Editing Mouthwash

{{Short description|Liquid rinse for oral hygiene}}
{{Other uses}}
{{Use dmy dates|date=June 2020}}
[[File:Listerine products.jpg|thumb|Range of mouthwashes by [[Listerine]]]]
'''Mouthwash''', '''mouth rinse''', '''oral rinse''', or '''mouth bath'''<ref name=pmid12856008>{{cite journal | vauthors = Matthews RW | title = Hot salt water mouth baths | journal = British Dental Journal | volume = 195 | issue = 1 | page = 3 | date = July 2003 | pmid = 12856008 | doi = 10.1038/sj.bdj.4810318 | s2cid = 3995032 }}</ref> 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 [[gargling|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 medication|anti-fungal]] action. Additionally, some rinses act as saliva substitutes to neutralize acid and keep the mouth moist in [[xerostomia]] (dry mouth).<ref name=wsj>{{cite web | vauthors = Reddy S | date = 12 January 2015 | work = The Wall Street Journal |url= https://www.wsj.com/articles/there-is-more-to-your-mouthwash-than-a-minty-taste-1421096379|title=There is More to Your Mouthwash Than a Minty Taste}}</ref><ref name=medX>{{cite web | author = Tufts University | date = 23 March 2015 | publisher = Medical Xpress |url=http://medicalxpress.com/news/2015-03-mouthwash.html|title=Should I use mouthwash?}}</ref> Cosmetic mouthrinses temporarily control or reduce bad breath and leave the mouth with a pleasant taste.<ref name=ada>{{cite web|url=http://www.ada.org/en/science-research/ada-seal-of-acceptance/product-category-information/mouthrinses | archive-url = https://web.archive.org/web/20141011031124/http://www.ada.org/en/science-research/ada-seal-of-acceptance/product-category-information/mouthrinses | archive-date = 11 October 2014 |title=Learn More About Mouthrinses | publisher = American Dental Association }}</ref>

Rinsing with water or mouthwash after brushing with a [[Toothpaste#Fluorides|fluoride toothpaste]] can reduce the availability of salivary fluoride. This can lower the anti-cavity re-mineralization and antibacterial effects of fluoride.<ref name=pmid21591596>{{cite journal | vauthors = Mystikos C, Yoshino T, Ramberg P, Birkhed D | title = Effect of post-brushing mouthrinse solutions on salivary fluoride retention | journal = Swedish Dental Journal | volume = 35 | issue = 1 | pages = 17–24 | year = 2011 | pmid = 21591596 }}</ref><ref name=pmid1423447>{{cite journal | vauthors = Chesters RK, Huntington E, Burchell CK, Stephen KW | title = Effect of oral care habits on caries in adolescents | journal = Caries Research | volume = 26 | issue = 4 | pages = 299–304 | year = 1992 | pmid = 1423447 | doi = 10.1159/000261456 }}</ref><ref name=pmid18534177>{{cite journal | vauthors = Zamataro CB, Tenuta LM, Cury JA | title = Low-fluoride dentifrice and the effect of postbrushing rinsing on fluoride availability in saliva | journal = European Archives of Paediatric Dentistry | volume = 9 | issue = 2 | pages = 90–3 | date = June 2008 | pmid = 18534177 | doi = 10.1007/BF03262616 | s2cid = 31708112 }}</ref> 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.<ref name="pmid21591596"/> 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"<ref name=":0">{{cite web | publisher = Public Health England, Department of Health. | title = Delivering better oral health: an evidence-based toolkit for prevention | edition = 3rd | date = March 2017 | url = https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf }}</ref> they believed there was a limited evidence base for best practice.<ref name=pmid22498529>{{cite journal | vauthors = Pitts N, Duckworth RM, Marsh P, Mutti B, Parnell C, Zero D | title = Post-brushing rinsing for the control of dental caries: exploration of the available evidence to establish what advice we should give our patients | journal = British Dental Journal | volume = 212 | issue = 7 | pages = 315–20 | date = April 2012 | pmid = 22498529 | doi = 10.1038/sj.bdj.2012.260 | doi-access = free }}</ref>

==Use==
Common use involves rinsing the mouth with about 20–50 [[milliliter|ml]] (2/3 [[fluid ounce|fl oz]]) 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.<ref name=pmid8794967>{{cite journal | vauthors = Kozlovsky A, Goldberg S, Natour I, Rogatky-Gat A, Gelernter I, Rosenberg M | title = Efficacy of a 2-phase oil: water mouthrinse in controlling oral malodor, gingivitis, and plaque | journal = Journal of Periodontology | volume = 67 | issue = 6 | pages = 577–82 | date = June 1996 | pmid = 8794967 | doi = 10.1902/jop.1996.67.6.577 }}</ref><ref name=pmid1552460>{{cite journal | vauthors = Rosenberg M, Gelernter I, Barki M, Bar-Ness R | title = Day-long reduction of oral malodor by a two-phase oil:water mouthrinse as compared to chlorhexidine and placebo rinses | journal = Journal of Periodontology | volume = 63 | issue = 1 | pages = 39–43 | date = January 1992 | pmid = 1552460 | doi = 10.1902/jop.1992.63.1.39 }}</ref><ref name=pmid2076696>{{cite journal | vauthors = Rosenberg M | title = Bad breath, diagnosis and treatment | journal = University of Toronto Dental Journal | volume = 3 | issue = 2 | pages = 7–11 | year = 1990 | pmid = 2076696 }}</ref>
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.<ref>{{cite web|title=Oral health promotion messages: "Spit don't rinse"|url=http://www.networks.nhs.uk/nhs-networks/healthcare-professionals-commissioning-network/messageboard/healthcare-professionals-commissioning-network-forum/795055410/562863043/oral-health-promotion-messages-doc}}</ref> A fluoride mouthrinse can be used at a different time of the day to brushing.<ref name=":0" />

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 [[infusion]]s 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.<ref name="Pubchem">{{cite web|url=https://pubchem.ncbi.nlm.nih.gov/compound/Eucalyptol|title=Eucalyptol {{!}} C10H18O - PubChem|last=Pubchem|website=pubchem.ncbi.nlm.nih.gov|access-date=2016-12-01}}</ref>

==Dangerous misuse==
{{main|Surrogate alcohol}}

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.<ref>{{Cite web |title=What Are the Dangers of Drinking Mouthwash? {{!}} Laguna Hospital |url=https://lagunatreatment.com/alcohol-abuse/drinking-mouthwash/ |access-date=2023-01-22 |website=Laguna Treatment Hospital |language=en}}</ref> 0% alcohol mouthwashes do exist, as well as many other formulations for different needs (covered in the above sections). 

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. 

It is a common cause of death among homeless people during winter months, because a person can feel warmer after drinking it.<ref>{{Cite web |title=The People Giving Alcoholics Beer to Get Them to Stop Drinking Mouthwash |url=https://www.vice.com/en/article/5gj7nd/people-are-getting-wasted-off-mouthwash-and-rubbing-alcohol-and-its-killing-them |access-date=2023-01-22 |website=www.vice.com |date=16 March 2016 |language=en}}
</ref>

==<span class="anchor" id="Magic mouthwash"></span> 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 [[Dental plaque|bacterial plaque]] that causes [[Dental caries|cavities]], [[gingivitis]], and [[bad breath]]. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both [[toothbrush|brushing]] and [[flossing]].<ref name=pmid17138709>{{cite journal | vauthors = Gunsolley JC | title = A meta-analysis of six-month studies of antiplaque and antigingivitis agents | journal = Journal of the American Dental Association | volume = 137 | issue = 12 | pages = 1649–57 | date = December 2006 | pmid = 17138709 | doi = 10.14219/jada.archive.2006.0110 | s2cid = 9347082 }}</ref><ref name=pmid2366142>{{cite journal | vauthors = Tal H, Rosenberg M | title = Estimation of dental plaque levels and gingival inflammation using a simple oral rinse technique | journal = Journal of Periodontology | volume = 61 | issue = 6 | pages = 339–42 | date = June 1990 | pmid = 2366142 | doi = 10.1902/jop.1990.61.6.339 }}</ref><ref>{{cite news | url=http://www.nbcnews.com/id/6799764 | archive-url=https://web.archive.org/web/20141006203443/http://www.nbcnews.com/id/6799764 | url-status=dead | archive-date=6 October 2014 |title=Listerine no replacement for flossing?|work=NBC News | date=7 January 2005 | access-date=14 October 2013 }}</ref> 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.<ref>{{cite web | author = Jake | date = 1 April 2015 |title=Should I use Mouthwash |url=http://brushflossandmouthwash.com/should-i-be-using-mouthwash/ }}</ref>
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.<ref>{{cite journal |doi=10.1590/S1806-83242007000500005 |title=The effect of mouthrinses against oral microorganisms |journal=Brazilian Oral Research |volume=21 |pages=23–8 |year=2007 | vauthors = Cortelli JR, Thénoux RE |doi-access=free }}</ref>

