Best Mouthwashes

What does mouthwash do?

The range of mouthwashes on supermarket and chemist shelves is so broad that it’s almost dizzying to have to decipher what a mouthwash does.

Most all-purpose mouthwashes will claim to kill bacteria and germs, freshen breath, target plaque and gingivitis and help fortify tooth enamel against decay.

This is an impressive series of claims, however whether a mouthwash does this depends on a number of factors, not least of which whether it is a cosmetic or medical/ therapeutic mouthwash.

What doesn't mouthwash do?

It's important to note that rinsing with mouthwash should never be a substitute for twice-daily brushing, and flossing.

Mouthwash won't do its part to prevent plaque, as the circular motion of toothbrush bristles and flossing is necessary to remove the food particles, sugar and acids that build up on teeth, and lodge themselves in-between teeth, at the end of each day.

Mouthwash also can't remove tartar - the hardened plaque that’s already built up on teeth, and this can only be properly done by a dentist.

While some people occasionally or regularly use mouthwash as a substitute for brushing, this isn’t recommended for good oral hygiene. Regular brushing for at least 2 minutes a day is necessary.

Additionally, avoid looking for a kids mouthwash until your child is over 6 years of age. Children under 6 often still swallow, instead of spitting out toothpaste and mouthwash. The addition of alcohol, chemicals or other harsh ingredients in mouthwash can result in adverse side effects in young children, such as nausea.

Types of Mouthwashes

Broadly speaking, there are two types of mouthwash - cosmetic and medical, also known as therapeutic.

Cosmetic Mouthwashes

Cosmetic mouthwash is the focus of most mouthwash advertising, and the main offerings from household brand names you’ll see on shelves. Some popular ones include Colgate Plax and Listerine Total Care.

Cosmetic mouthwash can be described as perfume for your mouth - temporarily freshening breath and leaving your mouth feeling clean. However, in terms of oral health benefits, cosmetic mouthwash does little to protect your teeth or keep them clean (despite promises of ‘round-the-clock’ protection).

However, for many people, swishing with a capful of mouthwash is a familiar and essential part of their daily oral hygiene routine. If your routine wouldn’t feel complete without this, using a cosmetic mouthwash shouldn't do any harm, as long as you choose containing helpful rather than harmful ingredients (such as alcohol, ethanol, and hydrogen peroxide).

Therapeutic Mouthwashes

These mouthwashes are more beneficial from an oral health standpoint, as they are specifically designed to help control and alleviate the symptoms of certain conditions. However, it’s still always best to consult with your dentist beforehand about which mouthwashes are best to help treat a certain condition.

Gum disease

If you have gum disease, choosing a mouthwash for gingivitis with active antimicrobial ingredients may help. In an alcohol-free mouthwash, the antimicrobial ingredients will often include cetylpyridinium chloride and chlorhexidine.

Chlorhexidine works to target the specific bacteria that cause gum disease, without killing good bacteria too, like alcohol would. Well-known mouthwashes with chlorhexidine include Savacol, which is also an antiseptic mouthwash.

However, while chlorhexidine and cetylpyridinium chloride can provide effective relief from gum disease, they’re often not a viable long-term solution. Both these agents can produce brown staining on teeth. It’s best to have mouthwashes that contain these ingredients prescribed by a dentist, and check in regularly to ensure you won’t experience any side effects from prolonged usage.

As a natural alternative, essential oils can also be an effective antimicrobial agent.

Tooth decay

Tooth decay happens as the result of enamel (the outer protective covering on your tooth surface) being worn down over time. This may happen due to a number of factors, including poor dental hygiene and consuming foods and drinks high in acid and sugar content.

Choosing a fluoride-rich mouthwash can help protect teeth against further damage. Fluoride is a fortifying mineral for teeth, but should not be swallowed, as it can be toxic - and children under 8 shouldn’t use it at all, as they are at risk of developing fluorosis if it the mouthwash is swallowed.

