Research in the field of microbiotas 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 mutants 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 regrown, future treatments could provide a viable long term solution.
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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. Sometimes a significant amount of alcohol (up to 27% vol) is added, as a carrier for the flavor, to provide “bite”. 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. In addition, alcohol is a 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.
It is hypothesized that alcohol mouthwashes acts as a carcinogen (cancer-inducing). Generally, there is no scientific consensus about this. One review stated:
There is now sufficient evidence to accept the proposition that developing oral cancer is increased or contributed to by the use of alcohol-containing mouthwashes. Whilst many of these products may have been shown to be effective in penetrating oral microbial biofilms in vitro and reducing oral bacterial load, it would be wise to restrict their use to short-term therapeutic situations if needed. Perhaps the use of mouthwashes that do not contain alcohol may be equally effective. Further, mouth rinses should be prescribed by dentists, like any other medication. There may well be a reason for the use of alcohol-containing mouth rinses, but only for a particular situation and for a limited and controlled period of time. As such, patients should be provided with written instructions for mouthwash use, and mouthwash use should be restricted to adults for short durations and specific, clearly defined reasons. It is the opinion of the authors that, in light of the evidence currently available of the association of alcohol-containing mouthwashes with the development of oral cancer, it would be inadvisable for oral healthcare professionals to recommend the long-term use of alcohol-containing mouthwashes.
The same researchers also state that the risk of acquiring oral cancer rises almost five times for users of alcohol-containing mouthwash who neither smoke nor drink (with a higher rate of increase for those who do). In addition, the authors highlight side effects from several mainstream mouthwashes that included dental erosion and accidental poisoning of children. The review garnered media attention and conflicting opinions from other researchers. Yinka Ebo of Cancer Research UK disputed the findings, concluding that “there is still not enough evidence to suggest that using mouthwash that contains alcohol will increase the risk of mouth cancer”. Studies conducted in 1985, 1995, 2003, and 2012 did not support an association between alcohol-containing mouth rinses and oral cancer. Andrew Penman, chief executive of The Cancer Council New South Wales, called for further research on the matter. In a March 2009 brief, the American Dental Association said “the available evidence does not support a connection between oral cancer and alcohol-containing mouth rinse”. 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.
You might not be aware of the fact that oral health actually determines your overall health. One of the vital parts of the procedure for oral hygiene consists of using mouthwash.
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