Mouthwash, How to Choose

There are two categories that a mouthwash can fall into. They can be therapeutic and cosmetic. Cosmetic mouthwashes only freshen breath. They make your mouth taste good but do not get to the root of the problem. They don’t kill bacteria or strengthen teeth. Therapeutic mouthwashes do something to protect oral tissues. They can kill bacteria, strengthen teeth or act as saliva substitutes.

Antibacterial Mouthwashes

Some antibacterial mouthwashes can be bought over the counter while other stronger options are available by prescription or through your dental office.

Listerine

listerine mouthwash

Listerine comes in a variety of flavors to suit most tastes

Active Ingredients: Eucalyptol, menthol, methyl salicylate, and thymol
Available: Over the counter
Important notes: Listerine also makes a fluoride rinse and an alcohol free rinse. These are not antiseptic rinses. They do not have FDA approval to be called antiseptic. Also since Listerine has been around so long generics are very common and work very well. Alcohol can be drying to the oral mucosa. Previous claims that alcohol based rinses cause oral cancer have been disproved through clinical studies.
Best For: Patients with gingivitis who are not bothered by alcohol.

Avoid if: You are allergic to any of the ingredients, have dry mouth or can’t have alcohol.

Read More about Listerine

Crest Pro Health, Cepacol

crest prohealth mouthwash

Crest Pro Health antibacterial mouthwash

Cepacol antibacterial mouthwash

Cepacol antibacterial mouthwash

Active Ingredients: cetylpyridinum chloride
(Crest Pro Health has 0.07%, Cepacol has 0.05%)
Important notes: Can cause brown staining and taste alteration
Available: Over the counter
Best For: Patients with gingivitis that need an alchol free mouthwash.
Avoid if:You are allergic to any ingredient or are whitening as there is a possibility of staining.

Read More about Crest Pro-Health Rinse

Cloysis

closys antibacterial alcohol free mouthwash

Closys Mouthwash

Active Ingredients:Stabilized Chlorine Dioxide
Important notes: Cloysis was created by a periodontist to fight periodontal disease by reducing bacteria, it also helps reduce bad breath in the process. It does not contain alcohol, cause stain or taste alteration.
Available: Over the counter
Best For: Patients with periodontal disease who need an alcohol free rinse. Patients with dry mouth.
Avoid if:You are allergic to any ingredient

Read More about Closys

Breath Rx

Breath Rx mouth wash
Active Ingredients: cetylpyridinum chloride, zinc and essential oils
Important notes: Alcohol free, promoted as a breath freshener, but it is an antibacterial rinse.
Available: Through dental professionals
Best For: Patients concerned with bad breath, caused by oral bacteria. Breath Rx is antibacterial but is the weaker than Listerine, Crest Pro Health and Closys.1
Avoid if: You have active periodontal disease, as there are better options available, or if you are allergic to any of the ingredients.

Chlorhexidine Gluconate 0.12% (Peridex, Perioguard)

Chlorhexidine Gluconate 0.12%
Active Ingredients: Chlorhexidine Gluconate 0.12%.
Important notes: Chlorhexidine is the gold standard of care for treatment of gingivitis and other oral infections. It can cause surface staining which can be removed by your hygienist. Stain may be difficult or impossible to remove on rough surfaces or restorations. Meticulous home care can prevent excessive staining. Some patients experience altered taste when using Chlorhexidine.
Available: Chlorhexidine is a prescription rinse, it is available through your pharmacy or your dentist may keep it in stock to dispense to patients.
Best For: Infections such as gingivitis, mucositis, preventing cavities in patients who can’t accomplish proper home care and preventing pneumonia in patients on ventilators.
Avoid if: You have had a reaction to chlorhexidine in the past.

Read More aboutChlorhexidine Gluconate 0.12%

Gel-Kam, PerioMed, Stanimax

stannous fluoride mouth wash
Active Ingredients: Stannous Fluoride 0.63%
Important notes: May cause surface staining which can be removed by your dental hygienist.
Available: Prescription strength, available at pharmacies or your dentist may carry to dispense to patients.
Best For: Controlling periodontal disease, cavities, sensitivity and reducing plaque accumulation. Kills bacteria for up to 8 hours for prolonged benefit.
Avoid if: You have an allergy to fluoride.

Fluoride Rinses

Stannous Fluoride

See above section titled Gel-Kam, PerioMed, Stanimax. This rinse is both antibacterial and a fluoride rinse with the ability to kill bacteria and strengthen teeth.