Minor and transient side effects of mouthwashes are very common, such as [[Dysgeusia|taste disturbance]], tooth staining, [[xerostomia|sensation of a dry mouth]], etc. Alcohol-containing mouthwashes may make dry mouth and halitosis worse, as they dry out the mouth.<ref>{{cite book | vauthors = Oneschuk D, Hagen N, MacDonald N |title=Palliative Medicine: A case-based manual|year=2012|publisher=Oxford University Press|isbn=9780191628733|page=126 | url = https://books.google.com/books?id=MJOE2MflzngC&q=non+alcoholic+mouthwash+halitosis&pg=PA126 |edition=3rd}}</ref><ref>{{cite web | vauthors = Philipp J | date = 16 July 2015 | work = azcentral.com |url=http://www.azcentral.com/story/entertainment/life/health/2015/07/16/medications-diseases-among-factors-dry-mouth-cbt/30270419/|title=Medications, diseases among factors for dry mouth}}</ref> Soreness, ulceration and redness may sometimes occur (e.g., [[aphthous stomatitis]] or [[allergic contact stomatitis]]) 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 (e.g. saltwater), 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 ulcer]]s, other [[oral ulcer]]s, and other mouth pain.<ref name="DetailDoc"/> "Magic mouthwashes" are prescription mouthwashes [[Compounding|compounded]] in a [[pharmacy]] from a list of ingredients specified by a doctor.<ref>{{cite web|url=http://www.drotterholt.com/magicmouthwash.html |title=Magic Mouthwash |access-date=2009-12-05 | vauthors = Otterholt R }}</ref><ref>{{cite web|url=http://www.pharmacistsletter.com/(S(4xxt15452khjdpbrnmrxdbfi))/pl/Browse.aspx?s=PL&dd=230703&cat=4313&pt=2 |title=Magic Mouthwash |access-date=2009-12-05 |work=Pharmacist's Letter |publisher=Therapeutic Research Center }}</ref> Despite a lack of evidence that prescription mouthwashes are more effective in decreasing the pain of oral [[lesion]]s, many patients and prescribers continue to use them. There has been only one [[Controlled experiment|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 (such as [[chlorhexidine]]) or a [[Saline (medicine)|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.<ref name="DetailDoc"/>

==History==
[[File:Listerine advertisement, 1932.jpg|thumb|Listerine advertisement, 1932]]
[[File:Katalog vintern 1905-1906. AB Nordiska Kompaniet. Hår-, Toalett- & Tandvatten, Pomada & Brilliantine - Nordiska Museet - NMA.0040796.jpg|thumb|left|Swedish ad for toiletries, 1905/1906]]
The first known references to mouth rinsing is in [[Ayurveda]]<ref name=pmid21760690>{{cite journal | vauthors = Singh A, Purohit B | title = Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health | journal = Journal of Ayurveda and Integrative Medicine | volume = 2 | issue = 2 | pages = 64–8 | date = April 2011 | pmid = 21760690 | pmc = 3131773 | doi = 10.4103/0975-9476.82525 | doi-access = free }}</ref> for treatment of gingivitis.<ref>{{cite journal |title = Mouthwash: A review for South African health care workers |journal=South African Family Practice |volume=52 |issue=2 |pages=121–7 |year=2014 | vauthors = Van Zyl AW, Van Heerden WF | doi = 10.1080/20786204.2010.10873950 |hdl=2263/14207 |doi-access=free |hdl-access=free }}</ref> Later, in the [[ancient Greece|Greek]] and [[Ancient Rome|Roman]] periods, mouth rinsing following mechanical cleansing became common among the upper classes, and [[Hippocrates]] recommended a mixture of salt, [[alum]], and vinegar.<ref name=pmid9643227>{{cite journal | vauthors = Fischman SL | title = The history of oral hygiene products: how far have we come in 6000 years? | journal = Periodontology 2000 | volume = 15 | pages = 7–14 | date = October 1997 | pmid = 9643227 | doi = 10.1111/j.1600-0757.1997.tb00099.x | doi-access = free }}</ref> The Jewish [[Talmud]], dating back about 1,800 years, suggests a cure for gum ailments containing "dough water" and olive oil.<ref name=pmid12389360>{{cite journal | vauthors = Shifman A, Orenbuch S, Rosenberg M | title = Bad breath--a major disability according to the Talmud | journal = The Israel Medical Association Journal | volume = 4 | issue = 10 | pages = 843–5 | date = October 2002 | pmid = 12389360 }}</ref> The ancient Chinese had also gargled salt water, tea and wine as a form of mouthwash after meals, due to the antiseptic properties of those liquids.<ref>{{Cite web |date=2019-12-12 |title=Getting to the roots of dentistry in ancient China |url=https://www.scmp.com/magazines/post-magazine/short-reads/article/3041650/getting-roots-dentistry-ancient-china-it-wasnt |access-date=2022-05-18 |website=South China Morning Post |language=en}}</ref>

Before Europeans came to the Americas, Native North American and Mesoamerican cultures used mouthwashes, often made from plants such as ''[[Coptis trifolia]]''.<ref name=Keoke2002 /> Peoples of the Americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as [[teething]] and mouth ulcers.<ref name=Keoke2002>{{cite book| vauthors = Keoke ED, Porterfield KM | title=Encyclopedia of American Indian contributions to the world 15,000 years of inventions and innovations|year=2002|publisher=Facts on File|location=New York, NY|isbn=978-1-4381-0990-9|page=180|url=https://books.google.com/books?id=QIFTVWJH3doC&q=salt+mouthwash&pg=PA180}}</ref>

[[Anton van Leeuwenhoek]], the famous 17th century [[Microscopy|microscopist]], discovered living organisms (living, because they were mobile) in deposits on the teeth (what we now call [[dental plaque]]). 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.<ref>{{cite book | vauthors = Lax A |date=27 October 2005 |title=Toxin: The cunning of bacterial poisons |url=https://books.google.com/books?id=IuvRClJOT5EC&q=Leeuwenhoek+dental+plaque+mouthwash&pg=PT27 |publisher=Oxford University Press |isbn=978-0-19-157850-2}}</ref>
In 1892, German [[Richard Seifert (inventor)|Richard Seifert]] invented mouthwash product [[Odol]], which was produced by company founder [[Karl August Lingner]] (1861–1916) in [[Dresden]].<ref>[http://lingner-archiv.jimdo.com/ Lingner-Archiv (German)]</ref>

That remained the state of affairs until the late 1960s when Harald Loe (at the time a professor at the [[Aarhus University|Royal Dental College]] in [[Aarhus]], Denmark) 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.<ref name=pmid4575037>{{cite journal | vauthors = Budtz-Jörgensen E, Löe H | title = Chlorhexidine as a denture disinfectant in the treatment of denture stomatitis | journal = Scandinavian Journal of Dental Research | volume = 80 | issue = 6 | pages = 457–64 | year = 1972 | pmid = 4575037 | doi = 10.1111/j.1600-0722.1972.tb00314.x }}</ref>

