How safe is the use of mouth wash?

Periodontics specialist answers questions about the risks of the presence of ethanol in some oral antiseptics.

Mouth washing liquids, also known as oral antiseptic, have been conquering more and more consumers with promises of fresh breath and protection against cavities. Nevertheless, some odontology specialists show some resistance towards the use of the product and, many times, discourage their patients from using them as a complement to their oral hygiene.

For Dr. Claudio Mendes Pannuti, Doctor and Professor of Periodontics at the College of Odontology of the University of São Paulo (FOUSP), the explanation for such resistance lies in the idea that mouth wash liquids, especially those containing ethanol in their formulas, in concentrations that vary from 5% to 27%, may cause buccal cancer. “That association has generated controversies for decades among dentists, but a recent study proves that such correlation does not exist (reference of the study: Gandini et al., 2012).

Dr. Pannuti explains that, first of all, odontology professionals have to differentiate the ingestion of alcoholic beverages (which is one of the causing factors for some types of cancer, including mouth and oropharynx) and the topic use of mouth wash with alcohol in their formula. That is true because alcoholic beverages contain, besides ethanol, several contaminants, such as nitrosamines and aflatoxins, which are considered carcinogenic. “The consumption of alcoholic beverages generates acetaldehyde, formed by the oxidation of ethanol and which is also considered carcinogenic agent for humans,” he added.

However, the alcohol used in the composition of mouth wash is of pharmaceutical level and is free from impurities.

“Perhaps the fact that the use of mouth wash with alcohol may elevate a little the concentrations of acetaldehyde in the saliva temporarily may have been the reason why they have been considered as responsible for buccal cancer,” says Dr. Pannuti. He clarifies that “that concentration returns to initial values rapidly, while after the consumption of alcoholic beverages, the acetaldehyde may be detected in the mouth hours after the ingestion”.
Systematic review – to reach the conclusion that buccal and oropharynx cancer have no relationship with mouth wash use, researchers carried out a systematic review that investigated the effect of mouth wash on the increase of buccal cancer through epidemiological studies.

The authors did not find significant relationships between the use of mouth wash with alcohol and buccal cancer, not even a trend in the increase of the risk according to the quantities used daily of those products. And, that is why the research concluded that, if used as recommended (twice a day for 30 seconds), the brief contact of the ethanol of the mouth wash products with the mucosa does not promote a carcinogenic effect, and, therefore, can be considered safe,

“However the same research suggests an association between buccal cancer and the lack of oral health care”, emphasizes Dr. Pannuti. The lack of care comprise low brushing frequency and habits like smoking or consuming excessive alcoholic beverages. “Or rather, the recommendation that the research offers is to always keep a daily routine of oral hygiene.”

Which mouth wash to recommend?

The use of buccal antiseptic liquids promotes additional benefits in the reduction of bacterial plaque and gingivitis, when compared to biofilm mechanical control. For that reason, according to Dr. Pannuti, recommending those products as a complement to patients’ buccal hygiene habits is very valid. “The correct recommendation of an antiseptic will depend on the patient’s clinical situation”, he said. For post-operative applications and short-term use, a good option is the moth washing products with chlorhexidine, because they are proved to be very efficient. For long term use the recommendation is of products with effective active ingredients that are less aggressive such as products with essential oils.

Published by Pablo Henrique Asenjo de Macedo

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