These are (usually flavoured) antiseptic solutions, also known as gargles, used for cleaning the mouth and freshening breath. Mouth washing also plays a role in patients who are unable to use a toothbrush or where a painful periodontal condition limits tooth brushing. It may also be used in patients with superficial infections of the mouth and can be beneficial in patients suffering from halitosis.

Saline Mouthwash

Use - superficial oral infections.
Essence - this has a mechanical cleansing effect and if warmed, causes local hyperaemia.
Examples - compound sodium chloride solution (prescribable: mix with equal amount of water) or home made: mix half teaspoon of salt in a glassful of warm water.
Administration - use frequently and vigorously.

Fluoride Mouthwashes

Use - recommended for people who are at particular risk of dental decay (they contain around 1450ppmF).
Administration - as directed on individual product.

Total Mouthwashes

Use - combine decay prevention with breath freshening properties.
Administration - as directed on individual product.

Antiseptic Mouthwashes

Chlorhexidine Gluconate9 - this helps inhibit plaque formation and is used in:

• The treatment of denture stomatitis
• The treatment of secondary infection in mouth ulceration
• The treatment and prevention of gum inflammation, particularly where tooth brushing is difficult (e.g. following oral surgery)
• Prevention of oral candidiasis in immunocompromised patients
• Prevention of bacteraemia in patients undergoing dental procedures requiring antibacterial prophylaxis
• It may reduce the incidence of alveolar osteitis following wisdom tooth extraction

It has no prophylactic value in periodontal and plaque disease once pocketing has occurred. It may cause mucosal irritation - try diluting with equal volume of water - and reversible brown staining of teeth, silicate or composite restorations and tongue. Limit staining by brushing teeth before using chlorhexidine. Do this at least 30 minutes before using this mouthwash as it may interact with some ingredients of toothpaste.

Oxidising Agents such as hydrogen peroxide, used in Vincent's angina and has a mechanical cleansing effect

Povidone Iodine is used for oral mucosal infections. Do not use for longer than 14 days as a significant amount of iodine may be absorbed. For this reason, avoid in pregnancy, breast-feeding mothers, patients on lithium therapy and with thyroid disorders.10 It may also interfere with tests for occult blood. Not for children under 6 years.

Hexetidine11 is used for general oral hygiene and in the treatment of minor infections e.g. oral thrush and in the prevention and treatment of gingivitis. It can also be used in the management of sore throat and recurrent aphthous ulcers as well as for halitosis. Rarely, it may cause taste disturbance and transient anaesthesia. Not for children under 6 years. Use to rinse the mouth or to gargle and avoid swallowing large quantities.

Thymol Preparations come as mouthwash solution-tablets, which may be handy for travellers.

Mouthwashes are generally used 2-4 times a day, after meals. Refer to instructions on individual product for specific administration.

A word of caution about mouthwashes

These products are generally regarded as useful, easy products to use in oral hygiene. Whilst this is true, they are still medicinal products, a fact that is overlooked possibly due to their wide availability. Mouthwashes can have significant alcohol content and do not always come with child proof caps. There have been case reports of accidental ingestion by young children with two reported deaths. Their bright colourings and pleasant smell/taste make them attractive targets and patients who have young children should be reminded of this when being advised to use mouthwashes.

The alcohol content of mouthwashes has raised questions as to its possible role in the development of oropharyngeal cancers in individuals who use the product heavily.12,13 However, review of the evidence suggests that this association is an artefact of recall bias and that there is no association between the two.