Mouthwash
Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.
Usually mouthwashes are antiseptic solutions intended to reduce the microbial load in the mouth, although other mouthwashes might be given for other reasons such as for their analgesic, anti-inflammatory or anti-fungal action. Additionally, some rinses act as saliva substitutes to neutralize acid and keep the mouth moist in xerostomia. Cosmetic mouthrinses temporarily control or reduce bad breath and leave the mouth with a pleasant taste.
Rinsing with water or mouthwash after brushing with a fluoride toothpaste can reduce the availability of salivary fluoride. This can lower the anti-cavity re-mineralization and antibacterial effects of fluoride. Fluoridated mouthwash may mitigate this effect or in high concentrations increase available fluoride, but is not as cost-effective as leaving the fluoride toothpaste on the teeth after brushing. A group of experts discussing post brushing rinsing in 2012 found that although there was clear guidance given in many public health advice publications to "spit, avoid rinsing with water/excessive rinsing with water" they believed there was a limited evidence base for best practice.
Use
Common use involves rinsing the mouth with about of mouthwash. The wash is typically swished or gargled for about half a minute and then spat out. Most companies suggest not drinking water immediately after using mouthwash. In some brands, the expectorate is stained, so that one can see the bacteria and debris.Mouthwash should not be used immediately after brushing the teeth so as not to wash away the beneficial fluoride residue left from the toothpaste. Similarly, the mouth should not be rinsed out with water after brushing. Patients were told to "spit don't rinse" after toothbrushing as part of a National Health Service campaign in the UK. A fluoride mouthrinse can be used at a different time of the day to brushing.
Gargling is where the head is tilted back, allowing the mouthwash to sit in the back of the mouth while exhaling, causing the liquid to bubble. Gargling is practiced in Japan for perceived prevention of viral infection. One commonly used way is with infusions or tea. In some cultures, gargling is usually done in private, typically in a bathroom at a sink so the liquid can be rinsed away.
Dangerous misuse
Serious harm and even death can quickly result from ingestion due to the high alcohol content and other substances harmful to ingestion present in some brands of mouthwash. Zero percent alcohol mouthwashes do exist, as well as many other formulations for different needs.These risks may be higher in toddlers and young children if they are allowed to use toothpaste and/or mouthwash unsupervised, where they may swallow it. Misuse in this way can be avoided with parental admission or supervision and by using child-safe forms or a children's brand of mouthwash.
Surrogate alcohol use such as ingestion of mouthwash is a common cause of death among homeless people during winter months, because a person can feel warmer after drinking it.
Effects
The most commonly used mouthwashes are commercial antiseptics, which are used at home as part of an oral hygiene routine. Mouthwashes combine ingredients to treat a variety of oral conditions. Variations are common, and mouthwash has no standard formulation, so its use and recommendation involves concerns about patient safety. Some manufacturers of mouthwash state that their antiseptic and antiplaque mouthwashes kill the bacterial plaque that causes cavities, gingivitis, and bad breath. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both brushing and flossing. The American Dental Association asserts that regular brushing and proper flossing are enough in most cases, in addition to regular dental check-ups, although they approve many mouthwashes.For many patients, however, the mechanical methods could be tedious and time-consuming, and, additionally, some local conditions may render them especially difficult. Chemotherapeutic agents, including mouthwashes, could have a key role as adjuncts to daily home care, preventing and controlling supragingival plaque, gingivitis and oral malodor.
Minor and transient side effects of mouthwashes are very common, such as taste disturbance, tooth staining, sensation of a dry mouth, etc. Alcohol-containing mouthwashes may make dry mouth and halitosis worse, as they dry out the mouth. Soreness, ulceration and redness may sometimes occur if the person is allergic or sensitive to mouthwash ingredients, such as preservatives, coloring, flavors and fragrances. Such effects might be reduced or eliminated by diluting the mouthwash with water, using a different mouthwash, or foregoing mouthwash entirely.
Prescription mouthwashes are used prior to and after oral surgery procedures, such as tooth extraction, or to treat the pain associated with mucositis caused by radiation therapy or chemotherapy. They are also prescribed for aphthous ulcers, other oral ulcers, and other mouth pain. "Magic mouthwashes" are prescription mouthwashes compounded in a pharmacy from a list of ingredients specified by a doctor. Despite a lack of evidence that prescription mouthwashes are more effective in decreasing the pain of oral lesions, many patients and prescribers continue to use them. There has been only one controlled study to evaluate the efficacy of magic mouthwash; it shows no difference in efficacy between the most common magic-mouthwash formulation, on the one hand, and commercial mouthwashes or a saline/baking soda solution, on the other. Current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief and in shortening the healing time of oral mucositis from cancer therapies.
Beyond the sanitization effects, the use of antiseptic mouthwash can disrupt the oral microbiome and interfere with the regulated production of nitric oxide, which in turn increase cardiovascular, and Alzheimer's Disease health risks.
History
The use of mouth rinses for health and disease is ancient and the literature is difficult to date precisely. The Huangdi Neijing is said to have been written around 2600-2700 BC and advises treating gingivitis or periodontis by using the urine of a child as a mouth wash. Ayurveda practices such as oil pulling are said to date to 3000-5000 years ago. for treatment of gingivitis. However, both of these practices are semi-mythical and specialists generally date this literature to around 200-300 BC. The ancient Chinese also gargled salt water, tea and wine as a form of mouthwash after meals, due to the antiseptic properties of those liquids, as recounted by the Shiji written circa 94 BCE.In the Greek and Roman periods, mouth rinsing following mechanical cleansing became common among the upper classes, and Hippocrates recommended a mixture of salt, alum, and vinegar. The Jewish Talmud, dating to 50 - 500 CE, suggests a cure for gum ailments containing "dough water" and olive oil.
Before Europeans came to the Americas, Native North American and Mesoamerican cultures used mouthwashes, often made from plants such as Coptis trifolia. Peoples of the Americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as teething and mouth ulcers.
Anton van Leeuwenhoek, the famous 17th century microscopist, discovered living organisms in deposits on the teeth. He also found organisms in water from the canal next to his home in Delft. He experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. Next he tried rinsing the mouth of himself and somebody else with a mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. He concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms.
In 1892, German Richard Seifert invented mouthwash product Odol, which was produced by company founder Karl August Lingner in Dresden.
That remained the state of affairs until the late 1960s when Harald Loe demonstrated that a chlorhexidine compound could prevent the build-up of dental plaque. The reason for chlorhexidine's effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours.
Since then commercial interest in mouthwashes has been intense and several newer products claim effectiveness in reducing the build-up in dental plaque and the associated severity of gingivitis, in addition to fighting bad breath. Many of these solutions aim to control the volatile sulfur compound–creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste. For example, the number of mouthwash variants in the United States of America has grown from 15 to 66 to 113.
Research
Research in the field of microbiotas shows that only a limited set of microbes cause tooth decay, with most of the bacteria in the human mouth being harmless. Focused attention on cavity-causing bacteria such as Streptococcus mutans has led research into new mouthwash treatments that prevent these bacteria from initially growing. While current mouthwash treatments must be used with a degree of frequency to prevent this bacteria from regrowing, future treatments could provide a viable long-term solution.A clinical trial and laboratory studies have shown that alcohol-containing mouthwash could reduce the growth of Neisseria gonorrhoeae in the pharynx. However, subsequent trials have found that there was no difference in gonorrhoea cases among men using daily mouthwash compared to those who did not use mouthwash for 12 weeks.