Mouthwashes have been around for decades as an additional part of oral hygiene routines. Many brands advertise themselves as an essential companion to brushing and flossing for complete oral health. However, more dentists are advising their patients to stop using mouthwash entirely. Why is this? Let’s take a closer look at the reasons dentists don’t recommend using mouthwash.
Alcohol Content
The majority of mainstream mouthwashes contain a significant amount of alcohol, ranging from 18-27%. The alcohol acts as an antiseptic to kill bacteria and germs in the mouth. However, prolonged use can lead to a few issues:
- Dry mouth – Alcohol is dehydrating and can dry out your mouth. This makes bad breath worse.
- Damage to oral tissues – Alcohol can irritate and inflame gum tissues, the soft palate, and tongue.
- Increased risk of oral cancer – High alcohol content is linked to a higher risk of cancers of the mouth, tongue, and throat.
For these reasons, dentists prefer to avoid recommending alcohol-containing rinses, especially for long-term daily use.
Masking Halitosis
Mouthwashes with potent flavors and high alcohol can temporarily mask bad breath by overriding unpleasant odors. However, they don’t treat the underlying cause. Bacteria and food debris can remain on the tongue, gums, and other areas of the mouth. The minty taste gives a false sense that the mouth is clean when germs still exist.
Dentists want to treat halitosis at its source through brushing, flossing, scraping the tongue, and addressing causes like dry mouth. Mouthwash use shouldn’t be a substitute for mechanical cleaning. It merely covers up smell instead of removing debris that causes odor.
Kills Good Bacteria
Antiseptic mouthwashes don’t discriminate between bad and good bacteria. Many oral bacteria are beneficial and protect against infection. Using strong antiseptic rinses can upset the delicate balance of microorganisms in the mouth.
This disturbance can allow potentially harmful bacteria to thrive, increasing the risk of cavities and gingivitis. Broad-spectrum antimicrobial ingredients like chlorhexidine, cetylpyridinium chloride and essential oils disrupt both pathogenic and commensal bacteria.
Staining and Tooth Discoloration
Mouthwashes with a high concentration of antibacterial ingredients like chlorhexidine and cetylpyridinium chloride can stain teeth over time with prolonged use. These chemicals bind to surface molecules in tooth enamel, causing yellow or brown discoloration.
While abrasive tooth cleaning can remove some of this extrinsic staining, it may require professional whitening treatments to completely undo the tooth discoloration from mouthwash use.
Taste Disturbances and Burning Sensation
Many users report changes in taste perception and a burning feeling in the mouth and tongue after using certain mouthwashes, especially those with alcohol. This can deter people from regular use despite the product’s promise for fresher breath and cleaner mouth.
The high alcohol content often irritates sensitive oral tissues. Certain ingredients like cetylpyridinium chloride and sodium lauryl sulfate also cause taste bud disturbances in some individuals.
Not Proven to Reduce Cavities and Gingivitis
While mouthwashes may temporarily reduce bad breath, there’s limited evidence that they provide additional protection against tooth decay and gingivitis. Most benefits come from the mechanical cleaning of brushing and flossing to disrupt dental plaque.
The American Dental Association (ADA) does not currently recommend anti-gingivitis or anti-cavity mouth rinses as part of routine oral care. More research is still needed to demonstrate their effectiveness for these uses.
Can Trigger Oral Allergies
Flavoring agents and other ingredients in some mouthwashes have been known to provoke allergic reactions in sensitive individuals. Symptoms may include mouth sores, swelling of the lips and tongue, and irritation.
Common allergens found in mouthwashes include menthol, peppermint oil, and sodium lauryl sulfate. Those with frequent mouth irritation should check the ingredients label and stop usage if an allergy is suspected.
Aggravation of Oral Conditions
The high alcohol content in many mouthwashes can exacerbate symptoms of certain oral health conditions. These include:
- Canker sores – Alcohol causes stinging in open mouth ulcers.
- Oral lichen planus – Alcohol increases inflammation and pain from this condition.
- Dry mouth (xerostomia) – Alcohol further dries out an already parched mouth.
Those susceptible to the above issues should avoid alcohol-based mouthwashes. The burn provides no oral health benefit and only aggravates these conditions.
Safety Concerns
There are some safety issues around mouthwash use, especially in children and for those with certain medical conditions. Potential risks include:
- Poisoning – Children have accidentally ingested mouthwash resulting in alcohol poisoning. The products need to be kept out of reach of kids.