Bad breath

While most everyday cosmetic mouthwashes promise the elimination of bad breath, some may actually make it worse.

This is because alcohol is commonly added to antibacterial mouthwash as the agent to kill bacteria and germs. The problem with this is that alcohol kills all bacteria - including good bacteria in your mouth, which help aid in digestion and provide nutrients for good bacteria in your gut.

These good bacteria contribute to maintaining the overall good health of your oral microbiome - the healthy ecosystem in your mouth. Removing these good bacteria with alcohol can actually make your breath smell worse.

Instead of choosing a mouthwash with alcohol in it, choose a mouthwash with an alternative antimicrobial agent that targets odour-causing bacteria. Some examples are chlorhexidine and cetylpyridinium chloride - however this may have unwanted side effects of tooth staining, as described above. Essential oils are a natural antimicrobial agent that can freshen breath, and so are oral probiotics.

Dry Mouth

If you experience dry mouth syndrome, it's best to avoid mouthwash with alcohol in it at all costs, as alcohol is drying to the mouth. Other chemicals may be drying, too, so it may be beneficial to make your own natural mouthwash at home. Otherwise, sometimes dry mouth can be caused by bacteria on the the tongue, and antibiotics may need to be prescribed.

After dental surgery

Your dentist will be able to recommend the best mouthwash for you (if you should be using any at all). However, avoid mouthwashes with alcohol, especially for tooth extraction. Your tooth socket will be exposed, and alcohol will dry it, causing irritation. Some mouthwashes containing benzocaine may help to reduce pain, as it’s a topical local anesthetic. Some antiseptic mouthwashes, when prescribed by your dentist, can also help kill infection.

Stained or discoloured teeth

Some mouthwashes claim to whiten teeth, but it’s important to note that this is a slow method of teeth whitening. A small quantity of hydrogen peroxide in mouthwash may be added, but because this is an indirect method of teeth whitening, it can take up to 12 weeks to see results, rather than 2 weeks, which is the case for many home teeth whitening kits using gel.

If you also experience tooth decay, it’s best to avoid a mouthwash containing hydrogen peroxide, as this can be abrasive for your enamel, causing it to thin, and worsen the decay.

Alternatives to mouthwash

If you're finding it difficult to find a natural mouthwash, or a cosmetic mouthwash that doesn't contain alcohol or other unwanted chemicals, there are a few natural alternatives to chemical-heavy rinses that you you can make or take at home. These include:

• Oral probiotics: This can help reduce odour-reducing bacteria, and restore the balance of good bacteria, which also fights bad breath
• Oil pulling: An old Ayurvedic health practice that involves 'swishing' coconut oil in the mouth for around 20 minutes, and which can naturally 'pull' out bacteria and other toxins from the mouth
• Salt water mouth wash: Useful in the short-term after a dental surgery, such as a tooth extraction, as salt naturally disinfects. However, long-term, it can soften teeth enamel
• Baking soda mouthwash: Also known as sodium bicarbonate mouthwash, this involves mixing half a tablespoon of baking soda with water, and adding a pinch of sea salt. As it's gentler than most readymade mouthwashes, baking soda mouthwwash can be effective when used on mouth sores, sensitive teeth, and a sore throat.

Conclusion

Compared to daily brushing and flossing, mouthwash isn't an essential step in everyone's oral care routine. Many brands offer cosmetic mouthwashes that help make your mouth smell and clean fresh, temporarily. Other mouthwashes are designed to help treat oral conditions, and these should be selected im consultation with a dentist.

Avoiding harsh ingredients such as alcohol or hydrogen peroxide may be necessary to safeguard the health of your mouth. Other active ingredients such as chlorhexidine may be effective for short-term use only, due to long-term side effects. Overall, careful inspection of the ingredients in any mouth wash, and discussing them with your dentist, is likely to be the most helpful approach when selecting a medical mouthwash.