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.<ref name=pmid1552460/><ref name=pmid8794967/><ref name=pmid8133414>{{cite journal | vauthors = Bosy A, Kulkarni GV, Rosenberg M, McCulloch CA | title = Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations | journal = Journal of Periodontology | volume = 65 | issue = 1 | pages = 37–46 | date = January 1994 | pmid = 8133414 | doi = 10.1902/jop.1994.65.1.37 }}</ref><ref name=pmid12013345>{{cite journal | vauthors = Loesche WJ, Kazor C | title = Microbiology and treatment of halitosis | journal = Periodontology 2000 | volume = 28 | pages = 256–79 | year = 2002 | pmid = 12013345 | doi = 10.1034/j.1600-0757.2002.280111.x }}</ref><ref name=pmid1499240>{{cite journal | vauthors = Yaegaki K, Sanada K | title = Effects of a two-phase oil-water mouthwash on halitosis | journal = Clinical Preventive Dentistry | volume = 14 | issue = 1 | pages = 5–9 | year = 1992 | pmid = 1499240 }}</ref> For example, the number of mouthwash variants in the United States of America has grown from 15 (1970) to 66 (1998) to 113 (2012).<ref>{{cite journal |doi=10.1057/dddmp.2013.34 |title=Customers' online shopping preferences in mass customization |journal=Journal of Direct, Data and Digital Marketing Practice |volume=15 |issue=1 |pages=20–35 |year=2013 | vauthors = Aichner T, Coletti P |doi-access=free }}</ref>

==Research==
Research in the field of [[Microbiota (microbiology)|microbiota]]s 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.<ref>{{cite web | vauthors = Greenwood V |url=https://www.discovermagazine.com/health/hacking-the-microbiome-for-fun-and-profit-can-killing-just-one-mouth-bacterium-stop-cavities |title=Hacking the Microbiome for Fun and Profit: Can Killing Just One Mouth Bacterium Stop Cavities? | work = Discover Magazine |access-date=31 October 2012|date=2012-02-02 }}</ref>

A clinical trial and laboratory studies have shown that alcohol-containing mouthwash could reduce the growth of ''Neisseria gonorrhoeae'' in the pharynx.<ref>{{Cite journal |last1=Chow |first1=Eric PF |last2=Howden |first2=Benjamin P. |last3=Walker |first3=Sandra |last4=Lee |first4=David |last5=Bradshaw |first5=Catriona S. |last6=Chen |first6=Marcus Y. |last7=Snow |first7=Anthony |last8=Cook |first8=Stuart |last9=Fehler |first9=Glenda |last10=Fairley |first10=Christopher K. |date=2017-03-01 |title=Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae: a randomised controlled trial and an in vitro study |url=https://sti.bmj.com/content/93/2/88 |journal=Sexually Transmitted Infections |language=en |volume=93 |issue=2 |pages=88–93 |doi=10.1136/sextrans-2016-052753 |issn=1368-4973 |pmid=27998950|s2cid=3479567 |doi-access=free }}</ref><ref>{{Cite journal |last1=Williams |first1=Eloise |last2=Zhang |first2=Bowen |last3=Chow |first3=Eric P. F. |last4=Chea |first4=Socheata |last5=Phillips |first5=Tiffany R. |last6=Maddaford |first6=Kate |last7=Krysiak |first7=Marcelina |last8=Nong |first8=Yi |last9=Stefanatos |first9=Helen |last10=Pasricha |first10=Shivani |last11=Fairley |first11=Christopher K. |last12=Wiliamson |first12=Deborah A. |date=2022-06-21 |title=Inhibitory Activity of Antibacterial Mouthwashes and Antiseptic Substances against Neisseria gonorrhoeae |journal=Antimicrobial Agents and Chemotherapy |language=en |volume=66 |issue=6 |pages=e0004222 |doi=10.1128/aac.00042-22 |issn=0066-4804 |pmc=9211398 |pmid=35579459}}</ref> 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.<ref>{{Cite journal |last1=Chow |first1=Eric P F |last2=Williamson |first2=Deborah A |last3=Hocking |first3=Jane S |last4=Law |first4=Matthew G |last5=Maddaford |first5=Kate |last6=Bradshaw |first6=Catriona S |last7=McNulty |first7=Anna |last8=Templeton |first8=David J |last9=Moore |first9=Richard |last10=Murray |first10=Gerald L |last11=Danielewski |first11=Jennifer A |last12=Wigan |first12=Rebecca |last13=Chen |first13=Marcus Y |last14=Guy |first14=Rebecca J |last15=Zhang |first15=Lei |date=May 2021 |title=Antiseptic mouthwash for gonorrhoea prevention (OMEGA): a randomised, double-blind, parallel-group, multicentre trial |url=https://linkinghub.elsevier.com/retrieve/pii/S1473309920307040 |journal=The Lancet Infectious Diseases |language=en |volume=21 |issue=5 |pages=647–656 |doi=10.1016/S1473-3099(20)30704-0|pmid=33676595 |s2cid=232142254 }}</ref><ref>{{Cite journal |last1=Van Dijck |first1=Christophe |last2=Tsoumanis |first2=Achilleas |last3=Rotsaert |first3=Anke |last4=Vuylsteke |first4=Bea |last5=Van den Bossche |first5=Dorien |last6=Paeleman |first6=Elke |last7=De Baetselier |first7=Irith |last8=Brosius |first8=Isabel |last9=Laumen |first9=Jolein |last10=Buyze |first10=Jozefien |last11=Wouters |first11=Kristien |last12=Lynen |first12=Lutgarde |last13=Van Esbroeck |first13=Marjan |last14=Herssens |first14=Natacha |last15=Abdellati |first15=Said |date=May 2021 |title=Antibacterial mouthwash to prevent sexually transmitted infections in men who have sex with men taking HIV pre-exposure prophylaxis (PReGo): a randomised, placebo-controlled, crossover trial |url=https://doi.org/10.1016/S1473-3099(20)30778-7 |journal=The Lancet Infectious Diseases |volume=21 |issue=5 |pages=657–667 |doi=10.1016/s1473-3099(20)30778-7 |pmid=33676596 |s2cid=232142467 |issn=1473-3099}}</ref>
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==Ingredients==
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===Alcohol===
[[File:Colgate Alcohol Free Mouthwash.jpg|thumb|An example of a commercial mouthwash brand which is alcohol-free]]
Alcohol is added to mouthwash not to destroy bacteria but to act as a carrier agent for essential active ingredients such as menthol, eucalyptol and thymol, which help to penetrate plaque.<ref name="cleef"/> Sometimes a significant amount of [[ethanol|alcohol]] (up to 27% vol) is added,<ref name="Mildau">{{cite journal | vauthors = Lachenmeier DW, Keck-Wilhelm A, Sauermann A, Mildau G |year=2008 |title=Safety Assessment of Alcohol-Containing Mouthwashes and Oral Rinses |journal=SOFW Journal |volume=134 |issue=10 |pages=70–8 |url=http://www.sofw.com/index/sofw_en/sofw_en_archive.html?cosearch=mouthwashes&cosearch_sa=mouthwashes&costart=&date_from%5BY%5D=2004&date_from%5Bm%5D=1&date_until%5BY%5D=2008&date_until%5Bm%5D=10&do_search_sa=1&naid=3193}}</ref> as a carrier for the [[flavoring|flavor]], to provide "bite".<ref name="Pader">{{cite journal | vauthors = Pader M |title=Oral rinses |journal=[[Cosmetics & Toiletries]] |date=October 1994 |volume=109 |issue=10 |pages=59–68 |issn=0361-4387}}</ref>{{Unreliable medical source|date=September 2011}} Because of the alcohol content, it is possible to fail a [[breathalyzer]] test after rinsing, although breath alcohol levels return to normal after 10 minutes.<ref>{{cite web|url=http://alcoholrehabadvice.com/dangers-of-drinking-mouthwash/|title=Dangers of Drinking Mouthwash {{!}} Alcohol Rehab Advice|website=alcoholrehabadvice.com|access-date=2016-12-01}}</ref> In addition, alcohol is a [[astringent|drying agent]], which encourages bacterial activity in the mouth, releasing more malodorous volatile sulfur compounds. Therefore, alcohol-containing mouthwash may temporarily worsen [[halitosis]] in those who already have it, or, indeed, be the sole cause of halitosis in other individuals.<ref name=":1" /> Alcohol in mouthwashes may act as a [[carcinogen]] (cancer-inducing agent) in some cases, see {{sectionlink|Oral cancer#Alcohol}}.<ref name=":19">{{Cite journal | vauthors = Rao KN, Mehta R, Dange P, Nagarkar NM |date=2024-05-08 |title=Alcohol-Containing Mouthwash and the Risk of Oral Cancer: Exploring the Association |url=https://www.researchgate.net/publication/380426336 |journal=Indian Journal of Surgical Oncology |volume=15 |issue=3 |pages=553–556 |language=en |doi=10.1007/s13193-024-01948-4 |issn=0975-7651|quote=There is some evidence for alcohol-containing mouthwash use which is associated with the potential risk of developing carcinoma of oral cavity. The results are inconclusive.}}</ref> Many newer brands of mouthwash are alcohol-free, not just in response to consumer concerns about oral cancer, but also to cater for religious groups who abstain from alcohol consumption.

