Mouth Rinses

How can mouth rinses benefit oral health?

Mouth rinses which contain fluoride can help to prevent dental decay. Fluoride mouth rinses may be recommended for children having orthodontic treatment, especially fixed appliance treatment which makes it more difficult to clean teeth. Fluoride rinses may also be recommended for children identified as at special decay risk, or for patients suffering from dry mouth, or who have undergone radiation therapy. For more information about fluoride, see the BDA's fact file on fluoride toothpastes.

Mouth rinses can also be formulated to counter inflammatory periodontal (gum) diseases, using ingredients such as:

• Chlorhexidine gluconate - one of the most effective anti-plaque agents, but it may stain the teeth if used over a long period of time;
• Triclosan - an anti-plaque agent with anti-inflammatory properties;
• Essential oils - also anti-plaque agents with anti-inflammatory properties;
• Cetylpyridinium chloride - an anti-plaque agent with bactericidal activity;
• Peroxide and perborates (oxygenating agents) - these are also anti-plaque agents;
• Chlorine dioxide - this agent is claimed to eliminate volatile sulphur compounds and reduce bad breath.

Mouth rinses with ingredients such as these may contain fluoride as well. Some mouth rinses have been the subject of extensive clinical trials which have shown them to be effective in reducing gingival inflammation1. However, many mouth rinses on the market have not been the subject of clinical testing and should be regarded as cosmetic rather than health products.

What about mouth rinses available only from pharmacies or on prescription?

This fact file is about daily use mouth rinses which are on general sale. Some mouth rinses are only available from pharmacies, either as over-the-counter (OTC) products or prescription-only-medicines (POM). These products should only be used on dentist advice. Some have side-effects such as staining if used for prolonged periods.

How can daily use mouth rinses help people with gum problems?

Effective and regular removal of plaque deposits is an essential part of the treatment and prevention of gum disease. But tooth brushing and periodic professional scaling - mechanical oral hygien - may not always be enough. This is where antimicrobial mouth rinses can help. They are an adjunct to tooth brushing, helping to make plaque removal more effective and reduce inflammation. Mouth rinses are not a substitute for regular tooth brushing with a fluoride toothpaste, but some have been shown to do a lot more than just freshen breath.

How often should mouth rinses be used?

Product packs normally advise use twice daily, sloshing the rinse round the mouth for half a minute or a minute - the advice varies from product to product. BDA-accredited products will have demonstrated efficacy at the levels shown on packs and efficacy will be reduced if the product is used less often. Equally, products should not be used more often than packs indicate. Check the label for specific instructions on duration of usage and on whether they should be used before or after brushing.

Should children use mouth rinses?

Packs normally show age limits. The minimum age for use varies according to the ingredients - it is normally higher for rinses containing higher levels of alcohol. But small children should not use any mouth rinses, because they are not able to spit out properly and there is therefore a risk of swallowing. Also, of course, most children have good gum health and do not need to use mouth rinses, unless they are identified as being at special need of a fluoride rinse for orthodontic or other reasons.

Why do mouth rinses contain alcohol?

Most mouth rinses contain some pharmaceutical grade alcohol, as a preservative and as a semi-active ingredient. The amount varies from product to product. The BDA's Accreditation Scheme advises use of child resistant closures for mouth rinses containing a high proportion of alcohol, to minimise the risk of accidental swallowing. Aftershave, perfume, cough mixtures and other household products also contain alcohol, so mouth rinses are not unusual in this respect, but it is important to follow their recommendations for use.

Do mouth rinses have any adverse effects?

It has sometimes been suggested that alcohol-containing mouth rinses might be a cause of oral cancer. Oral cancer is known to be associated with tobacco use and excessive alcohol consumption. People who smoke and drink may also use mouth rinses to conceal the smell, so the epidemiological data can be difficult to interpret. However, the BDA's Accreditation Panel carried out an independent assessment of mouth rinse safety and concluded that there is no evidence that if used as directed mouth rinses can lead to oral cancer. A further review, carried out by a working party of the US Food and Drug Administration in 1996 came to a similar conclusion.

It has also been suggested that some daily use mouth rinses may be a cause of tooth erosion as a result of their acidity. Some may, but products accredited by the BDA demonstrated non-erosiveness in normal use.

Which mouth rinses are accredited by the BDA?

The BDA Accreditation Scheme helps consumers identify products which have demonstrated safety, quality and efficacy to an independent panel of experts. Generally, these are brands from major manufacturers who are committed to research into the improvement of oral care products. The following rinses have gained BDA accreditation and now carry the BDA logo: