Alcohol in mouthwash has registered on the community’s radar recently. Many major papers, news and radio talk shows in Australia and New Zealand have exposed new university research linking oral cancer risk to mouthwashes high in alcohol.
Why is this exciting for me? Those who have attended my lectures know how long I‘ve been pushing the dental profession to take action on this serious issue and many other risk factors we allow or encourage our patients to be subjected to.
People generally trust healthcare professionals blindly, who, in turn, trust pharmaceutical companies and suppliers blindly to provide the best care, products and support. But I believe, as a healthcare professional, that it is my duty to ask questions, do my own research and figure out who is making or providing the best care and who isn’t. It is also my duty to make others aware.
What choices people make with that awareness are their concern. We should not be the cause of harm or lead people to think that something is good for them, when it isn’t, while better options are available with lower or no risks.
Why do some medications get taken off the market only after people get sick or die from using them? Why did we prescribe them or allow them to be sold without proper questioning and evaluation? Do people read and understand their potential risks when taking medications or buying health products over the counter?
Whether it is a mouthwash, multivitamin, Vioxx or a cancer treatment drug, one should be made aware of the good and bad aspects of that product, so they can make a choice.
This is called informed consent in all areas of healthcare, including dental medicine. It is a legal and ethical obligation for practitioners.
Every lecture I have given, regardless of the subject, involves a blurb on the risk factors of most over-the-counter oral care products. They are: ACID, ALCOHOL and SOAP.
Alcohol (ethanol) is known to increase your chances of getting cancer. There is nothing new about that. It is a tissue irritant, as it sucks water out of cells on contact (that’s the burning sensation you get when you drink distilled alcohol).
Constant irritation to any human tissue is a direct risk factor for that tissue to get permanently damaged and cancerous. Especially when combined with other risk factors like smoking, dry mouth (from dehydration or medication-induced), bacterial toxins and other toxins.
Any solution with more than 8 per cent alcohol will cause some cell death on contact. How often should we be exposing ourselves to that? Well, as little as possible really.
If you make that solution acidic the risk factor increases. Teeth and bones, like all minerals, dissolve in acid. That is why we get worn, eroded teeth when we eat or drink too many acids. The same goes for bones. Most commercial mouthwashes are acidic!
The constant use of acidic mouthwashes may increase tooth wear and erosion (ugly, sensitive and thin teeth) and may raise the risk for decay and bad breath (dry mouth=bad breath). The dark blue, green and red colours of mouthwashes also stain teeth. Why do they make them like that? Marketing and shelf life.
So what mouthwash should we use?
1 Alcohol free: to avoid irritating soft tissues and drying up the mouth.
2 Neutral or alkaline in pH: to fight the acid we get exposed to during the day.
3 Colourless: to avoid staining teeth.
4 Universal: can be used by any person of any age, with any other oral health risks they have.
5 Safe for kids.
Remember, anything that goes into your mouth you ingest into your body, even if you don’t swallow it. The fastest way to get something into your blood is into a vein. The second fastest is through the mucosa of the base of your mouth under the tongue.
Swallowing something actually prolongs the time it takes to get into your blood. So alcohol mouthwashes are not suitable for kids (says so on the bottle, actually), for the elderly, for smokers, for people with a dry mouth, on medication, sports people, people with reflux or heartburn, after oral surgery, or for prolonged use in general.
You’ll actually fail an alcohol breath test if you take it straight after using one of these mouthwashes. The alcohol concentration in most big brand mouthwashes is between 11% and 26%. That means up to a QUARTER of the bottle is alcohol (the rest is water with minimal active ingredients dissolved in).
Some of the cheapest and easiest mouthwashes to make at home are dissolving sodium bicarbonate (baking soda from the supermarket) or hydrogen peroxide (from any chemist) in water and rinsing it around in your mouth for a minute.
A teaspoon of baking soda in a small glass of water used twice daily will help a lot. Peroxide should be diluted to 1.5 or 2 per cent maximum for a mouthwash.
For stronger, more effective mouthwashes against specific problems (bad breath, tooth decay bacteria, gum and bone disease bacteria) send me an email through my website.
Remember though, no mouthwash in the world can replace proper physical cleaning of your mouth (daily by yourself and quarterly by a good hygienist). So please seek proper advice from a trusted clinician if you have a problem, don’t rely on magical cures, as there are none.
More on the effect of acid/alkaline balance on he body and oral health in the next blog.