===Benzydamine (analgesic)===
In painful oral conditions such as [[aphthous stomatitis]], analgesic mouthrinses (e.g. [[benzydamine]] mouthwash, or "Difflam") are sometimes used to ease pain, commonly used before meals to reduce discomfort while eating.

===Benzoic acid===
[[Benzoic acid]] acts as a buffer.<ref name="cleef"/>

===Betamethasone===
[[Betamethasone]] is sometimes used as an anti-inflammatory, corticosteroid mouthwash. It may be used for severe inflammatory conditions of the oral mucosa such as the severe forms of aphthous stomatitis.<ref name=Cawson2002 />{{rp|209}}

===Cetylpyridinium chloride (antiseptic, antimalodor)===
[[Cetylpyridinium chloride]] containing mouthwash (e.g. 0.05%) is used in some specialized mouthwashes for halitosis.<ref name="pmid27228022">{{Cite journal |last1=Kumbargere Nagraj |first1=Sumanth |last2=Eachempati |first2=Prashanti |last3=Uma |first3=Eswara |last4=Singh |first4=Vijendra Pal |last5=Ismail |first5=Noorliza Mastura |last6=Varghese |first6=Eby |date=2019-12-11 |editor-last=Cochrane Oral Health Group |title=Interventions for managing halitosis |journal=Cochrane Database of Systematic Reviews |language=en |volume=2019 |issue=12 |pages=CD006701 |doi=10.1002/14651858.CD012213.pub2 |pmc=6905014 |pmid=31825092}}</ref> Cetylpyridinium chloride mouthwash has less anti-plaque effect than chlorhexidine and may cause staining of teeth, or sometimes an oral burning sensation or [[mouth ulcer|ulceration]].<ref name=Scully2013 />

===Chlorhexidine digluconate and hexetidine (antiseptic)===
[[Chlorhexidine#Dental use|Chlorhexidine digluconate]] is a chemical antiseptic and is used in a 0.05–0.2% solution as a mouthwash.<ref>{{Cite journal |last1=Radzki |first1=Dominik |last2=Wilhelm-Węglarz |first2=Marta |last3=Pruska |first3=Katarzyna |last4=Kusiak |first4=Aida |last5=Ordyniec-Kwaśnica |first5=Iwona |date=January 2022 |title=A Fresh Look at Mouthwashes&mdash;What Is Inside and What Is It For? |journal=International Journal of Environmental Research and Public Health |language=en |volume=19 |issue=7 |pages=3926 |doi=10.3390/ijerph19073926 |issn=1660-4601 |pmc=8997378 |pmid=35409608|doi-access=free }}</ref><ref name=pmid1552460/><ref name="cleef">{{citation |title= Chemical composition of everyday products | vauthors = Toedt J, Koza D, Van Cleef-Toedt K |edition= illustrated |publisher= Greenwood Publishing Group |year= 2005 |isbn= 9780313325793 |pages= 48–49 |url= https://books.google.com/books?id=UnjD4aBm9ZcC&q=active+ingredients+mouthwash&pg=PA48}}</ref><ref name=pmid17391828>{{cite journal | vauthors = Ribeiro LG, Hashizume LN, Maltz M | title = The effect of different formulations of chlorhexidine in reducing levels of mutans streptococci in the oral cavity: A systematic review of the literature | journal = Journal of Dentistry | volume = 35 | issue = 5 | pages = 359–70 | date = May 2007 | pmid = 17391828 | doi = 10.1016/j.jdent.2007.01.007 }}</ref> There is no evidence to support that higher concentrations are more effective in controlling dental plaque and gingivitis.<ref name="pmid28362061">{{cite journal | vauthors = James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P | display-authors = 6 | title = Chlorhexidine mouthrinse as an adjunctive treatment for gingival health | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD008676 | date = March 2017 | issue = 12 | pmid = 28362061 | pmc = 6464488 | doi = 10.1002/14651858.CD008676.pub2 }}</ref> A randomized clinical trial conducted in Rabat University in [[Morocco]] found better results in [[Dental plaque|plaque]] inhibition when chlorohexidine with alcohol base 0.12% was used, when compared to an alcohol-free 0.1% chlorhexidine mouthrinse.<ref>{{cite journal | vauthors = Ennibi O, Lakhdar L, Bouziane A, Bensouda Y, Abouqal R | title = Chlorhexidine alcohol base mouthrinse versus Chlorhexidine formaldehyde base mouthrinse efficacy on plaque control: double blind, randomized clinical trials | journal = Medicina Oral, Patologia Oral y Cirugia Bucal | volume = 18 | issue = 1 | pages = e135-9 | date = January 2013 | pmid = 23229237 | pmc = 3548633 | doi = 10.4317/medoral.17863 }}</ref>

Chlorhexidine has good ''substantivity'' (the ability of a mouthwash to bind to hard and soft tissues in the mouth).<ref name=Scully2013 /> It has anti-plaque action, and also some anti-fungal action.<ref name=Scully2013 /> It is especially effective against Gram-negative [[Bacterial cellular morphologies#Bacillus|rod]]s.<ref name=Scully2013>{{cite book| vauthors = Scully C | title = Oral and maxillofacial medicine : the basis of diagnosis and treatment|year=2013|publisher=Churchill Livingstone|location=Edinburgh|isbn=9780702049484|edition=3rd|pages=39, 41}}</ref> The proportion of [[Gram-negative bacteria|Gram-negative]] rods increase as [[gingivitis]] develops, so it is also used to reduce gingivitis.<ref name=pmid28362061/><ref>{{cite journal | vauthors = Herrera D | title = Chlorhexidine mouthwash reduces plaque and gingivitis | journal = Evidence-Based Dentistry | volume = 14 | issue = 1 | pages = 17–8 | date = March 2013 | pmid = 23579302 | doi = 10.1038/sj.ebd.6400915 | doi-access = free }}</ref> It is sometimes used as an adjunct to prevent dental caries and to treat [[Periodontitis|periodontal disease]],<ref name=Scully2013 /> although it does not penetrate into periodontal pockets well.<ref name=BNF>{{cite web|title=Mouthwashes, gargles, and dentifrices|url=http://www.medicinescomplete.com/mc/bnf/current/PHP7409-mouthwashes-gargles-and-dentifrices.htm|work=[[British National Formulary]] March 2014|publisher=BMJ Group and the Royal Pharmaceutical Society of Great Britain 2014}}</ref> Chlorhexidine mouthwash alone is unable to prevent plaque, so it is not a substitute for regular toothbrushing and flossing.<ref name=BNF /> Instead, chlorhexidine mouthwash is more effective when used as an adjunctive treatment with toothbrushing and flossing.<ref name=pmid28362061/> In the short term, if toothbrushing is impossible due to pain, as may occur in [[primary herpetic gingivostomatitis]], chlorhexidine mouthwash is used as a temporary substitute for other oral hygiene measures.<ref name=BNF /> It is not suited for use in [[acute necrotizing ulcerative gingivitis]], however.<ref name=BNF /> Rinsing with [[chlorhexidine]] mouthwash before and after a tooth extraction may reduce the risk of a [[dry socket]].<ref name=CochraneChlorhex>{{cite journal |last1=Daly |first1=BJ |last2=Sharif |first2=MO |last3=Jones |first3=K |last4=Worthington |first4=HV |last5=Beattie |first5=A |title=Local interventions for the management of alveolar osteitis (dry socket). |journal=The Cochrane Database of Systematic Reviews |date=26 September 2022 |volume=2022 |issue=9 |pages=CD006968 |doi=10.1002/14651858.CD006968.pub3 |pmid=36156769|pmc=9511819 }}</ref> Other uses of chlorhexidine mouthwash include prevention of oral candidiasis in [[Immunocompetence|immunocompromise]]d persons,<ref name=BNF /> treatment of [[denture-related stomatitis]], mucosal ulceration/erosions and [[oral mucosa]]l lesions, general burning sensation<ref name=pmid28362061/> and many other uses.<ref name=BNF />

