Are Mouthwashes healthy? What does a dentist say?
The biggest enemy of a healthy mouth is dental plaque. Dental plaque builds up on the teeth very quickly. Plaque is made of bacterial colonies on your teeth mixed with food debris.
The dental plaque is part of a bigger problem that faces your mouth and teeth: tooth decay, gum disease, bad breath and other issues.
The unfortunate reality is that plaque build-up is happening continuously. We can never have an antiseptic mouth, free of bacteria, because bacteria is present in large amounts in the mouth; and is waiting for reasons to flourish and grow.
[That’s why, when you have surgery inside your mouth, the surgeon doesn’t even attempt to sterilise the operation site, because that is almost impossible. Believe me, I have worked in operating theatres and I have observed this first hand.]
The most important method for removing dental plaque will continue to be the mechanical removal of the dental plaque carried out by the toothbrush. This is further supported with interdental flossing in the form of flossing or interdental brushes.
Maintaining healthy dental habits can help keep symptoms at bay and prevent dental conditions from starting or worsening.
In addition to the oral hygiene steps mentioned above, one can add a mouthwash to the process.
Functions of Mouthwash
Amongst others, mouthwashes have a number of functions:
a) freshen the mouth
b) deliver chemicals to help strengthen teeth
c) help with large scale removal of plaque deposits (for those who are really lacking in Oral Hygiene)
d) neutralise the acid environment
e) deliver chemicals which kill bacteria
f) deliver chemicals that help to inhibit or delay plaque formation
So, as you can see mouthwashes can do a lot. It might be difficult to find a single mouthwash that does all the above. However, one may also be alarmed to see that there is a big role for chemicals to play in mouthwashes. These mouthwashes can be an important part of a health mouth.
For plaque to do damage, bacteria have to be well colonised to cause gingivitis, tooth decay and bad breath. Mouthwashes work in many ways to fight bacteria that does this, by either strengthening your natural defences or by disrupting the bacteria – chemically and – to a lesser degree – mechanically.
Mouthwash as a second line of defence
As I stated above, the most important part of dental hygiene is the mechanical removal: this is the first line of defence against dental plaque. Mouthwashes – however – can act as a second line of defence in oral hygiene.
Used correctly, they can be a helpful adjunct to the hygiene of our oral tissues.
Mouthwash should be considered as one of the weapons that you have in your artillery in your battle against dental plaque.
The concept of Chemicals
Many people will hear the word “chemicals” and be alarmed. There has been a negative association between the word “chemical” and health. Generally, we have been programmed to think that all “chemicals” are bad and that life would be better without them.
I want to spend a moment or two, to remove the myth around chemicals.
Chemicals are a part and parcel of our existence. Our bodies are made of billions of chemicals. Our food is a complex makeup of chemicals. Simple ingredients are chemicals. Take your ordinary average table salt: that is a chemical named Sodium Chloride (NaCl). Water is a chemical (H20); and so on.
We have to therefore understand that the building blocks of life are all chemicals.
There are good chemicals as well as “bad” chemicals. There are useful chemicals and there are dangerous ones.
It is true that chemicals come in all forms, shapes and sizes. Some are dangerous and even lethal. Whilst others are healthy and vital. We have to learn how to differentiate between the two.
Which chemicals should I avoid?
It is difficult to discuss all the different aspects of a mouthwash, and we will come back to this in a future article.
One chemical that is good to avoid in mouthwashes is alcohol. For many decades, manufacturers have been adding alcohol to mouthwashes for some benefits that are thought to be produced by the alcohol, namely the bactericidal effect it has, and because alcohol is a good solvent for other chemicals.
With an increase in the awareness of how this chemical may be detrimental to oral health, there has been a substantial move to produce alcohol free mouthwashes.
A recent review into the effect of alcohol mouthwashes concluded that alcohol-based mouthwash consumption significantly increases acetaldehyde levels in the first few minutes, but no evidence exists if long-term salivary acetaldehyde levels may increase with a high frequency of mouthwash use. The review went to state “There is still insufficient evidence of whether the use of alcohol-based mouthwash is an independent risk factor for oral or oropharynx cancer. Nonetheless, it does increase the risk when it occurs concomitantly with other risk factors such as smoking or alcohol.”
This review may not clearly state that alcohol based mouthwashes are detrimental to oral health, but as is the nature of scientific reviews they look at what can be termed “evidence”; and that doesn’t mean that the lack of evidence means there is no evidence.
As we now, have more and more options with alcohol free mouthwashes: then the wise choice would be to opt for these.
 Ustrell-Borràs M, Traboulsi-Garet B, Gay-Escoda C. Alcohol-based mouthwash as a risk factor of oral cancer: A systematic review. Med Oral Patol Oral Cir Bucal. 2020;25(1):e1‐e12. Published 2020 Jan 1. doi:10.4317/medoral.23085