Mouthwashes: Many mouthwashes contain significant quantities of alcohol and this may have several possible disadvantages. Firstly, they mustn’t be accidentally swallowed particularly by young children. In this regard, alcohol toxicity from this source has been reported.
Secondly, because of the known links between alcohol consumption plus tobacco smoking, and oral and pharyngeal cancer, it has been suggested that the frequent use of alcohol-containing mouthwashes might increase the incidence of this form of cancer. However, the evidence for this appears to be very weak, mainly because the statistical tests applied to test the strength of association are affected by the confounding effects of known etiological factors such as tobacco, smoking, and alcohol consumption in the subjects studied. Thirdly, it has been suggested that the use of alcohol-containing mouthwashes may increase the alcohol content of exhaled breath and could thus change the readings of the police breath test. However, this effect was found to be transient. Finally, alcohol-containing mouthwashes have been shown to reduce the hardness of composite and hybrid-resin restorations and these effects seem to relate to the percentage alcohol content of the mouthwash. It has also been found that composite resins soaked in alcohol-containing mouthwashes gain more weight than those soaked in alcohol-free mouthwashes. This suggests that some component of mouthwash, probable alcohol, is absorbed into the resin and may be responsible for the softening effect. However, one study has found that either alcohol-containing or alcohol-free mouthwashes reduced the hardness of composite resin and glass ionomer cement. In addition, it has been found that alcohol-containing mouthwashes may alter the color of some hybrid composite resins.
The main uses of anti-plaque mouthwashes are as follows:
To replace mechanical tooth brushing when this is not possible in the following situations:
- After oral or periodontal surgery and during the healing period.
- After intermaxillary fixation is used to treat jaw fractures or following cosmetic jaw surgery.
- Acute oral mucosal or gingival infections when pain and soreness prevent mechanical oral hygiene.
- For mentally or physically handicapped patients who are unable to brush their teeth themselves.
However, these patients may also not be able to use mouthwash so that swabbing the gingival margins by a care worker may be the only option. This may not necessarily be easier for the care worker to carry out than brushing. The long-term use of effective agents has the major disadvantage of causing tooth staining.
Anti-plaque mouthwashes have no place in the treatment of existing periodontal disease, either gingivitis or periodontitis since they cannot either reach the subgingival environment or penetrate thick layers of established plaque. In these situations they should only be used after supra- and subgingival scaling has been carried out, rendering the tooth surfaces clean, to maintain this situation for a short period when the soreness of the gingiva may prevent effective mechanical plaque control.
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