The use and selection of mouthrinses or mouthwashes is one of the more common queries patients ask of their dental professional. There are many options available on the shelves of supermarkets and pharmacies which can be quite overwhelming not just for patients, but also for us clinicians. The following article may serve as a guide to better help you understand which mouthrinse you can recommend to your patients to support their oral health.
Mouthrinses - a guide for recommending the right rinse for your patients
The use and selection of mouthrinses or mouthwashes is one of the more common queries patients ask of their dental professional. There are many options available on the shelves of supermarkets and pharmacies which can be quite overwhelming not just for patients, but also for us clinicians. The following article may serve as a guide to better help you understand which mouthrinse you can recommend to your patients to support their oral health.
Mouthrinses are generally divided into 2 main categories - cosmetic and medicinal. Cosmetic mouthrinses can remove oral debris, temporarily suppress bad breath, reduce bacteria in the mouth and refresh the mouth with a pleasant taste. Mouthrinses classified as medicinal, on the other hand may have the benefits associated with a cosmetic rinse, but also have other therapeutic efficacy benefits. These mouthrinses contain active agents which have a therapeutic effect on the mouth, such as antiseptic or high levels of anti-cavity ingredients. These can help patients with caries risk management as well as gingivitis, and periodontitis.
Whilst the majority of mouthrinses can be purchased over the counter by patients, instructions for use are always recommended so patients get the best out of the product to support their oral health.
Alcohol vs Alcohol Free Rinses
Clinicians and patients may be aware that some mouthrinses contain alcohol whilst others are alcohol free. Some mouthrinses can contain anywhere between 5-27% alcoholic concentrations. Alcohol in mouthrinses is used for several reasons for example, as a solubiliser, stabiliser, preservative, anti-plaque efficacy enhancer and provides a distinctive flavour. Some patients may be concerned about the risks of alcohol containing mouthrinses being a risk of future oral cancer. However, studies show there is insufficient evidence to confirm that alcohol containing mouthrinses represent an independent risk factor for the development of head and neck cancer.1 Importantly, it is recommended that alcohol containing mouthrinses should be avoided for certain patient groups including young children, pregnant and nursing women, and those who suffer from dry mouth. For these demographics, an alcohol free mouthrinse is ideal.
Preprocedural rinses:
Preprocedural rinsing is considered to be one key infection control strategy that can be adopted by dental practices to reduce the extent of contamination to the dental team who are working in the contamination zone. The oral cavity is colonized by various oral microorganisms which become aerosolized during certain dental procedures. Preprocedural rinsing is undertaken to decrease the number of microorganisms in the dental aerosol.2,3
Patients with periodontal disease:
Given periodontal disease is one the most common diseases that the global population suffers, the use of a mouthrinse can be effective to promote healthy periodontal tissues in conjunction with periodontal treatment. Gingivitis occurs after 2 to 3 weeks of undisturbed plaque accumulation alongside a shift in composition of subgingival bacteria from grampositive to gram-negative species. Chlorhexidine Gluconate has a biocidal action that is more effective against gram-negative bacteria given their cells have a larger negative charge.4 Following a course of periodontal treatment for patients with active periodontal disease, a chlorhexidine mouthrinse, containing 0.2% Chlorhexidine Gluconate, can be prescribed as a mouthrinse (10mL undiluted for 30 seconds twice daily for 2 weeks). Patients should also be advised that they may experience superficial staining from the prolonged use of Chlorhexidine mouthrinses, and patients should be assured that the stain can be removed.
Everyday Mouthrinse
If patients are looking for a daily mouthrinse to support their oral hygiene routines and promote healthy periodontium, clinicians can recommend the use of an anti-plaque mouthrinse such as Colgate Total Plaque Release Mouthwash. Colgate® Total Plaque Release Mouthwash is boosted with Zinc, a powerful mineral. It helps eliminate the bacteria that causes plaque and keeps working after rinsing to reduce heavy plaque build up 3X better**. Clinicians should instruct patients to rinse 20mL (fill to the cap line) for 30 seconds twice daily before spitting out.
Patients suffering from dry mouth (Xerostomia):
For patients who suffer from a chronic dry mouth due to reduced salivary flow (xerostomia), a mouthrinse can help to increase the moisture of the oral cavity providing some temporary relief. Specially formulated mouthrinses have been created with active moisturising agents which help to relieve mouth dryness. Aside from this, you can also recommend an alcohol free mouthrinse.
Patients with sensitive teeth:
Patients who suffer from sensitive teeth because of exposed root surfaces from gingival recession or loss of enamel from tooth abrasion, abfraction or acid erosion will usually be already using some therapeutic agent to manage their sensitivity. For patients looking to use a mouthrinse to add to their sensitive toothpaste management, clinicians can recommend a mouthwash that helps to gently clean the mouth and gums. For example, Colgate Sensi Pro Mouthwash is formulated for use in sensitive mouths and can be used for 30 seconds after brushing and flossing twice daily.
Patients undergoing teeth whitening:
Long term management of tooth discolouration either after or during any tooth whitening treatment is an important consideration for patients. Patients wishing to use a mouthrinse which will help promote a whiter smile, can use mouthrinses with active agents that are designed to remove surface stains and whiten teeth. These surface stains generally are caused by highly pigmented foods and drinks including coffee and wine. These mouthrinses provide a barrier on the surface of the enamel which reduces the chances of surface stains from forming. Colgate Optic White Mouthwash can be recommended to patients which uses a unique formula with an optic brightener that activates as it is swished to reflect light, leaving the teeth looking white instantly. Patients should rinse 20mL of mouthrinse for 30 seconds twice daily for best effects.
