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:
having orthodontic treatment
with high caries risk A.M.-P.M. Junior (Elder) mouth wash contains 0.03%
Triclosan and 0.05% Sodium Fluoride.
suffering from dry mouth and
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
replace mechanical tooth brushing when this is not possible in the following
cases of acute oral mucosal and gingival infections
periodontal or oral surgery and during the healing period
cosmetic jaw surgery or intermaxillary fixation used to treat jaw
mentally and physically handicapped patients.
an adjunct to normal mechanical brushing in situations where this may be
compromised by discomfort or inadequacies.
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 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.
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
antiseptics, like Chlorhexidine, Alexidine and Octenidine possess antiplaque
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
Different brands of Chlorhexidine are available in the
market, e.g., Rexidin (Warren), Clohex (Group) and A.M.-P.M (Elder).
has an unpleasant taste
alters taste sensation
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.
encourages supra gingival calculus formation.
erosion and parotid swelling are other much rarer side effects.
Since Chlorhexidine is poorly
absorbed by the GI tract, it displays very low toxicity.
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
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.
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
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
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