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==Dangerous misuse==
{{main|Surrogate alcohol}}
If one drinks mouthwash, serious harm and even death can quickly result from the high alcohol content and other harmful substances in 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> 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}}▼
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.
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</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>
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[[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]]''
[[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>
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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)===
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===Cetylpyridinium chloride (antiseptic, antimalodor)===
[[Cetylpyridinium chloride]] containing mouthwash (e.g. 0.05%) is used in some specialized mouthwashes for halitosis.<ref name="pmid27228022">{{
===Chlorhexidine digluconate and hexetidine (antiseptic)===
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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
[[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=
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>
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===Fluoride (anticavity)===
Anti-cavity mouthwashes
===Flavoring agents and Xylitol===
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