Does mouthwash work?
Not if used as a substitute for regular and meticulous brushing and flossing, two local dentists agree
A brief gargle with mouthwash gives one fresh, minty-fragrant breath and a clean mouth and helps create a very favourable impression on others, while foul breath causes a bad first impression and makes intimacy unpleasant. This is a message proclaimed by the flood of mouthwash advertisements in the media, and particularly on TV, in recent years.
Regular brushing and flossing are vital for oral hygiene.
The ferocity of the competition among market rivals is reflected in the comprehensive range of mouthwash products now available over the counter, a whole range of different rinse formulae that claim, variously, to help prevent cavities and gum disease, reduce bacterial growth in the mouth, control plaque build-up or even provide "total care".
But do we really need to use mouthwash?
"Well, I'd say no," was the verdict given by Dr Suwanee Kantanantha, an endodontist from the dental clinic at Samitivej Srinakarin Hospital. "Brushing your teeth properly and flossing on a regular basis _ at least twice at day, in the morning and the evening _ is sufficient to keep teeth and gums healthy. But the point is that you must do both of those things well."
While brushing removes plaque from the teeth and flossing can help clean the tight spaces between the teeth and below the gums, Dr Suwanee noted, a mouthwash is only useful for improving the overall cleanliness of the mouth; on its own, it doesn't have the ability to clean teeth and gums.
Dr Ann Chianchitlert, a dentist at Asavanant Dental Clinic, also in Bangkok, echoed the endodontist's views on the effectiveness of a regular routine of brushing and flossing for the maintenance of good oral health.
"It's best to brush and floss after each meal if you can," she added. "And the use of a fluoride toothpaste can help strengthen the teeth."
Dental plaque is so sticky, Dr Suwanee noted, that gargling with a mouthwash is not enough on its own to get rid of it. To drive the point home, she made an analogy with an everyday household task.
"If you want to wash a bowl, for instance, you'd put some washing liquid on it, but if you don't also use a cleaning pad to wash off the dirt, then the bowl doesn't get really clean. The stains are still there." The endodontist said many of her patients make the mistake of skipping brushing and flossing in favour of using a commercial rinse because they assume that the feeling of freshness that lingers in the mouth for a short time after gargling signifies that the mouth has been cleaned.
"A mouthwash is never a replacement for a good brush and floss," she said. "It is just an add-on to proper oral care." To be effective at all, she continued, a mouthwash should be used immediately after giving one's teeth a good brush and floss.
"And to make it really work, you need to gargle for at least a minute before spitting it out."
Most over-the-counter rinses are marketed as a method of battling chronic bad breath. But do they actually help?
"Well, they do, but for not for very long," was the verdict from Dr Ann. "A rinse helps reduce unpleasant smells from food fragments and refreshes your mouth temporarily. But saliva will gradually dilute what's left of the mouthwash residue over time."
Bad breath can be caused by a variety of things, Dr Ann said, including cavities, decaying food debris and gum disease. Illnesses that cause oral lesions or a sore throat can also trigger the condition.
"If you have chronic bad breath you may need to see a professional health-care provider to find out the root cause of the problem." Dr Ann advised.
So is a mouthwash any help whatsoever in reducing dental plaque?
It can help reduce further plaque accumulating on teeth and gums, Dr Suwanee replied, but it will do nothing to dislodge the plaque that has already built up.
"So, you still need to get back to the basic idea of an oral care routine: brushing and flossing well to remove old plaque on the teeth and gums. Anti-plaque mouthwash can be useful for controlling plaque build-up, but I'd say it helps only a little bit," he added.
Dr Suwanee went on to note that alcohol is a common ingredient in mouthwash, many of which have a concentration of up to 26%, which is more than twice that found in most wines. She also referred to a study which established a link between the use of high-alcohol mouthwash and oral cancer.
"People may experience a burning sensation in the mouth when using alcohol-based rinses as alcohol can irritate oral tissue," she said.
Sometimes there is no indication on the label regarding the alcohol content of a mouthwash, she added, advising caution in the use of such products.
"I usually tell patients of mine, particularly those who complain of oral sensitivity, to choose an alcohol-free rinse if at all possible," she said. "You know, people have different levels of sensitivity in the mouth. Some rinses are so strong that it's difficult to use them for very long. If you find you can't bear a particular mouthwash, quickly spit it out; it mightn't the right one for you. Seek professional advice to find the one that works best for you."
To control disease caused when plaque build-up around the teeth irritates the gums, Dr Ann said a mouthwash that contains a low concentration of chlorhexidine may do the job. Potential side-effects of this antiseptic, especially when used too often, include killing "good" oral bacteria which then makes one vulnerable to all sorts of infections. Chlorhexidine can also affect the taste of certain foods and beverages, she warned.
An antiseptic mouthwash is sometimes prescribed for patients who have just had oral surgery and are not yet comfortable with the idea of brushing their teeth.
"I usually prescribe a mouthwash containing chlorhexidine for patients suffering from acute gum disease," Dr Ann said. "But I usually advise using it only for a short period _ no more than a month."
The dentist noted that mouthwashes are usually prescribed for patients at high risk of dental cavities because of frequent sugar intake, destruction of tooth layers or habitually poor oral hygiene.
"But normal people should get into a good oral-care routine. If you don't brush and floss your teeth well," she said, "using a mouthwash is probably a total waste of your money."
Reference : http://www.bangkokpost.com