Mouthwashes in Oral Hygiene

Mouthwashes are solutions for rinsing the mouth and gargling, as an adjunct to maintaining oral hygiene. Good nutrition, brushing teeth, and flossing in between teeth are the primary defenses against plaque and tartar build-up, which potentially could lead to halitosis, dental caries, gin- givitis and periodontitis. A plethora of mouthwashes are available, each meeting a specific dental need. It is important to correctly match the properties of a specific mouth wash with the dental issue that needs attention.

Ingredients in Mouthwash

Mouthwashes are formulated with active ingredients designed to accomplish varied goals in den- tal hygiene, such as to prevent dental caries, kill caries-causing bacteria, to freshen breath and to kill bacteria involved in halitosis, to protect teeth against plaque formation and gingivitis, and to eliminate tooth stains. Active ingredients with antimicrobial activity include triclosan, benzalko- nium chloride, and chlorhexidine digluconate. Other additives include sanguinarine to control mouth odor, hydrogen peroxide as an oxidizing/antiplaque agent, fluoride to counteract the for- mation of dental caries, benzydamine for analgesic activity, and xylitol to stimulate salivary gland activity and thereby prevents mouth dryness.

Mouthwash and Children

Mouthwashes are a form of medication and, as such, a specific mouthwash may or may not be appropriate for a child. Because of the risk of swallowing and ingesting a mouthwash, instead of spitting it out, children under six years of age are not candidates for mouthwashes. Of particular concern are mouthwashes containing fluoride and alcohol. Dental caries (tooth decay) begins with bacterial metabolic activities of food debris on the surface of a tooth, resulting in the generation of acids which eat away and demineralize tooth enamel.

Fluoride, on the other hand, promotes remineralization of enamel with fluorapatite and fluor-hy- droxyapatite, making it resistant to acid attack. Ingestion of fluoride-containing mouthwash by preschool children has been reported. This may result in dental fluorosis (a mottled enamel).

Mild fluorosis, the most common form of fluorosis, is characterized as opaque paper white areas scattered irregularly over the tooth and may be of esthetic concern. With over the counter fluo- ride rinses, it is important that the child is able to follow the directions of expectorating.

Alcohol, added to some mouthwash as a preservative, or a solvent for a flavor, has antimicrobial properties. Alcohol-containing mouthwashes should be kept out of the reach of children. To be safe, look for mouthwashes that kill germs and specify alcohol-free.

Choosing a Mouthwash

When selecting a mouthwash for a child older than six years of age, focus on a product with therapeutic properties, rather than a mouthwash formulated solely for cosmetic properties. For example, a cosmetic mouthwash would be one which solely freshens breath without eliminating the cause of the dental issue. A therapeutic mouthwash, for example, may contain fluoride both to reduce tooth decay on tooth enamel and to kill germs. However, even here, the parent should understand that the mouthwash is not a replacement for brushing and flossing. Mouthwashes with sugars should be avoided.