The role of your mouthwash is simply to do one of two things: kill bacteria or reduce the ability of bacteria to stick to your teeth. The result is that you have a fresher taste and cleaner feeling due to having a lower bacteria count. We recommend using a mouth rinse as part of your regular home cleaning regimen in addition to brushing and flossing because it can work to prevent the activity of bacteria, not just remove it. So which rinse to use? What to the ingredients do?
In this post, I will review the most common ingredients in mouth rinses and explain how they work. Your decision on which to use will be guided by consultation with your dentist (Me!) based upon what needs you may have. So here are some of the active ingredients you may have read on the bottles of mouth rinses:
Fluoride- In over the counter concentrations, such as in toothpaste or mouth rinses like Act or Fluorigard, fluoride is meant to strenghten the outer layer of enamel on the teeth. It has a mild anti-bacterial effect, but is mostly used to minimize sensitivity or help the newly erupted teeth of young kids to mature properly. In higher prescription-strength concentrations, it can have anti-bacterial effects but is not the most commonly used rinse.
Chlorhexidine- This is found in prescription mouthwashes like Peridex or Perioguard and is available with and without alcohol. It is considered the gold standard to which other rinses are compared due to its “substantivity”- the ability to linger on the tissue in your mouth for an extended period of time. Primarily, it functions to cause bacteria to rupture but it also inhibits the ability of the bacteria to adhere to your teeth. This is most often used for patients with active periodontal disease or who have had dental surgeries. The potential downside to this rinse is that it can stain your teeth, although it is an external, removable stain.
Essential Oils- Most commonly found in Listerine, this combination of eucalyptol, menthol, methyl salicylate, and thymol have been used as a dental rinse since the early 1900′s when Listerine became the first over the counter mouthwash. They are very effective at killing bacteria by causing the cell walls to rupture, thereby lowering the overall bacterial count in your mouth. Current formulations of Listerine include versions with fluoride and with/without alcohol. The alcohol-free products don’t meet the same efficacy standards, which is important to consider.
Cetylpyridinium Chloride- This is the active ingredient in Crest Pro Health rinse and many others, at differing concentrations. It also works by causing the rupture of bacterial cell walls, and comes in alcohol and alcohol-free variations. It appears to have similar results as Listerine when used in the correct concentration- and you MUST have the concentration at the effective dose of .045%. Be aware that some rinses do not have this effective dose! Some people report an altered taste sensation when using this rinse, but that appears to be a personal preference. There is also some staining that can occur when using this product.
Stabilized Chlorine Dioxide- This ingredient is found in CloSYS and Oxifresh. It is promoted as binding to oxygen to kill bacteria by creating a super-oxygenated environment. It is alcohol free, does not stain your teeth, and has been shown to reduce bad breath. Unfortunately the research does not support claims that it kills bacteria, and more investigation is needed.
Delmopinol Hydrochloride- This is the active ingredient in GUM Perioshield and works by creating a less adhesive surface for bacteria to stick to. This is the only product considered a dental device as it works to break up the existing dental plaque and to stick to your teeth to prevent further plaque adherence. It has been used in Europe for over a decade and appears to have good research behind it. It does not stain teeth and has very little alcohol.
So as you can see, there are many considerations which all have the same goal of making your mouth more healthy. Please don’t hesitate to ask which may be the best for you, and also be understanding that there may be a specific version of a rinse you make like more than other versions!