- Asthma – Alcohol vapors can provoke bronchospasms in those with asthma and make it hard to breathe.
- Blood pressure – Patients on certain medications can experience blood pressure fluctuations from high alcohol-containing mouthwashes.
Dentists also advise women who are pregnant or breastfeeding to avoid alcohol-based rinses. The risks outweigh any marginal benefits from use during this time.
Oral Cancer Risks
Multiple studies have linked alcohol-containing mouthwashes with a higher incidence of oral cancer. A review published in the journal Oral Oncology found regular users have a 9% higher risk of developing these cancers.
The reason is likely that alcohol allows better absorption of other carcinogenic ingredients in mouthwashes, like acetaldehyde. The combination leads to cellular changes that cause genetic mutations.
Given the abundance of evidence, dentists see no reason to recommend daily use of alcohol-based mouth rinses solely for fresher breath and germ killing.
Formulation Concerns
Dentists often have concerns about the formulation of common over-the-counter mouthwash products. Issues may include:
- Questionable efficacy – Laboratory testing conditions may not translate into real-world oral health benefits.
- Harsh, burning ingredients – Oral tissue irritation discourages regular use.
- Masking, not treating, halitosis – Temporarily overrides bad breath without addressing the cause.
- Too strong and disruptive – Can kill off beneficial bacteria and create an imbalance in the oral microbiome.
Professional dental organizations set a high bar for safety and efficacy data before endorsing any oral hygiene product. Many mouthwashes have not yet met the level of evidence dentists prefer to see.
What Mouthwashes Do Dentists Recommend?
While most dentists advise against habitually using strong antiseptic and alcohol-based mouthwashes, they may recommend selective use of certain products. Examples include:
- Fluoride rinses – Help protect against cavities and remineralize tooth enamel.
- Saline rinses – Help cleanse the mouth and soothe irritation without alcohol.
- Chlorhexidine – May be prescribed for short-term use after oral surgery or dental cleaning.
- Essential oil rinses – Have some antimicrobial effects with less alcohol and burn.
For everyday use, dentists stress the fundamentals of brushing twice a day, daily flossing, and regular professional cleanings. Mouthwash should not be considered mandatory for good oral hygiene.
What About DIY Mouthwashes?
With concerns over the ingredients in store-bought rinses, some people are creating their own natural mouthwash recipes at home. Common components include:
- Baking soda – Has natural antibacterial effects.
- Hydrogen peroxide – Kills germs through its release of oxygen.
- Essential oils – Give antimicrobial and fresh flavor.
- Coconut oil – Helps clean the teeth.
- Aloe vera juice – Soothes oral tissues.
Dentists caution against solely relying on unproven home remedies, but recognize these have some oral health benefits with far fewer downsides than alcohol-based drugstore rinses when used sparingly.
Key Takeaways
In summary, here are some of the key reasons dentists don’t routinely advise their patients to use mouthwash:
- High alcohol content can irritate oral tissues and increase oral cancer risks.
- Can kill off beneficial bacteria and create an imbalance in the oral microbiome.
- Often masks halitosis instead of treating the underlying cause.
- Prone to staining and discoloring teeth with prolonged use.
- Insufficient evidence that most deliver meaningful benefits beyond brushing and flossing.
- Safety concerns especially around use in children and those with medical conditions.
While mouthwashes have a role, dentists focus on proven mechanical cleaning methods and see rinses as an adjunct at best, not a necessity. Brushing, flossing, tongue scraping, and professional cleanings form the core of evidence-based oral hygiene care.
Conclusion
Mouthwashes remain popular oral care products, used by millions seeking fresher breath, whiter teeth, and better overall oral hygiene. However, many dentists are now advising against regular use due to high alcohol content, marginal benefits, and potential health risks relative to proper brushing and flossing.
Dentists aim to treat the underlying causes of bad breath and dental problems rather than masking issues. There is also insufficient clinical evidence that mouthwashes conclusively prevent cavities, gingivitis, and periodontal disease. At best, they serve as a supplemental aid when used properly.
Oral health should focus first on proven cleaning methods before adding supplementary products. For most patients, dentists recommend avoiding alcohol-containing antiseptic mouth rinses and focusing on the mechanical removal of plaque and debris via brushing, flossing, and professional cleanings.