1. Learning Objectives
1. Benefits of mouth rinses
2. Properties
3. Uses
4. Contraindications (Walsh & Darby, 2015)
Mouth Rinses for Self-Care
Typically recommended as an adjunctive therapy to mechanical methods for the reduction
of plaque and gingivitis
DH Student: Leslee S.
2. ● Mouth rinses are available for both cosmetic and therapeutic use and are available
by prescription and over the counter formulations
Cosmetic uses: breath freshening and whitening
● Mouth rinses have the ability to reach more inaccessible areas often missed when
tooth brushing
(Walsh & Darby, 2015)
The Basics
Directions:
For most products clients are advised to swish twice daily for 30 seconds with 1 oz (20 mL)
after tooth brushing.*
*Manufacturer instructions should be followed for specific directions
Therapeutic uses: plaque reduction, control and reduction of periodontal disease, and
caries prevention.
Therapeutic benefits vary depending on active ingredient and formulation.
3. Ideal properties of a mouth rinse:
● Safe to use over long periods of time
● Palatable to user
● Inexpensive
● Highly soluble and stable in storage
● Effective
● Broad spectrum of effectiveness
● Adequate bioavailability
● Minimal side effects
● Adequate retention
Categories of active ingredients in oral
chemotherapeutics:
Antiseptic agents— Usually broad spectrum; kill or
prevent propagation of plaque microorganisms
Antibiotics— Broad or narrow spectrum; inhibit or kill
specific or groups of bacteria, or modulate host
inflammatory response
Modifying agents— Agents that alter the structure
and/or metabolic activity of bacteria
Anti Adhesives— Products that interfere with the ability
of bacteria to attach to the acquired pellicle
(Walsh & Darby, 2015)
4. General common contraindications:
Contraindicated in clients with physical or cognitive challenges who can not follow
rinsing instructions
Alcohol containing mouth rinses:
● Possible xerostomia implications—drying, irritating effect
● Recovering alcoholics
● Individuals taking certain antibiotics due to gastrointestinal upset
● Small children due to possible ingestion which can lead to intoxication, illness or
fatalities
Clients being treated with head/neck radiation:
● Clients being treated with radiotherapy may present with mucositis
● Sterile water, baking soda in water, or a saline rinse should be recommended
instead due to sensitivities
Sodium restricted diets:
● Some mouth rinses contain high amounts of sodium
● Clients should avoid mouth rinses high in sodium to avoid absorption through the
oral mucosa (Walsh & Darby, 2015)
(Wilkins, Wyche, & Boyd, 2017)
5. Preventative & Therapeutic Agents of mouth rinses:
Fluoride:
Stannous
● Deposit of fluoride ion on enamel
● Tin ion from stannous fluoride interferes with cell metabolism for
antimicrobial effect
Sodium
● Deposit of fluoride ion on enamel
● Cariostatic: inhibits demineralization and enhances remineralization
Uses:
● Prevention of demineralization
● Reduction of hypersensitivity
● Reduction of gingivitis
Considerations:
Stannous: tooth staining
Listerine Total Care
0.02% Sodium fluoride
$9.96
X-Pur Opti Rinse
0.5% Sodium fluoride
$10.99
(Wilkins, Wyche, & Boyd, 2017)
6. Chlorhexidine (CHX)
● Considered the “Golden standard”
● Most effective antimicrobial and antigingivitis agent
● Binds to oral hard and soft tissues
● Attaches to bacterial cell membrane and damages the cytoplasm
● Binds to pellicle and salivary mucins to prevent biofilm accumulation
● Bacterial and bacteriostatic
Substantivity— 8-12 hours
Available by prescription only in a 0.12% solution
Uses:
● Prevent and control biofilm formation
● Reduce viability of existing biofilm
● Inhibit and reduce the development of gingivitis
● Reduce mutans streptococci
Recommended for:
● Preprocedural rinse
● Before, during, after periodontal debridement
● Clients high risk for caries
● Immunocompromised clients more susceptible to infection
● Post Surgery for enhanced wound healing
Chlorhexidine gluconate mouth rinse 0.12%
$31.99
Considerations:
● Can stain teeth
● Increase in supragingival calculus
formation
● Altered taste perception
● Minor irritation to soft tissues, lips and
tongue
● Inactivated by sodium lauryl sulfate
commonly found in toothpastes—wait 30
mins after brushing before use
(Walsh & Darby, 2015) (Wilkins, Wyche, & Boyd, 2017)
7. Triclosan
● Bisphenol and nonionic antimicrobial agent
● Broad spectrum agent effective against both gram-negative and gram-positive
bacteria
● Acts on the microbial cytoplasmic membrane, causing leakage of the cell contents
● Antimicrobial and antigingivitis agent
● Low toxicity
● Not associated with any side effects
● Not as effective as CHX
Available in a 0.3% solution; usually found in toothpastes.
