental concerns due to an increased risk of decay and bad breath and affects your oral health 6.
For many people, a simple and effective remedy is readily available:
Frequent Water Rinses: One of the easiest ways to combat mild dry mouth is by rinsing your mouth with water regularly throughout the day. This can help stimulate saliva production and keep your mouth moist and comfortable.
However, it’s important to note that persistent dry mouth may sometimes indicate an underlying condition. For instance, Sjogren’s autoimmune syndrome can cause chronic dry mouth that may not respond adequately to simple water rinses. If you experience ongoing dry mouth along with other symptoms like dry eyes, joint pain, or fatigue, it’s crucial to consult a healthcare professional.
When to Seek Medical Advice:
- If dry mouth persists despite frequent water rinses
- If you experience additional symptoms beyond just dry mouth
- If dry mouth significantly impacts your quality of life
When choosing a mouthwash for dry mouth, check the ingredient label. Research has shown that mouthwashes aimed at fighting dry mouth should never contain alcohol; rather, they should contain anti-cavity properties such as fluoride or xylitol to help decrease the risk of cavities. The Act© mouthwash brand is a common dry mouth mouthwash sold in various retail stores.
Remember, while water rinses are a great first step, your oral health is important. Don’t hesitate to contact your dentist or doctor if you have concerns about chronic dry mouth.
Best Antimicrobial Mouthwash
Antimicrobial mouthwashes are either bactericidal or bacteriostatic. Chlorhexidine gluconate has long been considered the gold standard as an antimicrobial mouthwash that targets a spectrum of disease-causing pathogens.
This mouthwash is only recommended for a short duration because although it is effective at disrupting the plaque and bacteria in the mouth, it has been shown to stain the teeth and alter tastebuds if used for long periods 3. Chlorhexidine gluconate is available by prescription only, so those interested in using it must have an examination with their dentist before using it 3.
Best Mouthwash for Orthodontics (Braces)
Maintaining excellent oral hygiene becomes even more critical when undergoing orthodontic treatment, whether using traditional braces, Invisalign®, or other clear aligners.
While essential for achieving a straighter smile, these devices create additional surfaces where plaque—a sticky film of bacteria—can accumulate. This plaque doesn’t just cling to your teeth and gums; it also attaches to your orthodontic appliances, making thorough cleaning more challenging and important.
A detailed oral care routine is crucial to prevent tooth decay and gum disease, ensure your orthodontic treatment progresses as planned, and maintain fresh breath and overall oral health.
For those with traditional braces, this involves carefully brushing around brackets and under the wires, using specialized flossing techniques, and possibly incorporating additional tools like interdental brushes or water flossers. Clear aligner wearers must be diligent about cleaning their aligners and teeth after every meal before reinserting the trays.
Regardless of the type of orthodontic treatment, all patients should prioritize regular dental check-ups, use fluoride products, and be mindful of their diet to protect their oral health during this important phase of dental care.
Conclusion
Selecting the right mouthwash is an important decision for maintaining optimal oral health. A recent meta-analysis 7 provided valuable insights into the effectiveness of various mouthwash types. The study compared fluoride, antibacterial, and natural mouthwashes, revealing that each impacts oral health differently.
Fluoride mouthwashes proved most effective in reducing cavity risk, making them an excellent choice for those prone to tooth decay. Antibacterial options like chlorhexidine gluconate effectively lowered bacterial counts but may cause tooth staining over time, suggesting they’re best for short-term use or specific dental health issues. Natural mouthwashes, while popular, showed the least overall benefit in this study.
Based on these findings, fluoride-containing mouthwashes like Listerine Zero© with stannous fluoride emerged as a top recommendation for general use, offering a balance of cavity protection and gentle care.
It’s crucial to remember that individual oral health needs vary, and the ideal mouthwash choice should be made in consultation with a dental professional. Factors to consider include specific oral health concerns, sensitivity issues, and personal preferences. When incorporating mouthwash into your daily routine, always follow label instructions for safe and effective use.
While mouthwash is a valuable addition to your oral care regimen, it’s important to remember that it complements rather than replaces thorough brushing and flossing. Regular dental check-ups remain essential for maintaining overall oral health and addressing any specific concerns that may influence your choice of mouthwash.
References:
1)American Dental Association (ADA). (2024). Mouthrinses (mouthwash). Retrieved from: https://www.ada.org/resources/ada-library/oral-health-topics/mouthrinse-mouthwash
2) Asadoorian, J. (2024). Antimicrobial agents for control of periodontal disease. In J.A., Pieren, & C.C. Gadbury-Amyot (6th edition), Darby and Walsh Dental Hygiene Theory and Practice, (p421). Elsevier.
3) Brookes, Z., McGrath, C., & McCullough, M. (2023). Antimicrobial Mouthwashes: An Overview of Mechanisms-What Do We Still Need to Know?. International dental journal, 73 Suppl 2(Suppl 2), S64–S68. Retrieved from: https://doi.org/10.1016/j.identj.2023.08.009
4) Duane, B., Yap, T., Neelakantan, P., et al. (2023). Mouthwashes: Alternatives and Future Directions. International dental journal, 73 Suppl 2(Suppl 2), S89–S97. Retrieved from: https://doi.org/10.1016/j.identj.2023.08.011
5) Masory, A. (2019). Naturally beautiful: Millennials and preferences in beauty and personal care products. AlixPartners. Retrieved from: https://www.alixpartners.com/insights/102j5oz/naturally-beautiful-millennials-and-preferences-in-beauty-and-personal-care-prod/
6) Pieren, J.A., Gadbury-Amyot, C.C. (2024). Darby and Walsh Dental Hygiene Theory and Practice (6th edition). Elsevier.
7) Ren, X., Zhang, Y., Xiang, Y., et al. (2023). The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment: a systematic review and meta-analysis. BMC oral health, 23(1), 204. Retrieved from: https://doi.org/10.1186/s12903-023-02920-4
8) Whelan, C. (2022). The 9 best mouthwashes for whitening, cavities, gums, breath and more. Healthline. Retrieved from: https://www.healthline.com/health/dental-and-oral-health/best-mouthwash#1