Mouthwash use and the prevention of plaque, gingivitis and caries

Boyle, Peter and Koechlin, Alice and Autier, Philippe (2014) Mouthwash use and the prevention of plaque, gingivitis and caries. Oral Diseases, 20 (S1). pp. 1-68. ISSN 1601-0825

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Abstract

Careful quantitative assessment of data regarding use of mouthwash and risk of common oral conditions reveals that there is a clear evidence of benefi t from use in terms of reducing the risk of dental plaque, gingivitis, dental caries and that there are no major adverse effects including no evidence of an increased risk of oral cancer among users of mouthwash containing alcohol. Despite limitations in the quality of many studies conducted, there is a signifi cant reduction of both dental plaque and gingivitis associated with use of mouthwash preparations containing chlorhexidine or essential oils as an adjunct to standard care. The effect of mouthwash containing essential oils on both plaque and gingivitis is less than chlorhexidine in studies of less than 3 months duration but improves with increasing duration of use and equals or exceeds the effect of chlorhexidine when use is 6 months of longer. Mouthwash preparations containing cetylpyridinium or triclosan may also be effective, but less than the two former, while mouthwashes containing delmopinol are not effective for plaque and gingivitis control. How- ever, there is a large degree of heterogeneity and strong evidence of publication bias: there is a lack of small studies with a small effect of mouthwash. This results in a biased estimate of effect (over-estimated) because there is a tendency to publish mainly positive studies (those showing a strong decrease). Compared with fl uoride toothpaste used alone, topical fl uorides (mouthrinses, gels or varnishes) used in addition to fl uo- ride toothpaste reduce caries by 10% on average. Topical fl uorides (mouthrinses, gels, or varnishes) used in addition to fl uo- ride toothpaste achieve a modest reduction in caries compared to toothpaste used alone. No conclusions about any adverse effects can be reached, because such data were rarely reported in the trials. It is possible to conclude that mouthwash contain- ing fl uoride is a useful adjunct to fl uoridated toothpaste in reducing caries in children. As regards oral malignancy, quantitative analysis of mouthwash use and oral malignancy revealed no statistically signifi - cant association between mouthwash use and risk of oral cancer including no signifi cant trend in risk with increasing daily use; and no association between use of mouthwash containing alcohol and oral cancer risk. Most recent estimates of the population attributable risk for alcohol consumption and oral cancer put the fi gure at 1%. The dose of acetaldehyde from mouthwash is minute compared to that from other sources notable cigarette smoking, alco- hol drinking and certain foodstuffs including yoghurt and peas. It is extremely unlikely from a theoretical viewpoint that mouthwash could be a cause of oral cancer and this is substantiated from the lack of evidence of carcinogenicity found in epidemiological studies in humans. In summary, there is evidence supporting the use of mouthwashes in terms of preventing or reducing the risk of develop- ing a number of common conditions notably dental plaque, gingivitis and dental caries without any adverse effects. There is also evidence that mouthwash use does not increase the risk of oral cancer even when it contains a signifi cant percentage of alcohol. Mouthwash use makes a signifi cant contribution to public health.