Open Wide: Your Oral Hygiene

Is mouthwash a must?
By Dr. Rob for MSN Health & Fitness

Q: Do I need to use mouthwash to maintain good oral hygiene? If so, which types are best?

A: Mouthwash isn't a must when it comes to good oral hygiene. The key to a healthy mouth is preventing tooth decay and gum disease. This is best accomplished by brushing twice a day, flossing daily, and visiting your dentist periodically (at least every six months). That said, several types of mouthwash might help to improve your oral health by controlling or treating conditions such as bad breath, gingivitis and plaque buildup. However, the use of mouthwash does not replace brushing and flossing.

Types of mouthwash

When considering a mouthwash, think about why you need one. For example, while some freshen breath, others may help to decrease the occurrence of gingivitis. Additionally, some types are only available by prescription.


Bing Search: Oral Health
View results for: Dental Health Care Dental Problems Choosing a Dentist
In general, mouthwash (or rinses) are categorized into one or a combination of the following categories:

Cosmetic—Temporarily mask bad breath and/or rinse away food and sugary debris that combine with bacteria to form plaque. These types of products may be labeled as antiseptic mouthwashes.

Therapeutic—These are regulated by the Food and Drug Administration and may assist in the battle against the formation of plaque and gingivitis. Additionally, some contain fluoride and have the potential to strengthen teeth against the process of decay.

Common oral health concerns

Referring back to your question, I'd like to stress the importance of establishing regular health screenings with a family dentist. This is key, as many health conditions (cardiovascular problems, diabetes, immune system disorders, anemia, etc.) and medications are linked to oral health. That's why your examination will include a thorough evaluation of your gums, tongue and teeth. Conditions of concern include the following:

Plaque—A sticky substance consisting of food debris and bacteria that can form within 20 minutes after a meal. It converts sugars from our diet into acid, potentially leading to tooth decay and gum disease. It cannot be rinsed off, but can be removed by brushing and flossing.
Tartar—If plaque is not removed it will harden into tartar. This combination (plaque and tartar) can lead to other conditions such as cavities, gingivitis and tooth loss. Visit your dentist to have this removed.
Gingivitis—Inflammation of the gums that may appear as painless bleeding during or right after brushing and flossing.
Periodontitis—A process causing the destruction of the ligaments and bone supporting the teeth, potentially leading to the loss of teeth.
Discoloration of the teeth, tongue or gums.
Ulcerations or other abnormal areas affecting the tissues of your mouth.
Foul breath—May be caused by tooth decay, certain foods, tobacco, medications and medical conditions such as post-nasal drip, sinusitis, infections of the throat and gastroesophageal reflux.
Pain or inability to use certain teeth.

Treatment plans

An individualized treatment plan should be discussed with your family dentist to improve and maintain your oral health. The plan might include the following:

A recommendation to brush your teeth at least two times per day, but preferably after each meal and snack.
Instruction on the proper technique to brush your teeth (type of bristle, length of time, angle to hold the brush, how often the brush needs to be replaced, etc.)
Daily flossing and/or use of an interdental cleaner (a device that cleans between the teeth)
Regularly scheduled teeth cleaning
Follow-up for any existing mouth or dental concerns
Proper care of dental appliances, including retainers and dentures
If a mouthwash is recommended, it may be aimed toward these goals:

Reducing the amount of potentially harmful bacteria in your mouth
Masking or temporarily neutralizing bad breath
Strengthening tooth enamel to fight off decay
Relieving pain from ulcers, tissue irritation, etc.
Helping to clean areas of the mouth that may be hard to brush or floss due to braces or other dental devices
Relieving dry mouth by stimulating the production of saliva (dry mouth can contribute to tooth decay)
Preventing bacterial build-up after oral surgery (temporary use)
Using mouthwash

Needless to say, the use of mouthwash may play a role in your oral health plan. However, it's important to follow the instructions, especially since that particular product may not be appropriate for young children. (Ingesting mouthwash is a leading cause of poisoning in children; they're attracted to the often brightly colored liquid.) Additionally, the overuse or abuse (drinking) of mouthwash or rinse containing alcohol, fluoride or other ingredients may trigger side effects such as:

Dry mouth and irritated gums (especially with products containing alcohol)
Discoloration of the tongue or staining of the teeth
Sensitivity in the roots of the teeth
Change in your ability to taste food, drinks and spices
Alcohol ingestion (many products contain high concentrations)
Mouth ulcers
Dental fluorosis in children
Numbness of the mouth and tongue

Lastly, our bodies are a system. If one area is compromised, it can affect other areas of our health. Please pencil in regular visits with your family dentist and family physician. The two will work together as part of your personal health care team.

For further information, please visit the American Dental Association, the American Dental Hygienists Association, and the American Dietetic Association for tips toward better dental health.


Find More on MSN Health & Fitness:

Conquering Canker Sores
A Little Fluoride Goes a Long Way
A Bad Taste in Her Mouth
Bing Shopping: Sonicare Toothbrushes
Bing Shopping: Mouthwash
Find all articles by Dr. Rob.

Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.

Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.

Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features.