Patients with ulcers or post-extraction wounds:
There are occasions where patients will present with ulcers intraorally either from stress, dehydration or from a traumatic injury of the soft tissues. Trauma can be experienced from hot foods or drinks or from biting the cheek, lip or tongue. Although oral ulcers are generally self-limiting to 10 days of when it initially formed, clinicians can suggest an antiseptic rinse such as Colgate Savacol Antiseptic Mouth & Throat Rinse* which may relieve the discomfort of mouth ulcers. As previously mentioned, be sure to warn patients of prolonged use of chlorhexidine mouthrinses beyond the 2 week period which can lead to extrinsic staining of teeth. For ulcers, Colgate Savacol Antiseptic Mouth & Throat Rinse* can be used three times daily during the period of the ulcer.
For patients who have recently undergone a dental extraction, promoting good healing of the postextraction socket and wound is pivotal to the postoperative experience of a patient. Especially in areas which can be difficult to keep clean post-operatively such as the posterior area following third molar extraction, an antiseptic rinse such a Savacol* can be prescribed for 2 weeks, instructing the patient to rinse for 30 seconds after meals. Reducing the bacterial load around the extraction socket and wounds can help promote good healing and reduce post-operative pain.3
Patients undergoing dental implant treatment:
To aid healing and manage any postoperative infection following implant surgery, use of an antiseptic rinse for 7-14 days after surgery is advised. 6
Patients with Medication Related Osteonecrosis of the Jaw (MRONJ):
In the 2015 NHS England Guidelines, there was a recommendation to prescribe a Chlorhexidine Gluconate mouthrinse, twice daily in the week before extractions and then post operatively for up to 2 months to facilitate healing. However, NHS England guidelines have since been superseded by Scottish guidelines, advising not to use Chlorhexidine Gluconate mouthwashes prior to extraction in patients categorised as either low or high risk of MRONJ, stating that there is insufficient evidence to support the use. Importantly, for patients that do develop MRONJ, the American Association of Oral and Maxillofacial Surgeons advise to use a Chlorhexidine Gluconate mouthrinse in the early phases of managing these conditions.6
Patients with Dental Caries and Children Adolescents:
A frequent question from patients who are parents of children may ask if their child can use a mouthrinse. Children or adolescents with a higher caries risk or increased susceptibility to dental caries during orthodontic treatment can be prescribed a fluoride mouthrinse to prevent dental caries. Studies show the use of a fluoride mouthrinse twice daily, can reduce caries approximately 26% when used regularly. Importantly, only children above the age of 6 years should be recommended the use of a mouthrinse.9
This recommendation guide aims to simplify and demystify mouthrinses for clinicians so that you make the appropriate suggestions and prescriptions for your patients to help promote good oral health. Mouthrinses are a great adjunctive to include as part of a patient’s oral hygiene routines so they can continue to experience healthier teeth and gums.
*Savacol Antiseptic Mouth & Throat Rinse (General Medicine)
Contains Chlorhexidine gluconate 0.12mg/mL or 2mg/mL Antiseptic mouth and throat rinse. Reduces dental plaque and the incidence of gingivitis. Relieves the discomfort of mouth ulcers. Aids in the treatment of early gum disease. Prevention of oral candidiasis.
Savacol Antiseptic Mouth & Throat Rinse Alcohol Free (General Medicine)
Contains Chlorhexidine gluconate 2mg/mL Antiseptic mouth and throat rinse. Reduces dental plaque and the incidence of gingivitis. Aids in the treatment of gingivitis. May relieve the discomfort of mouth ulcers. Prevention of oral candidiasis.
Indications:
Reduces dental plaque and the incidence of gingivitis. Aids in the treatment of gingivitis. May relieve the discomfort of mouth ulcers. Prevention of oral candidiasis.
Warnings:
Savacol may lead to
- temporary change in taste perception,
- cause reversible staining of teeth and tooth-coloured restorations,
- lead to increased tartar production.
Savacol can cause severe allergic reactions.
Directions:
Rinse or gargle for 1 full minute after meals. Spit out.
Mouth ulcers: Rinse 3 times daily.
Dental Plaque and Gingivitis: Rinse 2 times daily.
Post dental treatment: On dentist advice only.
Denture rinse: Rinse daily in addition to denture cleaning to prevent denture breath.
Dosage
Savacol 0.12mg/mL
Adults: Use 15 mL undiluted
Children under 10 years: Use 7.5 mL undiluted, under adult supervision
Savacol 0.2mg/mL
Adults: Use 10 mL undiluted
Children under 10 years: Use 5 mL undiluted, under adult supervision
Colgate-Palmolive Ltd. Auckland, New Zealand
Colgate-Palmolive Pty Ltd, Sydney, Australia
**with 4 weeks regular twice daily use vs cetylpyridinium chloride antibacterial mouthwash without zinc.
Article Published June - Aug 2024 Dental Solutions
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Dr Kaejenn Tchia is a recent graduate working in a corporate private practice in Darwin, Northern Territory. He is the current President of the Australian Dental Association NT Branch Inc. He has also served leadership positions for Bupa Dental Corporation including the Clinical Advisory Panel, Clinical Procurement Committee and currently the Graduate Committee. He is passionate about helping and collaborating with fellow dental colleagues, recently embarking on a new journey to help recent graduates eliminate burnout through a 6-step B.E.L.I.E.F System through his motivational coaching platform, The Limitless Dentist. Kaejenn is a member of the Colgate Advocates for Oral Health Editorial Community and hopes to use this platform to raise awareness of the importance of mental health in dentistry and provide mindset tools, which can help his colleagues unlock their next level of growth and success.
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