December 3, 2012

Which Mouthrinse Is Best? (i.e. Does Listerine Work Magic?)

I have had a few requests and questions pertaining to mouthwash, specifically Listerine, so today I will attempt to reveal every secret hidden inside those pretty little bottles.

This is going to be difficult to explain only because there are so many rinses out there that promise you so many different things. I’ll keep it as short as possible. To keep it as simple as possible, I’ll break it down into FAQ, key definitions, and key ingredients.


Do I have to use mouthrinse to have a healthy mouth?
Absolutely not. The two most important things you can do for your mouth, besides having regular cleanings, are to 1) properly brush two times each day and 2) properly floss once each day. This is the most effective, the easiest, and the least-costly way to have a healthy mouth. If you do these two things and nothing else, your mouth should be in pretty good shape.

Everything that happens in your mouth builds off of your brushing and flossing. However, there are certain oral conditions which you may already have that warrant additional help.

How do I know if I should use mouthrinse? Using a rinse is never a bad idea. So far, research has shown many rinses are effective at what they claim to do. What we don't have yet is a total cure for cavities and gum disease. Mouthrinses may claim they "help" with gum disease, but there is no one product that actually has the answer (that includes you, Listerine). 

We know that certain bacteria cause cavities and certain bacteria cause gum disease, but what we do not understand yet is how someone may have that bacteria present but not have the disease. Welcome to the mystery surrounding dentistry. There is talk about possible vaccinations for cavities and gum disease. That, of course, would be wonderful for the patient, though not as wonderful when it puts dentists out of business. 

After reading this information, if you are unsure if you should use a rinse, its fine to go ahead and start. But next time you see your dental hygienist, ask her for a recommendation that will be specific to your mouth.

Is there one perfect mouthrinse for me? Quite possibly. But again, that depends on what is currently happening in your mouth. Do you have bad breath? Do you have cavities? Do you want whiter teeth? Do you have gum disease? Do you have all of the above?

Can I replace brushing or flossing with mouthrinse? Don’t even think about it. The most important thing you can do for your mouth is to mechanically remove the plaque from all sides of your the teeth, which is why you brush and floss. Mouthrinse will not do that for you.

Two Key Definitions

It is important for you to understand the difference between a therapeutic mouthrinse and a cosmetic mouthrins. According to FDA standards,

1. A therapeutic mouthrinse is any rinse that claims to treat disease, prevent disease, or affect the structure or function of the body. This type of rinse is considered a ‘drug’ and undergoes rigorous testing to make it safe and effective. Therapeutic rinses must be pre-approved by the FDA before they can make any advertised claim.

Examples of these therapeutic claims that are advertised on the bottle include Restores Enamel, Strengthens Teeth, Kills Bad Breath Bacteria, Cleans Whole Mouth, Fights Gum Disease, Reduces Plaque and Tartar, Whitens Teeth, Antiseptic, and Antiplaque.

For example, Listerine Fluoride Defense claims it is Anticavity. Because cavities are caused by bacteria, it is actually a disease of the mouth. The rinse also contains fluoride, which is an over-the-counter drug that changes the enamel of your tooth. So because of these two things, it will be classified as a therapeutic mouthrinse.

2. A cosmetic product is anything that is used on the human body for cleansing, beautifying, or promoting attractiveness. These are not as closely regulated by the FDA, and their claims are not pre-approved. An example of a cosmetic rinse is one that does nothing else except freshen your breath. Examples of other cosmetic products are perfumes, lipstick, lotion, deoderant (not antiperspirant, which would be therapeutic), fingernail polish, etc. These products do not promise to fight disease and do not include any known drugs. 

Technically, you could boil a mint leaf in water, advertise it as a cosmetic rinse that promises to freshen your breath, and it would be legit (don‘t get any silly ideas).

Because there isn’t therapeutic value in cosmetic rinses, they seem to be becoming obsolete. However, brands will still hang on to the product as long as consumers will buy it. In the past, I have used Plax as an example of a cosmetic mouthwash. It’s only claim used to be Freshens Breath. But recently, the brand was bought by Colgate and has since jumped on the therapeutic mouthrinse bandwagon.  

My point is that if you are going to use a mouthrinse in this day and age, there is no reason why you should buy a cosmetic rinse. Why spend your money on something that only freshens your breath, when you can use that same money to buy a product that does so much more?