Chlorhexidine mouthwash is known to have minor adverse effects.<ref name=CochraneChlorhex/> Chlorhexidine binds to [[tannin]]s, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth.<ref name=Scully2013 /> A systematic review of commercial chlorhexidine products with anti-discoloration systems (ADSs) found that the ADSs were able to reduce tooth staining without affecting the beneficial effects of chlorhexidine.<ref>{{cite journal |last1=Swaaij |first1=Bregje W. M. |last2=van der Weijden |first2=G. A. (Fridus) |last3=Bakker |first3=Eric W. P. |last4=Graziani |first4=Filippo |last5=Slot |first5=Dagmar E. |title=Does chlorhexidine mouthwash, with an anti-discoloration system, reduce tooth surface discoloration without losing its efficacy? A systematic review and meta-analysis |journal=International Journal of Dental Hygiene |date=August 2019 |volume=18 |issue=1 |pages=27–43 |doi=10.1111/idh.12402|pmid=31054209 |pmc=7003798 |doi-access=free}}</ref> Chlorhexidine mouthwash can also cause taste disturbance or alteration.<ref name=pmid28362061/> Chlorhexidine is rarely associated with other issues like overgrowth of enterobacteria in persons with [[leukemia]], desquamation, irritation, and [[stomatitis]] of oral mucosa,<ref name=Scully2013 /><ref name=CochraneChlorhex/> salivary gland pain and swelling, and hypersensitivity reactions including anaphylaxis.<ref name=Scully2013 />

[[Hexetidine]]<ref name="cleef"/> also has anti-plaque, analgesic, astringent and anti-malodor properties, but is considered an inferior alternative to chlorhexidine.<ref>{{cite web|url=http://ebd.ada.org/en/evidence/evidence-by-topic/periodontics/the-effect-of-hexetidine-mouthwash-on-the-prevention-of-plaque-and-gingival-inflammation-a-systema|title=Effect of hexetidine mouthwash - systematic review|access-date=12 October 2015|archive-url=https://web.archive.org/web/20160304082604/http://ebd.ada.org/en/evidence/evidence-by-topic/periodontics/the-effect-of-hexetidine-mouthwash-on-the-prevention-of-plaque-and-gingival-inflammation-a-systema|archive-date=4 March 2016|url-status=dead}}</ref>

===Chlorine dioxide=== 
In dilute concentrations, [[chlorine dioxide]] is an ingredient that acts as an antiseptic agent in some mouthwashes.<ref name="pmid32410557">{{cite journal |vauthors=Kerémi B, Márta K, Farkas K, Czumbel LM, Tóth B, Szakács Z, Csupor D, Czimmer J, Rumbus Z, Révész P, Németh A, Gerber G, Hegyi P, Varga G |title=Effects of Chlorine Dioxide on Oral Hygiene - A Systematic Review and Meta-analysis |journal=Current Pharmaceutical Design |volume=26 |issue=25 |pages=3015–3025 |date=2020 |pmid=32410557 |pmc=8383470 |doi=10.2174/1381612826666200515134450}}</ref><ref name="pmid36634129">{{cite journal |vauthors=Szalai E, Tajti P, Szabó B, Hegyi P, Czumbel LM, Shojazadeh S, Varga G, Németh O, Keremi B |title=Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials |journal=PLOS ONE |volume=18 |issue=1 |pages=e0280377 |date=2023 |pmid=36634129 |pmc=9836286 |doi=10.1371/journal.pone.0280377|doi-access=free |bibcode=2023PLoSO..1880377S }}</ref>

===Edible oils===
In traditional [[Ayurvedic medicine]], the use of oil mouthwashes is called "Kavala" ("oil swishing") or "Gandusha",<ref name=pmid21760690/><ref name="Beck2014"/> and this practice has more recently been re-marketed by the [[complementary and alternative medicine]] industry as "[[oil pulling]]".<ref name="pmid21760690"/><!-- "Oil pulling [...] has recently become very popular as a CAM remedy for many different health ailments." N.B., by consensus discussion (see https://en.wikipedia.org/wiki/Talk:Oil_pulling#Unreliable_source_for_claim_about_dental_plaque) this source does not meet WP:MEDRS and is not suitable to support statements about effects of oil pulling on health --> Its promoters claim it works by "pulling out" "toxins", which are known as [[ama (ayurveda)|ama]] in Ayurvedic medicine, and thereby reducing [[inflammation]].<ref>{{cite web | url=https://www.foxnews.com/health/what-is-oil-pulling-examining-the-ancient-detoxifying-ritual/ | title=What is oil pulling? Examining the ancient detoxifying ritual | work=[[Fox News Channel]] | date=24 March 2014 | access-date=24 March 2014 | vauthors = Grush L }}</ref> Ayurvedic literature claims that oil pulling is capable of improving oral and systemic health, including a benefit in conditions such as [[headache]]s, [[migraine]]s, [[diabetes mellitus]], [[asthma]],<ref name="pmid21760690"/> and [[acne vulgaris|acne]], as well as [[Tooth whitening|whitening teeth]].<ref name="Butler2014"/>

Oil pulling has received little study and there is little evidence to support claims made by the technique's advocates.<ref name="Beck2014"/> When compared with chlorhexidine in one small study, it was found to be less effective at reducing oral bacterial load,<ref name=pmid19336860>{{cite journal | vauthors = Asokan S, Emmadi P, Chamundeswari R | title = Effect of oil pulling on plaque induced gingivitis: a randomized, controlled, triple-blind study | journal = Indian Journal of Dental Research | volume = 20 | issue = 1 | pages = 47–51 | year = 2009 | pmid = 19336860 | doi = 10.4103/0970-9290.49067 | doi-access = free }}</ref><ref>{{cite web|url=http://www.rdhmag.com/articles/print/volume-34/issue-5/columns/a-second-look-at-oil-pulling.html |title=A second look at oil pulling as dental home care therapy|date=16 May 2014 }}</ref> and the other health claims of oil pulling have failed scientific verification<ref name="Beck2014"/> or have not been investigated.<ref name="Beck2014"/> There is a report of [[lipid pneumonia]] caused by accidental inhalation of the oil during oil pulling.<ref name=pmid24429325>{{cite journal | vauthors = Kim JY, Jung JW, Choi JC, Shin JW, Park IW, Choi BW | title = Recurrent lipoid pneumonia associated with oil pulling | journal = The International Journal of Tuberculosis and Lung Disease | volume = 18 | issue = 2 | pages = 251–2 | date = February 2014 | pmid = 24429325 | doi = 10.5588/ijtld.13.0852 }}</ref><ref name="oil pulling leg">{{cite web | vauthors = Novella S | date = 12 March 2014 | work = Science Based Medicine |url=http://www.sciencebasedmedicine.org/oil-pulling-your-leg/ |title=Oil Pulling Your Leg }}</ref><ref>{{cite news | vauthors = Arbogast S | date = 21 May 2014 | work = CBS Pittsburgh |url=http://pittsburgh.cbslocal.com/2014/05/21/does-oil-pulling-actually-have-health-benefits/ |title=Does 'Oil-Pulling' Actually Have Health Benefits?}}</ref>

