Your Mouthwash

People gargle mouthwash thinking it will get rid of bad breath, but that is the minty liquid’s least effective function.

Dentists say mouthwash and other rinses can be beneficial to overall oral health and an important part of daily oral hygiene routines but aren't essential.

Mouthwashes can be divided into two main categories: cosmetic and therapeutic. Cosmetic rinses reduce and help control bad breath and leave a pleasant taste in the mouth.

But, they don’t really deal with the actual cause of bad breath—they don’t kill the bacteria and they don’t chemically inactivate the compounds that cause bad breath.

Therapeutic rinses have more targeted functions and come both over-the-counter and by prescription. They can help reduce tooth plaque or gingivitis, inflammation of the gum which can lead to gum disease. They can also help neutralize the acidity of the mouth to lessen the decay process. They may hydrate individuals who suffer from dry mouth, and help soothe canker sores. Fluoride and xylitol rinses aid in cavity prevention.

The American Dental Association, a professional association of dentists, tests products and has a council on scientific affairs which evaluates products to determine if they are safe and effective. Those that pass the tests receive a seal, which can be found on the product. Currently, 128 mouthwashes have the seal.

The ADA has found just two products that satisfy claims they eliminate bad breath and neither are mouthwashes. They are toothpastes, said Clifford Whall, director of the seal of acceptance program at the Chicago-based ADA.

Some therapeutic rinses work by neutralizing the pH of the mouth. When the bacteria in our mouth consume carbohydrates and sugars, their metabolic waste is acid. The acid draws out the minerals, resulting in an acidic mouth that leads to tooth decay.

An important ingredient to look for in such rinses is xylitol, a naturally occurring sugar alcohol which certain bacteria are unable to metabolize. Xylitol stimulates salivary function due to its sweetness and taste and helps restore the mouth to a neutral level of acidity.

But some dentists recommend looking for alcohol-free mouthwashes because they can dry out the mouth. A dry mouth can end up encouraging bacterial activity, resulting in worse breath.

Alcohol is used as a preservative—to increase the shelf life of mouthwash—and as a carrier for flavor. The alcohol itself isn't the antiseptic. Rather, it dissolves essential oils (like menthol and eucalyptol) or active ingredients, which together have an antiseptic effect.

The therapeutic mouthwashes with the ADA seal currently have alcohol in them.

Your saliva is more than adequate to keep the mouth moist. It might be an issue for people who have dry mouth, as alcohol could irritate their mouth.

Studies have found an association between the alcohol in mouth rinses and oral cancer.

But some experts say such evidence is weak. “The association between mouthwash and oral cancers is not strong,” said Mumtaz Khan, a head and neck cancer surgeon at Cleveland Clinic. “I personally do not tell my patients not to use mouthwash.”

Fluoride rinses typically don't contain alcohol and can usually be used by children age 6 and above. Before that age manufacturers and dentists don’t recommend them because children may swallow the fluid.

But fluoride rinses are only important for individuals who are prone to cavities. If you’ve had one or more new cavities in the last year then you should have some kind of additional fluoride.

Dentists warn that individuals who find that they need to use mouthwash excessively for bad breath may have an underlying problem that needs to be addressed.

There are a lot of things that can cause bad breath that aren't going to be remedied by mouthwash—cosmetic or therapeutic. Deep cavities, untreated periodontal or gum disease, infections of the gum and bone, can all cause breath to be incredibly strong.

Using mouthwash before or after you brush and floss makes a difference but Mouthwash isn't a substitution for floss and brush.