8 Key Ingredients
There are a few common ingredients found in many mouthrinses that you should be aware of. I bring these to your attention because, like any other ingredient in anything else, because sometimes people can have side effects from certain ingredients. And sometimes there may be controversy surrounding the use of certain ingredients. I always suggest you do your own research, but advise you to make sure your facts are coming from a current, unbiased, and reliable source. The Cochrane Collaboration is just one example of a reliable source.

1. Fluoride Out of all the rinses on the market, those that contain fluoride are the most important and most effective. Any rinse that claims Anticavity, Restores Enamel, or Strengthens Teeth must contain fluoride. ACT is one of the oldest and most popular brands. 

Technically, whether or not you should use a fluoride rinse depends on how much fluoride you receive on a daily basis.

The following is a list of examples of conditions and characteristics that can be helped by fluoride. If even ONE of these applies to you, then you should rinse with fluoride every day.

If you have ever had a cavity.
If you only drink bottled/filtered water.
If your tap water does not contain flouride (naturally-occurring or added).
If you have ever bleached your teeth, will be bleaching, or are currently bleaching.
If you consider yourself a student (even college, graduate and post-graduate).
If you have sensitive teeth.
If you have ever had any restorations (fillings, crowns, bridges, veneers).
If you currently have braces, will be getting braces, or have recently had them removed.
2. Sodium Lauryl Sulfate (SLS) This is a synthetic detergent and surfactant that is used in many cleaning supplies, toothpastes, and other oral products. Its what makes your toothpaste foam. Some people have side effects from using it (I do!). The most common oral side effect is gingival sloughing-- basically, your gums and cheeks peel shortly after use. If this happens to you, use products that use minimal to no SLS.

3. Alcohol Products will use alcohol as a solvent, as a preservative, as a vehicle for the active ingredient, and sometimes for it’s antibacterial properties. Alcohol may cause dry mouth. Some Listerine products have about 30% alcohol in. This is why Listerine burns when you use it. People who have alcoholic tendencies should refrain from using these products. There are many comparable, alcohol-free products available.

4. Hydrogen Peroxide/ Carbamide Peroxide Whitening mouthrinses will always contain one of these. A rinse that promises to Whiten Faster or Whiten Stronger will probably have a higher percentage of whitening agent in than other products.

5. Chlorhexidine gluconate This is an antimicrobial agent that is found in prescription-only rinses (such as Peridex). It helps fight gum disease and cavities by killing bacteria. This may stain teeth with long-term use, but the stain can be removed by your hygienist during a cleaning.

6. Cetylpyridinium chloride This is an antimicrobial agent that is found in rinses like Crest Pro-Heath. It helps fight gum disease and bad breath by killing bacteria. It is also known to stain teeth with long-term use, but the stain can be removed by your hygienist during a cleaning.

7. Essential Oils These are Listerine’s “magical” ingredients. Some of the more common essential oils used in oral care products are eucalyptol, menthol, methylsalicylate, and thymol. Essential oils are known to fight gum disease and bad breath by killing bacteria and preventing plaque from forming.

8. Artificial Coloring Artifical Coloring is the key to using the product. If the color of the rinse looks unedible, then noone will want to use it. The problems with artificial dyes are that some people can have sensitivies towards them, and they can also stain your teeth (the darker the color, the more likely it will stain). This stain may be controlled with the use of an electric toothbrush or may be removed by your dental hygienist during a cleaning.


So which mouthrinse is best?

Well, that depends on the current condition of your mouth. But like I said before, using a mouthrinse, even one with fluoride in, is not a bad idea.

If you are like me and are concerned with multiple areas at once, there are a few rinses out there that pretty much do everything. Two of the more popular ones are Crest Pro-Health and Listerine Total Care. Like always, be sure to discuss this with your dental hygienist because she will know what is best for your mouth.

But, like I said before, the health of your mouth simply comes down to properly brushing and flossing. Using a mouthrinse may help, but only if your brushing and flossing is perfect.

Let's go back to the basics.

Your friendly dental hygienist, (m)

*As always, I try to present the most current, valid, un-biased facts on dentistry. I promise I will clearly note when I am giving my opinion. The medical field is always changing, so when new research comes out, I will do my best to update you. If you are curious to know where I get my facts, please go here and here or feel free to contact me.


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