The mouth is rinsed with approximately one tablespoon of oil for 10–20 minutes then spat out.<ref name="Beck2014">{{cite news| url=https://www.theatlantic.com/health/archive/2014/03/swishing-with-oil-for-oral-health-not-recommended/284490/ | work=The Atlantic | title=Swishing With Oil for Oral Health: Not Recommended| vauthors = Beck J |date=19 March 2014}}</ref><ref name="Butler2014">{{cite news| url=https://www.washingtonpost.com/news/to-your-health/wp/2014/03/20/everyone-is-talking-about-oil-pulling-but-does-this-health-practice-actually-work/ | location=Washington State, U.S.A. | newspaper=The Washington Post | title=Everyone is talking about 'oil pulling.' But does this health practice actually work?| vauthors = Butler B | date=20 March 2014}}</ref> [[Sesame oil]], [[coconut oil]] and [[ghee]] are traditionally used,<ref name="Butler2014"/> but newer oils such as [[sunflower oil]] are also used.<ref name="Butler2014"/>

===Essential oils===
[[Phenols|Phenolic compounds]] and [[monoterpene]]s include [[essential oil]] constituents that have some antibacterial properties,<ref name="cleef"/><ref name=pmid17608576/> such as [[eucalyptol]],<ref name="Pubchem" /> [[eugenol]],<ref name="cleef"/> [[hinokitiol]],<ref>{{cite journal | vauthors = Iha K, Suzuki N, Yoneda M, Takeshita T, Hirofuji T | title = Effect of mouth cleaning with hinokitiol-containing gel on oral malodor: a randomized, open-label pilot study | journal = Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology | volume = 116 | issue = 4 | pages = 433–9 | date = October 2013 | pmid = 23969334 | doi = 10.1016/j.oooo.2013.05.021 }}</ref> [[menthol]],<ref>{{cite journal | vauthors = Alshehri FA | title = The use of mouthwash containing essential oils (LISTERINE®) to improve oral health: A systematic review | journal = The Saudi Dental Journal | volume = 30 | issue = 1 | pages = 2–6 | date = January 2018 | pmid = 30166864 | pmc = 6112363 | doi = 10.1016/j.sdentj.2017.12.004 }}</ref> [[phenol]],<ref name="cleef"/> or [[thymol]].<ref name="cleef"/>
[[Essential oil]]s are oils which have been extracted from plants. Mouthwashes based on [[essential oil]]s could be more effective than traditional mouthcare as [[Gingivitis#Treatment|anti-gingival]] treatments.<ref name=pmid17608576>{{cite journal | vauthors = Stoeken JE, Paraskevas S, van der Weijden GA | title = The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review | journal = Journal of Periodontology | volume = 78 | issue = 7 | pages = 1218–28 | date = July 2007 | pmid = 17608576 | doi = 10.1902/jop.2007.060269 }}</ref><ref name="pmid21043801">{{cite journal | vauthors = Van Leeuwen MP, Slot DE, Van der Weijden GA | title = Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review | journal = Journal of Periodontology | volume = 82 | issue = 2 | pages = 174–94 | date = February 2011 | pmid = 21043801 | doi = 10.1902/jop.2010.100266 }}</ref> They have been found effective in [[Halitosis#Mouthwashes|reducing halitosis]], and are being used in several commercial mouthwashes.

===Fluoride (anticavity)===
Anti-cavity mouthwashes contain [[fluoride]] compounds (such as [[sodium fluoride]], [[stannous fluoride]], or [[sodium monofluorophosphate]]) to protect against [[tooth decay]].<ref name="pmid37709645">{{cite journal |vauthors=Yazicioglu O, Ucuncu MK, Guven K |title=Ingredients in Commercially Available Mouthwashes |journal=International Dental Journal |volume=74 |issue=2 |pages=223–241 |date=April 2024 |pmid=37709645 |pmc=10988267 |doi=10.1016/j.identj.2023.08.004 |quote=Amongst the mouthwashes included in our study, sodium fluoride, sodium monofluorophosphate, and stannous fluoride were found.}}</ref><ref>{{cite journal | vauthors = Marinho VC, Chong LY, Worthington HV, Walsh T | title = Fluoride mouthrinses for preventing dental caries in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD002284 | date = July 2016 | pmid = 27472005 | pmc = 6457869 | doi = 10.1002/14651858.CD002284.pub2 }}</ref> Fluoride-containing mouthwashes are used as prevention for dental caries for individuals who are considered at higher risk for tooth decay, whether due to xerostomia related to salivary dysfunction or side effects of medication, to not drinking fluoridated water, or to being physically unable to care for their oral needs (brushing and flossing), and as treatment for those with dentinal hypersensitivity, gingival recession/ root exposure.

===Flavoring agents and Xylitol===
[[Flavoring agent]]s include sweeteners such as [[sorbitol]], [[sucralose]], [[Saccharin|sodium saccharin]], and [[xylitol]], which stimulate salivary function due to their sweetness and taste and helps restore the mouth to a neutral level of acidity.<ref name=wsj/>

Xylitol rinses double as a bacterial inhibitor,<ref name=pmid9831777>{{cite journal | vauthors = Giertsen E, Emberland H, Scheie AA | title = Effects of mouth rinses with xylitol and fluoride on dental plaque and saliva | journal = Caries Research | volume = 33 | issue = 1 | pages = 23–31 | year = 1999 | pmid = 9831777 | doi = 10.1159/000016492 | s2cid = 46789673 }}</ref> and have been used as substitute for alcohol to avoid dryness of mouth associated with alcohol.<ref name=wsj/>

===Hydrogen peroxide===
[[Hydrogen peroxide]] can be used as an oxidizing mouthwash (e.g. Peroxyl, 1.5%).<ref name=BNF /><ref name=pmid379049>{{cite journal | vauthors = Wennström J, Lindhe J | title = Effect of hydrogen peroxide on developing plaque and gingivitis in man | journal = Journal of Clinical Periodontology | volume = 6 | issue = 2 | pages = 115–30 | date = April 1979 | pmid = 379049 | doi = 10.1111/j.1600-051x.1979.tb02190.x }}</ref> It kills anaerobic bacteria, and also has a mechanical cleansing action when it froths as it comes into contact with debris in mouth.<ref name=BNF /> It is often used in the short term to treat [[acute necrotising ulcerative gingivitis]].<ref name=BNF /> Side effects can occur with prolonged use, including [[hypertrophy]] of the [[lingual papilla]]e.<ref name=BNF />

===Lactoperoxidase (saliva substitute)===
[[Enzyme]]s and non-enzymatic proteins, such as [[Lactoperoxidase#Oral care|lactoperoxidase]], [[lysozyme]], and [[lactoferrin]], have been used in mouthwashes (e.g., [[Biotene#Ingredients|Biotene]]) to reduce levels of oral bacteria, and, hence, of the acids produced by these bacteria.<ref name="Hoogedoorn_1985">{{cite book | vauthors = Hoogedoorn H |veditors=Tenovuo JO, Pruitt KM | title = The Lactoperoxidase system: chemistry and biological significance | publisher = Dekker | location = New York | year = 1985 | pages = 217–228 | isbn = 978-0-8247-7298-7 | chapter = Activation of the salivary peroxidase system: clinical studies }}</ref>

===Lidocaine/xylocaine===
Oral [[lidocaine]] is useful for the treatment of [[mucositis]] symptoms ([[inflammation]] of [[mucous membrane]]s) induced by radiation or chemotherapy.<ref>{{cite journal | vauthors = Yamashita S, Sato S, Kakiuchi Y, Miyabe M, Yamaguchi H | title = Lidocaine toxicity during frequent viscous lidocaine use for painful tongue ulcer | journal = Journal of Pain and Symptom Management | volume = 24 | issue = 5 | pages = 543–5 | date = November 2002 | pmid = 12547053 | doi = 10.1016/S0885-3924(02)00498-0 | doi-access = free }}</ref> There is evidence that lidocaine anesthetic mouthwash has the potential to be systemically absorbed, when it was tested in patients with oral mucositis who underwent a bone marrow transplant.<ref>{{cite journal | vauthors = Elad S, Cohen G, Zylber-Katz E, Findler M, Galili D, Garfunkel AA, Or R | title = Systemic absorption of lidocaine after topical application for the treatment of oral mucositis in bone marrow transplantation patients | journal = Journal of Oral Pathology & Medicine | volume = 28 | issue = 4 | pages = 170–2 | date = April 1999 | pmid = 10235370 | doi = 10.1111/j.1600-0714.1999.tb02018.x }}</ref>

