Mouth washes

From simple breath fresheners to products that can really influence oral health, a variety of mouth washes are available in the market.

Fluoride containing mouth rinses help to prevent dental decay. They may be recommended for:

1. Children having orthodontic treatment
2. Children with high caries risk A.M.-P.M. Junior (Elder) mouth wash contains 0.03% Triclosan and 0.05% Sodium Fluoride.
3. Patients suffering from dry mouth and
4. Patients who have undergone radiation therapy.

Antiplaque or anti microbial mouth wash is used to inhibit bacterial plaque formation and prevent or resolve chronic gingivitis. They can affect only supra gingival plaque. So they have no role in the treatment of existing periodontal disease, since they cannot either reach the sub gingival environment or penetrate thick layers of established plaque. In these situations, they are used after supra and sub gingival scaling has been done, rendering the tooth surfaces clean, in order to maintain this situation for a short period when the soreness of the gingiva may prevent effective mechanical plaque control.

Indications for Antiplaque mouth washes

1. To replace mechanical tooth brushing when this is not possible in the following situations.
1. In cases of acute oral mucosal and gingival infections
2. After periodontal or oral surgery and during the healing period
3. After cosmetic jaw surgery or intermaxillary fixation used to treat jaw fractures.
4. For mentally and physically handicapped patients.
2. As an adjunct to normal mechanical brushing in situations where this may be compromised by discomfort or inadequacies.

a. After scaling when there is cervical hypersensitivity due to exposed root surfaces, prescribe mouth washes for about 4 weeks. Measures to treat hypersensitivity should also be instituted simultaneously.

b. Following sub gingival scaling and root planning when the gingivae may be sore for a few daysm use of a mouth wash is recommended for about 3 days.

Types of Antiplaque mouth washes

1. Mouth washes containing essential oils. Listerine (Parke Davis), one of the oldest mouth washes available, is an essential oil/phenolic mouth wash. It has been shown to have moderate plaque inhibitory effect and some anti-gingivitis effect. Its lack of profound plaque inhibitory effect is because it has poor oral retention.
2. Oxygenating agents like Hydrogen peroxide, buffered Sodium peroxyborate and Peroxy carbonate in mouth washes have a beneficial effect on acute ulcerative gingivitis, probably by inhibiting anaerobic bacteria
3. Bisguanide antiseptics, like Chlorhexidine, Alexidine and Octenidine possess antiplaque activity.

Bisguanide antiseptics are able to kill a wide range of microorganisms by damaging the cell wall.

Chlorhexidine molecule gets adsorbed onto the oral surfaces and gets released at bactericidal level over prolonged periods. Due to this process, Chlorhexidine has antiplaque properties unsurpassed by other agents.

The antibacterial action of Chlorhexidine is due to and increase in cellular membrane permeability followed by coagulation of the cytoplasmic macromolecules. It is effective in vitro against both Gram +ve and Gram –ve bacteria including aerobes and anaerobes and yeast and fungi.

Substantivity is the ability of drugs to adsorb onto and bind to soft and hard tissues. The substantivity of Chlorhexidine was first described in the 1970s. Due to this property, Chlorhexidine can maintain effective concentration for prolonged periods of time.

Different brands of Chlorhexidine are available in the market, e.g., Rexidin (Warren), Clohex (Group) and A.M.-P.M (Elder).

Side effects

1. It has an unpleasant taste
2. It alters taste sensation
3. Produces brown stains on teeth, which is very difficult to remove. This can also affect the mucous membranes and tongue and may be related to the precipitation of chromogenic dietary factors onto the teeth and mucous membranes, Due to this reason, it is important to advise patients using Chlorhexidine mouth wash to avoid the intake of tea, coffee and red wine during the duration of its use. Remember to severely restrict its use in patients with visible anterior composite and glass ionomer restorations since they also get stained.
4. Chlorhexidine encourages supra gingival calculus formation.
5. Mucosal erosion and parotid swelling are other much rarer side effects.

Since Chlorhexidine is poorly absorbed by the GI tract, it displays very low toxicity.

4. Triclosan, a trichlora-2’-hydroxy diphenyl ether, is a non-ionic antiseptic. It has a moderate antiseptic effect when used as a mouth wash in combination with zinc.

It has been shown to reduce histamine induced dermal inflammation and reduce the severity and healing period of aphthous ulcers.

Colgate Total Plax mouth wsh has Triclosan and Sodium fluoride as its components. Triclosan has little or no substantivity, but is oral retention can be increased by its combination with copolymers of methoxy ethylene and maleic acid.

5. Povidone iodine appears to have no significant plaque inhibitory activity when used as 1% mouth wash and the absorption of significant levels of iodine through the oral mucosal may make this compound for prolonged use in the oral cavity. It could cause problem of iodine sensitivity in sensitized individuals.

Piodin (Glaxo Wellcome), Povidine Gargle (Stadmed) are povidone iodine mouth washes available in the market.

The alcohol content of mouth washes

Most mouth washes contain pharmaceutical grade alcohol, as a preservative and as a semi- active ingredient. Significant amounts of alcohol contained in many mouth washes can lead to certain disadvantages. Care should be taken that they are not accidentally swallowed, especially by children, to avoid toxicity. Small children should not be advised mouth washes, because they are not able to spit out properly. More over, most children have good gingival health.

Because of known links between alcohol consumption plus tobacco smoking and oral and oral and pharyngeal cancer, it has been suggested that the frequent use of alcohol containing mouth washes might increase the incidence of this form of cancer.

Lastly, alcohol containing mouth washes have been shown to reduce the hardness of composite and hybrid resin restorations.