Listerine Total Care and Total Care Zero

Listerine Total Care fluoride mouthwash

Available with or without alcohol

Active Ingredients: sodium fluoride 0.0221%
Important notes: Listerine Total Care and Total Care Zero are fluoride rinses, they do not kill bacteria or contain the active ingredients in original Listerine that kill bacteria.
Available: Over the Counter
Best For: patients with tooth decay or poor home care.
Avoid if:You are getting fluoride from other sources or are allergic to any of the ingredients.

Crest Pro Health Complete and Crest Pro Health For Me

Crest Prohealth fluoride rinse
Crest Pro Health for me fluoride mouthwash
Active Ingredients: sodium fluoride 0.022%
Important notes: Crest Pro Health Complete and Crest Pro Health for Me are fluoride rinses, they do not kill bacteria and do not contain the active ingredients in original Crest Pro Health that are antibacterial. In a study comparing these rinses with Listerine Total Care and Act the Crest rinses were found to be the most effective fluoride rinses.2
Available: Over the Counter
Best For: Patients at risk for cavities or with poor home care.
Avoid if: You are getting fluoride from other sources or are allergic to any of the ingredients.

Act

Act Fluoride Rinse

Flavors for Everyone

Active Ingredients: 0.05% sodium fluoride
Important notes: Alcohol free and available in many flavors.
Available: Over the counter
Best For: Patients that are at risk for cavities, but stronger options are available if the patient has severe decay or is at high risk for decay.
Avoid if:Young children who can’t swish and spit should not used as ingesting fluoride mouthwash is not recommended. Patients with allergies to fluoride should not use.

There are many other companies that make fluoride rinses on the market as well. If you are wondering if they are beneficial you can compare the percentages of active ingredients to some of the more popular brands that I have mentioned above. There are several reasons why you may want to choose a different fluoride rinse from price, to earth friendliness. Keep in mind that a fluoride rinse that is cheap but has very little fluoride is not really a bargain. Going organic is a matter of personal choice and there are some great earth friendly products out there. I really like Tom’s of Maine products. No animal testing and all the products I have tried are very tasty. (Who wants to use a gross tasting oral hygiene product, not me!)

Dry Mouth Rinses

Biotene

Biotene dry mouth oral rinse
Active Ingredients: Natural salivary enzymes (Lactoferrin, Lysozyme, Lactoperoxidase, and Potassium Thiocynate), Xylitol, and several humectant agents(ingredients that help with moisture retention)
Important notes:Biotene is a brand name, and several products are made by this company, including a couple of different mouth washes. Biotene is used as a saliva substitute, not as a salivary stimulant.
Available: Over the counter
Best For: Patients with dry mouth from medications or health conditions.
Avoid if: You are allergic to any ingredient.

Oasis

Oasis dry mouth rinse
Active Ingredients: Glycerine and Sorbitol
Important notes:
Available: Over the counter
Best For:Patients with dry mouth from medications or health conditions.
Avoid if:You are allergic to any ingredients.

Pre-brush Rinses

Plax

Active Ingredients:0.05% w/w cetyl pyridinium chloride (CPC)
Important notes: There is not sufficient evidence to conclude that the use of this product is any better than rinsing with water. The amount of active ingredient is not enough to be antibacterial.
Available: Over the counter
Best For:I generally don’t recommend this product to patients.
Avoid if:If you have an allergy to any ingredient.

Listerine Agent Cool Blue

Listerine Agent Cool Blue Plaque disclosing rinse

See Where to Brush!


Active Ingredients:none
Important notes:This rinse contains a colored dye that stains plaque so it is easier to see and brush away.
Available: Over the counter
Best For:Kids who need to brush better, or anyone who isn’t brushing well. I often recommend “painting” the teeth with this instead of swishing. Use a cotton swab to apply and there will be much less mess.

Avoid if: You are allergic to any ingredient.


1 Drake, David, MS, PhD; Villhauer, Alissa L., BS. An In Vitro Comparative Study Determining Bactericidal Activity of Stabilized Chlorine Dioxide and Other Oral Rinses. Journal of Clinical Dentistry 22:1–5. 2011.
2Faller RV, Casey K, Amburgey J. Anticaries potential of commercial fluoride rinses as determined by fluoridation and remineralization efficiency J Clin Dent. 2011;22(2):29-35.

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