===Methyl salicylate===
[[Methyl salicylate]] functions as an antiseptic, antiinflammatory, and analgesic agent, a flavoring, and a fragrance.<ref name=":1">{{Cite news|url=http://www.theecologist.org/green_green_living/behind_the_label/269558/behind_the_label_listerine_teeth_and_gum_defence.html|title=Behind the label: Listerine teeth and gum defence|newspaper=The Ecologist|access-date=2016-12-01}}</ref> Methyl salicylate has some anti-plaque action, but less than chlorhexidine.<ref name=Scully2013 /> Methyl salicylate does not stain teeth.<ref name=Scully2013 />

===Nystatin===
[[Nystatin]] suspension is an [[Antifungal medication|antifungal]] ingredient used for the treatment of [[oral candidiasis]].<ref name="Nystatin PI">{{cite web|title=NYSTATIN- nystatin suspension|url=https://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=ac2bbe44-79e5-430d-b1c3-b2a565964c3e&type=pdf&name=ac2bbe44-79e5-430d-b1c3-b2a565964c3e|publisher=Qualitest Pharmaceuticals|access-date=17 March 2018}}</ref>

===Potassium oxalate===
A randomized clinical trial found promising results in controlling and reducing [[Dentin hypersensitivity|dentine hypersensitivity]] when potassium oxalate mouthwash was used in conjugation with toothbrushing.<ref>{{cite journal | vauthors = Lynch MC, Perfekt R, McGuire JA, Milleman J, Gallob J, Amini P, Milleman K | title = Potassium oxalate mouthrinse reduces dentinal hypersensitivity: A randomized controlled clinical study | journal = Journal of the American Dental Association | volume = 149 | issue = 7 | pages = 608–618 | date = July 2018 | pmid = 29728195 | doi = 10.1016/j.adaj.2018.02.027 | doi-access = free }}</ref>

===Povidone/iodine (PVP-I)===
A 2005 study found that gargling three times a day with simple water or with a [[povidone-iodine]] solution was effective in preventing [[upper respiratory infection]] and decreasing the severity of symptoms if contracted.<ref name=pmid16242593>{{cite journal | vauthors = Satomura K, Kitamura T, Kawamura T, Shimbo T, Watanabe M, Kamei M, Takano Y, Tamakoshi A | display-authors = 6 | title = Prevention of upper respiratory tract infections by gargling: a randomized trial | journal = American Journal of Preventive Medicine | volume = 29 | issue = 4 | pages = 302–7 | date = November 2005 | pmid = 16242593 | doi = 10.1016/j.amepre.2005.06.013 }}</ref> Other sources attribute the benefit to a simple placebo effect.<ref>[https://web.archive.org/web/20091218181745/http://search.japantimes.co.jp/cgi-bin/fl20091215zg.html To gargle or not to gargle?] [[Japan Times]], 15 December 2009</ref>

PVP-I in general covers "a wider virucidal spectrum, covering both enveloped and nonenveloped viruses, than the other commercially available antiseptics",<ref>{{cite journal | vauthors = Kawana R, Kitamura T, Nakagomi O, Matsumoto I, Arita M, Yoshihara N, Yanagi K, Yamada A, Morita O, Yoshida Y, Furuya Y, Chiba S | display-authors = 6 | title = Inactivation of human viruses by povidone-iodine in comparison with other antiseptics | journal = Dermatology | volume = 195 Suppl 2 | pages = 29–35 | date = 1997 | issue = 2 | pmid = 9403252 | doi = 10.1159/000246027 }}</ref> which also includes the novel [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] Virus.<ref>{{cite journal | vauthors = Bidra AS, Pelletier JS, Westover JB, Frank S, Brown SM, Tessema B | title = Comparison of In Vitro Inactivation of SARS CoV-2 with Hydrogen Peroxide and Povidone-Iodine Oral Antiseptic Rinses | journal = Journal of Prosthodontics | volume = 29 | issue = 7 | pages = 599–603 | date = August 2020 | pmid = 32608097 | pmc = 7361576 | doi = 10.1111/jopr.13220 }}</ref><ref>{{cite journal | vauthors = Maurya RK, Singh H, Kapoor P, Sharma P, Srivastava D | title = Povidone-iodine preprocedural rinse-An evidence-based, second-line defense against severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in dental healthcare | journal = Infection Control and Hospital Epidemiology | pages = 822–824 | date = March 2021 | volume = 43 | issue = 6 | pmid = 33706836 | pmc = 7985894 | doi = 10.1017/ice.2021.90 }}</ref><ref>{{Cite web |title=COLCORONA COVID19 Clinical Trial |url=https://www.colcorona.net/de/corona-halsschmerzen |access-date=2022-12-11 |website=www.colcorona.net |language=en-US}}</ref>

===Sanguinarine===
[[Sanguinarine]]-containing mouthwashes are marketed as anti-plaque and anti-malodor treatments.<ref name=Scully2013 /> Sanguinarine is a toxic alkaloid herbal extract, obtained from plants such as ''[[Sanguinaria canadensis]]'' (bloodroot), ''[[Argemone mexicana]]'' (Mexican prickly poppy), and others.<ref name=Scully2013 /> However, its use is strongly associated with the development of [[leukoplakia]] (a white patch in the mouth), usually in the buccal sulcus.<ref name=Scully2013 /><ref>[http://www.aaomp.org/public/docs/leukoplakia.pdf Leukoplakia] {{webarchive|url=https://web.archive.org/web/20130703162903/http://www.aaomp.org/public/docs/leukoplakia.pdf |date=3 July 2013 }}, (pdf format) hosted by the American Academy of Oral and Maxillofacial Pathology.  Page accessed on 19 December 2006.</ref> This type of leukoplakia has been termed "sanguinaria-associated keratosis", and more than 80% of people with leukoplakia in the [[vestibule of the mouth]] have used this substance. Upon stopping contact with the causative substance, the lesions may persist for years. Although this type of leukoplakia may show [[dysplasia]], the potential for [[malignancy|malignant]] transformation is unknown.<ref name=Neville2002>{{cite book | vauthors = Neville BW, Damm DD, Allen CM, Bouquot JE |title=Oral & maxillofacial pathology|year=2002|publisher=W.B. Saunders|location=Philadelphia|isbn=978-0721690032|pages=337–345|edition=2nd}}</ref> Ironically, elements within the complementary and alternative medicine industry promote the use of sanguinaria as a therapy for cancer.

