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Mouth Rinses and Washes

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One of the most asked questions in my office is "Do I need to use a mouth wash?" to address a periodontal or "gum" problem. This is one of the most difficult questions to answer, for a couple of reasons. Let me begin to answer this question with some facts. This is a complex topic, so I will keep my assertions general.

The idea that a mouth wash is a part of good oral hygiene has been around, even before the advent of Listerine. The pharmaceutical companies that sell these mouth rinses have always made the assertion that their product "kill the bacteria that cause gingivitis", and to some degree this claim is true. Through various mechanisms, they in fact do reduce the amount of bacteria that cause periodontal (gum) inflammation, or gingivitis. They do "kill" bacteria they can reach. This is where the controversy starts.

Most people who have been to my office can attest to the fact that around the tooth and gums exist "pockets" where bacteria, in a biofilm, can lie undisturbed, hence creating gingivitis. These pockets have various depths, and to make a long story short, these rinses do not penetrate these pouches with complete efficacy. So, as one can see without the 50 dollar charts, gingivitis will still exist in some form, even with the use of these rinses. The American Dental Association stepped in after the pharmaceutical companies made the claim that rinsing was as effective as flossing. For this  "pocket" reason, I do not feel that rinses are essential  to the practice off good oral hygiene. Attention to detail flossing will reach these areas in most circumstances in patients with healthy gingivae.

Let me be very clear. Many rinses disrupt biofilms and kill bacteria, i.e. control plaque. Your gums may appear very healthy, but if a patient uses these rinses and still has bleeding when they floss, the periodontal disease remains. For this reason, I maintain that flossing is key to good oral hygiene. There is a technique involved to maximizing your effort, and I can you this method, or the American Dental Association has a video of this technique on the patient window of ADA.org.

In the interests of clarity, there has been one rinse which has which has received FDA approval for efficacy in reducing plaque and gingivitis. This is Peridex, and sorry, it does not penetrate the pocket effectively. Gum doctors use this after surgery, when tooth brushing may be a problem, and this rinse stains teeth badly. An additional question arises about water piks. They are great at removing debris, but not much else. Effective tooth brushing accomplishes the debris removal task. So, brushing twice a day and flossing once a day is generally all a patient requires. There are some exceptions, and I will happy to discuss these exceptions at your next appointment.

Mouth rinses/washes do little good as far as halitosis is concerned. Oral malodor, or bad breath again is caused by oral bacteria, and without going into an anatomic lecture of the tongue, oral bacteria do become longed into the microscopic nooks and crannies of the tongue, and left to their devices can cause a funk, or so I am told. In any event, this perceived malodor is only masked by mouthwashes, and brushing the tongue, coupled with flossing once a day ( I do know I am beginning to sound like a broken record) will go a long way to solving this issue. Let me know if I can help you!

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