Usually combine with other active ingredients that have greater effectiveness
Uses:
● Reduce biofilm and gingivitis
● Reduce biofilm accumulation
● Reduce supragingival calculus formation
● Reduce bleeding on probing
(Walsh & Darby, 2015)
(Wilkins, Wyche, & Boyd, 2017)
8. Listerine Cool Mint
Eucalyptol 0.092%, Menthol 0.042%,
Methyl salicylate 0.060%, Thymol
0.064%
$6.48
Phenolic-related Essential oils
Combination of thymol, eucalyptol, menthol, and methyl salicylate
● Phenolics disrupt cell walls and inhibit bacterial enzymes
● Decreases pathogenicity of biofilm
● Antimicrobial and antigingivitis agent
● Prevents bacteria from aggregating
● Slows bacterial multiplication
● Reduce bacterial load
● Anti-inflammatory properties
Uses:
● Reduce levels of biofilm and gingivitis
● for individuals unable to perform adequate brushing and flossing
● Initially or periodically to help improve oral hygiene
● Adjunct for mechanical self-care routines that are not sufficient in reducing biofilm,
bleeding and gingivitis
● Preprocedural rinse
Considerations:
● Burning sensation
● Bitter taste
● Poor substativity
● Contraindicated for current and recovering alcoholics if alcohol is included
(Walsh & Darby, 2015)
(Wilkins, Wyche, & Boyd, 2017)
9. Quaternary Ammonium Compounds
● Cationic agents that bind to oral tissues
● Rupture the cell wall and alter the cytoplasm
● Initial attachment to oral tissue is very strong, but released rapidly
● Decreases the ability of bacteria to attach to the pellicle
● Low substantivity compared to CHX
Available agents:
Cetylpyridinium Chloride (CPC) -most commonly used 0.05%-0.07% ex. Cepacol
Domiphen bromide 0.045% ex. Scope
Benzethonium chloride 0.05% ex. Colgate 100
Uses:
● Reduce biofilm accumulation
● Adjunct for mechanical self-care routines
● Reduce halitosis
Considerations:
● Staining of teeth
● Increased supragingival calculus formation
● Burning sensation
● Inactivated by sodium lauryl sulfate commonly found in toothpastes—wait 30 mins
Crest Pro-Health Multi-Protection
Cetylpyridinium Chloride 0.07%
$6.38
(Walsh & Darby, 2015)
(Wilkins, Wyche, & Boyd, 2017)
10. Oxygenating Agents
● Ex. Hydrogen peroxide
● Mediums that have had oxygen added to them
● Antimicrobial as a result of oxygen release
● Affects both gram-positive and gram-negative microorganisms
● Alters bacterial cell membrane increasing permeability
● Sometimes combined with CHX to improve effectiveness and avoid tooth staining
associated with CHX
● Poor substantivity
Uses:
● Short-term use to reduce symptoms of pericoronitis and necrotizing ulcerative
gingivitis
● Negligible antimicrobial effect
● Debriding agent
Considerations:
● Does not consistently prevent plaque biofilm accumulation short term
● When used long term some reduction in gingival redness can be seen
Colgate Peroxyl
1.5% Hydrogen peroxide
$7.97
(Walsh & Darby, 2015)
(Wilkins, Wyche, & Boyd, 2017)
11. Oxidizing Agents
● Ex. Chlorine dioxide
● Products that have had an increase in oxidation number
● Neutralization of volatile sulfur compounds (VSCs) that contribute to
malodor
Uses:
● Mainly cosmetic
● Short-term use to reduce VSCs in the control of oral malodor
Considerations:
● No clinical evidence the use of these products for the reduction of biofilm
or gingivitis
Therabreath 24-hour Fresh Breath Oral Rinse
$9.95
(Walsh & Darby, 2015)
(Wilkins, Wyche, & Boyd, 2017)
12. Ingredient Function
Alcohol Enhances flavor impact; contributes to
cleansing
Flavour Adds pleasantness/freshness; makes breath
temporarily fresh
Humectant Adds “body”; inhibits crystallization around
closure
Surfactant Solubilizes the flavour; provides foaming
action
Water Major vehicle to carry other ingredients
Preservative Preserves aqueous formulation
Dyes Add colour
Sweeteners Contribute to overall flavour perception
Active ingredient Provide therapeutic and/or benefits
Common ingredients and functions in mouth rinses(Wilkins, Wyche, & Boyd, 2017)
13. References
Canadian Pharmacy King. (n.d.). Peridex (Chlorhexidine 0.12%). Retrieved from https://
www.canadianpharmacyking.com/Drug/Peridex
Colgate. (n.d.). Mouthwash: Dental Products: Colgate Professional. Retrieved from https://
www.colgateprofessional.ca/en-ca/products/products-list/colgate-peroxyl-mouthrinse
Dental Product Shopper. (n.d.). Peridex Chlorhexidine Gluconate 0.12% Oral Rinse. Retrieved from
https://www.dentalproductshopper.com/peridex-chlorhexidine-gluconate-012-oral-rinse
Listerine. (n.d.). TOTAL CARE Anticavity Fluoride Mouthwash. Retrieved from https://www.listerine.com/
mouthwash/anticavity/listerine-total-care-anticavity-mouthwash#inactive-ingredients
Oral Science. (n.d.). X-PUR Opti-Rinse 0.05% Fluoride. Retrieved from https://boutique.oralscience.com/
products/x-pur-opti-rinse-0-05
Smart Label. (n.d.). Crest Pro-Health Multi-Protection Cool Wintergreen Mouthwash 500 mL. Retrieved
from https://smartlabel.pg.com/en-ca/00056100034414.html
Therabreath. (n.d.). TheraBreath 24-Hour Fresh Breath Oral Rinse. Retrieved from https://
www.therabreath.com/mouthwash/therabreath-oral-rinse/
Walmart. (n.d.). Online Shopping Canada: Everyday Low Prices at Walmart.ca! Retrieved from https://
www.walmart.ca/en
Walsh, M. M., & Darby, M. L. (2015). Dental hygiene: theory and practice. St. Louis: Elsevier Saunders.
Wilkins, E. M., Wyche, C. J., & Boyd, L. D. (2017). Clinical practice of the dental hygienist (12th ed.).
Philadelphia: Wolters kluwer.
