Modern alcohol-based mouthwashes have been around since the 1800s, introduced to help fight germs and bacteria. However, there’s been a rise in controversy as new research suggests alcohol-based mouthwashes can do more harm to your oral health and well-being than good. Through scientific evidence, this article explores the history behind alcohol-based mouthwashes, the risks they present, alternative mouthwash options, and how to properly incorporate effective mouthwashes for proper oral hygiene.
1. Historical Context and Reasons for the Popularity of Alcohol-Based Mouthwashes
Before we dig into the risks of alcohol-based mouthwashes, it’s important to understand the historical context behind it’s use. Around the 18th century, Anton van Leeuwenhoek, better known as the “father of modernmicrobiology,” discovered oral bacteria, and soon after he experimented with different solutions to kill oral bacteria. Upon experimenting, Leeuwenhoek realized that by submerging bacteria in alcohol they would die. This discovery prompted the popularity of alcohol-based mouthwashes in people’s everyday oral hygiene routines.
The first time a prescription mouthwash was ever sold over the counter in the United States was in 1914 after Englishdoctor Joseph Lister was the first surgeon to perform surgery in a sterilized space with antiseptic. Lister’s practice soon grew as people realized that sterilizing antiseptics reduced death rates. Furthermore, these discoveries inspired Robert Wood Johnson and Dr. Joseph Lawrence to dig deeper into modern practices that utilize sterilizing wounds in surgery.
Dr. Lawrenece continued to create the popular mouthwash brand loved by many ‘Listerine’. While Listerine’s modern use is for oral hygiene, historically, it was used to disinfect wounds during surgery, cure dandruff, clean floors, act as a deodorant alternative, and even as a “beneficial remedy” for diseases like smallpox and gonorrhea. Alcohol-based mouthwash made people feel as though they were reducing their oral bacteria while also getting fresh breath, which is why it became such a common consumer product.
2. Scientific Evidence Supporting Alcohol-Based Mouthwashes
Scientific research has shown that alcohol-based mouthwashes have the ability to increase the risks of a condition called xerostomia, or dry mouth, due to alcohol’s ability to reduce saliva. Saliva’s role is in flushing away bacteria in your mouth, however, alcohol-based mouthwashes decrease saliva’s ability to safeguard oral health by disrupting beneficial bacteria in the process of eliminating harmful bacteria. For many, experiencing a burning sensation when using alcohol-based mouthwash is also common, because it causes mucosal irritation that leads to inflammation of the mouth and soft tissues.
The high acidity in alcohol-based mouthwashes can also lead to degradation and tooth decay as it dissolves your teeth’ enamel. Ethanol has the ability to weaken dental adhesives used for crowns, veneers, etc., so using alcohol-based mouthwashes can lead to early degradation of expensive and time-consuming dental work. Tumors are also known to form in acidic environments, which is increased with the usage of alcohol-based mouthwashes when it comes to developing oral cancer.
Scientific evidence has shown a potential link between alcohol-based mouthwashes and increased cancer risks. In 2009, the International Journal of Cancer produced experimental results that concluded that there are potential risk factors that lead to oral cancer for frequent users of alcohol-based mouthwash. Long-term alcohol-based mouthwash use has been shown to increase salivary acetaldehyde levels linked to oral cancer. Acetaldehyde is an ethanol metabolite found in the human body after consuming alcoholic beverages, and alcohol-based mouthwashes lead to acetaldehyde levels similar to those of alcoholic beverage consumption. Most mouthwash manufacturers recommend using mouthwash twice a day, and it was observed that this recommended use causes acetaldehyde exposure of 0.26 μg/kg bodyweight per day on average, corresponds to a higher estimated lifetime risk of cancer.
However, in 2019, PubMed Central produced experimental results that stated there was not enough long-term evidence to further determine a direct link between oral cancer and alcohol-based mouthwashes alone. However, it was said to have a clear increase in the risk of oral cancer when alcohol-based mouthwash use was coupled with outside factors like smoking and drinking.
3. The Association Between Alcohol-Based Mouthwashes and Heart Disease
Recent studies have also begun to link the use of alcohol-based mouthwashes with an increased risk for heart disease. The need to understand factors that contribute to hypertension, a major risk factor for heart disease, is what drives further research on the link between alcohol-based mouthwash use and heart disease. A meta-analysis published in the Journal of ClinicalPeriodontology indicates association of mouthwash use and risk of hypertension in adults, concluding that those who used antiseptic or alcohol-based mouthwashes every day showed a higher risk of hypertension.
While the association between the two is still not fully understood, further research is required. However, hypotheses as to the mechanism of this correlation have come out, arguing that alcohol alters the oral microbiome in a way that disrupts the balance of bacteria in the mouth. This imbalance could lead to chronic inflammation, a known risk factor for cardiovascular diseases like hypertension.
4. Alternatives to Alcohol-Based Mouthwashes
In addition to brushing and flossing your teeth twice a day, many people like to enhance their oral hygiene routine with mouthwash, which can help fight bacteria. People can safely use alcohol-free mouthwash to decrease oral bacteria without some of the risks associated with alcohol-based mouthwashes. These mouthwashes often use better alternatives like essential oils, chlorhexidine, or cetylpyridinium chloride that act as antimicrobial agents.
Sugar-free gum and mints that contain xylitol could also be used as alternatives to tooth decay and for adding freshness to your breath.
5. Best Practices for Incorporating Mouthwash into Oral Hygiene Routines
When shopping for mouthwash, it’s important to look at the ingredients and search for cleaner elements. It’s important to couple mouthwash with brushing and flossing daily to ensure that you are maximizing your oral health as mouthwash alone can’t replace the work of brushing and flossing twice a day. If you do use mouthwash, it’s important to follow the recommended usage on the back of mouthwash bottles and, if any concerns or questions arise, to consult your dental provider for recommendations.
6. Conclusion
It’s clear that alcohol-based mouthwashes have risks associated with them– such as dry mouth, oral microbiome disruption, and mucosal irritation. Other potential risks such as its link to oral cancer have also been looked at, although further investigations are needed.
It’s important to take these risks into consideration when choosing a mouthwash to add to your oral hygiene routine and read the ingredients and labels when shopping for mouthwash. If your hesitant about your own potential risk of cancer or hypertension, perhaps stay away from alcohol-based mouthwashes, and consult with oral health professionals for personalized suggestions.