===Sodium bicarbonate (baking soda)===
[[Sodium bicarbonate]] is sometimes combined with salt to make a simple homemade mouthwash, indicated for any of the reasons that a saltwater mouthwash might be used. Pre-mixed mouthwashes of 1% sodium bicarbonate and 1.5% sodium chloride in [[aqueous solution]] are marketed, although pharmacists will easily be able to produce such a formulation from the base ingredients when required. Sodium bicarbonate mouthwash is sometimes used to remove viscous saliva and to aid visualization of the oral tissues during examination of the mouth.<ref name=Cawson2002>{{cite book|vauthors=Cawson RA, Odell EW, Porter S |title=Cawson's Essentials of Oral Pathology and Oral Medicine|year=2002|publisher=Churchill Livingstone|location=Edinburgh|isbn=978-0443071065|edition=7th}}</ref>{{rp|4}}

===Sodium chloride (salt)===
{{main|Salt rinse}}
{{See also|Saline (medicine)}}

Saline has a mechanical cleansing action and an antiseptic action, as it is a [[hypertonic]] solution in relation to bacteria, which undergo [[lysis]]. The heat of the solution produces a therapeutic increase in blood flow ([[hyperemia]])<ref name=BNF /> to the surgical site, promoting healing.<ref name=pmid12856008/> Hot saltwater mouthwashes also encourage the draining of [[pus]] from [[dental abscess]]es.<ref>{{cite book |  vauthors = Edwards C, Stillman P |title=Minor Illness or Major Disease?: The Clinical Pharmacist in the Community|year=2006|publisher=Pharmaceutical Press|location=London [u.a.]|isbn=9780853696278|page=223|url=https://books.google.com/books?id=o2nftDmulYIC&q=salt+mouthwash&pg=PA223|edition=4th}}</ref> In contrast, if heat is applied on the side of the face (e.g., hot water bottle) rather than inside the mouth, it may cause a dental abscess to drain extra-orally, which is later associated with an area of [[fibrosis]] on the face (see [[cutaneous sinus of dental origin]]).<ref name=Wray2003 />

Saltwater mouthwashes are also routinely used after oral surgery, to keep food debris out of healing wounds and to prevent infection. Some oral surgeons consider saltwater mouthwashes the mainstay of wound cleanliness after surgery.<ref name=Wray2003>{{cite book|vauthors=Wray D, Stenhouse D, Lee D, Clark AJ |title=Textbook of General and Oral Surgery|year=2003|publisher=Churchill Livingstone|location=Edinburgh [etc.]|isbn=978-0443070839|pages=199, 210, 222}}</ref> In dental extractions, hot saltwater mouthbaths should start about 24 hours after a dental extraction.<ref name=Wray2003 /> The term ''mouth bath'' implies that the liquid is passively held in the mouth, rather than vigorously swilled around (which could dislodge a blood clot). Once the blood clot has stabilized, the mouthwash can be used more vigorously.<ref name=Wray2003 /> These mouthwashes tend to be advised for use about 6 times per day, especially after meals (to remove food from the socket).<ref name=Wray2003 />

===Sodium lauryl sulfate (foaming agent)===
[[Sodium lauryl sulfate]] (SLS) is used as a foaming agent in many oral hygiene products, including many mouthwashes. Some may suggest that it is probably advisable to use mouthwash at least an hour after brushing with toothpaste when the toothpaste contains SLS, since the anionic compounds in the SLS [[toothpaste]] can deactivate cationic agents present in the mouthwash.<ref name=pmid11905111>{{cite journal | vauthors = Rosenberg M | title = The science of bad breath | journal = Scientific American | volume = 286 | issue = 4 | pages = 72–9 | date = April 2002 | pmid = 11905111 | doi = 10.1038/scientificamerican0402-72 | bibcode = 2002SciAm.286d..72R }}</ref>

===Sucralfate===
[[Sucralfate]] is a mucosal coating agent, composed of an aluminum salt of sulfated [[sucrose]].<ref name="Saunders et al">{{cite journal | vauthors = Saunders DP, Epstein JB, Elad S, Allemano J, Bossi P, van de Wetering MD, Rao NG, Potting C, Cheng KK, Freidank A, Brennan MT, Bowen J, Dennis K, Lalla RV | display-authors = 6 | title = Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients | journal = Supportive Care in Cancer | volume = 21 | issue = 11 | pages = 3191–207 | date = November 2013 | pmid = 23832272 | doi = 10.1007/s00520-013-1871-y | doi-access = free }}</ref> It is not recommended for use in the prevention of [[oral mucositis]] in head and neck cancer patients receiving [[radiotherapy]] or [[chemoradiation]], due to a lack of efficacy found in a well-designed, [[randomized controlled trial]].<ref name="Saunders et al" />

===Tetracycline (antibiotic)===
[[Tetracycline]] is an antibiotic which may sometimes be used as a mouthwash in adults (it causes red staining of teeth in children). It is sometimes use for herpetiforme ulceration (an uncommon type of aphthous stomatitis), but prolonged use may lead to oral candidiasis, as the fungal population of the mouth overgrows in the absence of enough competing bacteria.<ref name=Cawson2002 />{{rp|209}} Similarly, minocycline mouthwashes of 0.5% concentrations can relieve symptoms of [[recurrent aphthous stomatitis]].<ref>{{cite journal | vauthors = Yarom N, Zelig K, Epstein JB, Gorsky M | title = The efficacy of minocycline mouth rinses on the symptoms associated with recurrent aphthous stomatitis: a randomized, double-blind, crossover study assessing different doses of oral rinse | journal = Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology | volume = 123 | issue = 6 | pages = 675–679 | date = June 2017 | pmid = 28411006 | doi = 10.1016/j.oooo.2017.02.013 }}</ref> [[Erythromycin]] is similar.<ref name="DetailDoc">{{cite journal|title=Magic Mouthwash|journal=Pharmacist's Letter/Prescriber's Letter|date=2007-07-03 | vauthors = Tom WC |volume=23|issue=230703|pages=1–5|url=http://mercypharmacy.wikispaces.com/file/view/MAGIC%20MOUTHWASH.pdf |access-date=2009-12-09 }}</ref>

===Tranexamic acid===
A 4.8% [[tranexamic acid]] solution is sometimes used as an [[antifibrinolytic]] mouthwash to prevent bleeding during and after oral surgery in persons with [[coagulopathy|coagulopathies]] (clotting disorders) or who are taking [[anticoagulant]]s (blood thinners such as [[warfarin]]).<ref name=Glick2003>{{cite book|vauthors=Greenberg MS, Glick M |title=Burket's oral medicine diagnosis & treatment|year=2003|publisher=BC Decker|location=Hamilton, Ont.|isbn=978-1550091861|edition=10th}}</ref>{{rp|473}}

===Triclosan===
[[Triclosan]] is a non-ionic chlorinate bisphenol antiseptic found in some mouthwashes.<ref>{{cite web|url=http://drbenkim.com/articles/triclosan-products.htm|title=Products That Contain Triclosan|work=drbenkim.com}}</ref> When used in mouthwash (e.g. 0.03%), there is moderate substantivity, broad spectrum anti-bacterial action, some anti-fungal action, and significant anti-plaque effect, especially when combined with a [[copolymer]] or [[zinc citrate]].<ref name=Scully2013 /> Triclosan does not cause staining of the teeth.<ref name=Scully2013 /> The safety of triclosan has been questioned.<ref>{{cite web|url=http://newyorkorthodontists.net/triclosan-dangers-side-effects-in-toothpastes-and-mouthwash/|title=New studies show dangers of Triclosan in Toothpastes and Mouthwash|work=New York Orthodontists|date=2012-08-15}}</ref>

===Zinc===
[[Astringents]] like zinc chloride provide a pleasant-tasting sensation and shrink tissues.<ref name=GentleDENTALcare>{{cite web|url=http://www.dentalgentlecare.com/mouthrinses.htm|title=FAMILY GENTLE DENTAL CARE - Mouth Rinses|date=14 September 2022 }}</ref> [[Zinc#Topical use|Zinc]], when used in combination with other antiseptic agents, can limit the buildup of [[Calculus (dental)#Prevention|tartar]].<ref>{{Cite news|url=http://www.livestrong.com/article/290616-zinc-treatment-for-bad-breath/|title=Zinc for Bad Breath (Halitosis)| vauthors = McNamara M |newspaper=LIVESTRONG.COM|access-date=2016-12-01}}</ref>

== See also ==
* [[Sodium fluoride/malic acid]]
* [[Virucide]]

== References ==
{{Reflist|32em}}

== External links ==
* [https://www.today.com/news/be-kissable-get-rid-bad-breath-wbna17011346 Article on Bad-Breath Prevention Products] – from MSNBC
* [http://www.mayoclinic.com/health/magic-mouthwash/AN02024 Mayo Clinic Q&A on Magic Mouthwash for chemotherapy sores]
* [https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/mouthrinse-mouthwash American Dental Association article on mouthwash]

{{Periodontology}}
{{Throat preparations}}
{{Dosage forms}}
{{Authority control}}

[[Category:Dentifrices]]
[[Category:Oral hygiene]]
[[Category:Drug delivery devices]]
[[Category:Dosage forms]]