PHARM REPORT / KATHLEEN DOHENY : Some Advice on How to Select the Best Mouthwash for You

The evidence is building, perhaps more quickly than that plaque on your teeth. Mouthwashes don’t just improve early morning kissability. Used daily, mouthwashes can help ward off cavities and gum disease.

Growing numbers of researchers say so, even though the Food and Drug Administration is withholding comment until it reviews more manufacturers’ data, probably this summer.

The Market

In 1992, Americans spent $750 million on over-the-counter mouthwashes, according to Lenka Grskovic of Kline & Co., an international business consulting firm.


The Scare

Sales actually declined slightly--about 3%--from the year before. That’s attributable, she says, to scary research suggesting alcohol in mouthwash increases the risk of oral cancer--a finding most scientists now consider unfounded.

“There’s insufficient evidence to demonstrate alcohol-containing mouthwashes contribute in any real way to oral cancer,” says Kenneth Burrell, interim director of the American Dental Assn.'s division of scientific affairs.

The Choices

Picking a mouthwash is no picnic, as you know from strolling the gargle aisle. There are mouthwashes for grown-ups and rinses just for kids. Other makers tempt you with alcohol-free formulas or flavors like cinnamon or peppermint. Even Listerine, the mouthwash that requires an acquired taste, debuted in Cool Mint flavor last year. There are mouthwashes with promising names like Act and dozens of plain-Jane but economical house brands.

The Scoop

To make mouthwash shopping easier, dentists suggest you pinpoint your goal. Are you trying to ward off cavities? Or are you hoping to prevent or minimize gum disease? (Sorry, there’s no mouthwash yet that can do both, says Vladimir Spolsky, UCLA associate professor of public health dentistry and supervisor of its preventive dentistry teaching program.)

If cavities are your nemesis, look for mouthwashes with sodium fluoride as the active ingredient, dentists suggest. One example is Listermint with Fluoride.

If you worry more about gum disease, pick mouthwashes that list as active ingredients cetylpyridinium chloride or domiphen bromide, suggests Thomas A. Gossel, associate dean of the College of Pharmacy at Ohio Northern University at Ada, who has researched mouthwashes. Cepacol and Scope both have cetylpyridinium chloride; Scope also has domiphen bromide. To help prevent gum problems, Spolsky suggests also considering mouthwash with sanguinaria as an active ingredient (such as Viadent).

If you worry about both? You might alternate mouthwash types, dentists suggest.

The Claims

For a while, mouthwash makers were fond of making dramatic claims, such as saying that their formula removed many hundreds of times more plaque than just brushing. In recent years, some have toned down their claims, inspired by a not-so-subtle FDA announcement in September, 1990.

“We made the point that these were drug claims,” says FDA spokesman Mike Shaffer. There was a call for data, which has been pouring in to the FDA. A special dental panel formed to evaluate these claims is tentatively scheduled to meet this summer, Shaffer says. Until then, the mouthwash claims are “not supported but allowed because they are under review.”

Some dental watchers think it’ll be shoo-in.

The Seal of Acceptance

Dozens and dozens of over-the-counter mouthwashes have earned the American Dental Assn. seal of acceptance as plaque-busters and cavity-blasters, says Chris Martin, an ADA spokesman.

The Process

Mouthwashes work in a couple of ways: the mechanical swishing action helps get rid of bad bugs and the mouthwash formula itself kills the critters.

Even veteran users might need a brushup on mouthwash use. “Take just a swig,” says Gossel, who published research on mouthwashes recently in U.S. Pharmacist. That’s about one or two tablespoonfuls.

Twice-a-day rinsing, for 30 seconds each time, is recommended by Gossel. Swish it around good in your mouth. The swishing action helps loosen plaque, Gossel says. When you’re done swishing, spit, don’t swallow.

The best time to rinse, Gossel says, is after brushing and about 30 minutes before you plan to eat or drink.

To minimize plaque accumulation, be sure to use mouthwash every 24-48 hours, Gossel says. Once plaque hardens into tartar, it can irritate the gums.

Beyond Mouthwash

Good as it is, mouthwash can’t work miracles, especially if the bad bugs have taken up residence in your gums.

“Most over-the-counter mouthwashes have no effect on periodontal disease,” says Barrie Kenney, UCLA professor and director of postdoctoral periodontics. What’s needed then, he says, is stronger stuff--like Peridex (chlorhexidine), a prescription-only mouthwash. But it’s expensive. At one San Fernando Valley drugstore, it sells for $22.45 a pint, about a 30-day supply. The formula also can stain teeth, especially those of coffee drinkers, Kenney adds. A solution: Dip your brush in it, he tells patients.

The Big Picture

When dentists say mouthwash helps prevent gum disease and cavities, they all dwell on the word helps. A little mint mouthwash can never be a substitute for regular professional checkups and daily brushing and flossing. It won’t reduce bleeding gums or make decay disappear. Nor will it solve all your bad-breath problems.

The Small Picture

Children should be supervised during mouthwash use to minimize toxicity risks.

No Time?

If mouthwash is too much to add to an already busy day, even Gossel doesn’t see it as critical.

“If you brush and floss after every meal, you don’t need mouthwash,” he says. But in the next breath, he admits, not many people have great brushing and flossing habits.

The best bet? Try using mouthwash as you walk around the house doing other morning routines like getting dressed or making coffee. You can even use mouthwash while you’re in the shower.

Here’s a Real Mouthful

Do your dentist and hygienist seem to be speaking another language as they probe, poke and plead with you to floss every day? Here’s a vocabulary guide:

* Plaque: Soft, sticky colorless film that provides a comfortable home for bacteria. Plaque builds up quickly on teeth and gums. When not removed, it becomes tartar.

* Tartar: Accumulated plaque that thickens and hardens; also called calculus.

* Gingivitis: Inflammation of the gums (gingiva), caused by plaque buildup.

* Pockets: Deepened spaces between teeth and gums that occur when inflamed gums separate from the teeth. Pockets attract bacteria, which in turn can eat away at underlying bones and tissues that attach teeth to bone. Gum disease worsens and teeth can loosen.