Download Mouthwash claims don`t all stand up to scrutiny

Mouthwash claims don't
all stand up to scrutiny
Rinses no substitute
for brushing, flossing
to prevent gum disease
Harvard Health Letter
Freshens breath! Gives YOUT mouth a
tingling sensation! But what do mouthwashes really accomplish?
Late last year, the u.s. Food and Drug
Administration warned three mouthwash
manufacturers to stop suggesting that
their products that have fluoride as the
main active ingredient would prevent gum
disease and remove dental plaque, the
sticky biofilm of bacteria and other substances that collects on teeth above and
below the gumline. And several years ago,
a federal judge ordered pfizer, which
owned the Listerine brand at the time, to
stop an ad campaign that said the mouthwash was as effective as flossing for preventingtooth and gum decay.
Mouthwash plays a fairly minor role in
the prevention of plaque and gum disease.
Brushing and flossing are much more
important.
Mouthwash manufacturers started
making claims about their products preventing plaque and gingivitis (mflammation of the gums) in the early1980s, after
experiments conducted in the mid-1960s
showed that gingivitis developed in a
matter of weeks in the absence of oral
hygiene.
Many of the mouthwashes are highly
artificial concoctions that contain sweeteners for taste and artificial colorings.
Alcohol is often included because it keeps
other ingredients in solution and tends to
accentuate the flavor. Mouthwash will
make your breath smell better for some
period of time. The question is whether
that's achieved by ingredients that kill off
bacteria or by strong flavors that merely
mask the problem.
A 2008 review of the existing research
(only five studies passed muster) concluded that two of the antibacterial agents
most commonly used in mouthwashes,
cetylpyridinium chloride and chlorhexidine, may reduce the levels of bacteria that
produce halitosis (bad breath), and that
other ingredients (zinc, chlorine dioxide)
may neutralize smelly sulfur compounds.
Cetylpyridinium chloride is an ingredient in Scope, Cepacol, and other popular
brands. In this cormtry, mouthwashes
containing chlorhexidine, such as Peridex,
are available by prescription only and used
mainly after oral surgery. The problem
with chlorhexidine is that it creates brown
HOLA IMAGES PHOTO
Some mouthwash manufacturers have
been chastised for overstated claims.
stains on the teeth and gums.
Bacteria cause both cavities and gum
disease, but the species that cause cavities
are different from those that cause gum
disease, said Dr. Nadeem Karimbux, an
associate professor at the Harvard School
of Dental Medicine.
The dozen or so species of bacteria that
cause gum disease interact with gum
tissue, causing inflammation, which can
break down gum tissue as well as the bone
that holds teeth in place. Brushing and
flossing is the best way to remove plaque,
but the annbacterial ingredients in mouthwash do have a modest effect.
!fit weren't for those brown stains, we
might see a lot more mouthwashes bragging about their chlorhexidine content,
because it may be the most effective of the
commonly available - and testedagents.
The 19th centwy inventors ofListerine
were on to something because the four
essential oils in Listerine (eucalyptol,
menthol, methyl salicylate, thymol) have
also come out of the clinical trials looking
quite effective, even if Pfizer did overreach
with claims of equivalence to flossing.
Listerine has,the American Dental Association's "Seal of Acceptance" as a plaque
fighter. A review done several years ago
found the evidence for cetylpyridinium
chloride more mixed.
The conventional mouthwashes do not
prevent cavities, nor do they claim to. The
bacteria that cause tooth decay need to be
removed by mechanical means, principally brushing. However, there are now
mouthwashes on the market that contain
fluoride, and some of them, like ACT
Fluoride Rinse, have the ADMs blessing as
proven cavity fighters.
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