In spitting distance of better oral health


  Posted by: Dental Design      12th December 2023

With Canadian researchers recently identifying a link between high white blood cells in the saliva of healthy young adults and an early cardiovascular disease warning sign,[i] the humble mouthwash may prove to be not so humble after all.

The Mount Royal University studyi used a simple oral rinse to see if levels of white blood cells – an indicator of gum inflammation – in the saliva of healthy adults could be linked to warning signs of heart disease. They found that high levels correlated with compromised flow-mediation dilation, an early indicator of poor arterial health.

Periodontitis is a common infection of the gingiva which has previously been linked to the development of cardiovascular disease:[ii] scientists suspect that inflammatory factors may enter the bloodstream through the gums and damage the vascular system.

In fact, while brushing and interdental cleaning are the foundations of maintaining good oral health, incorporating a mouthwash into the daily routine could provide additional benefits.

One of the primary advantages of using mouthwash is its ability to kill bacteria in the mouth. Bacteria thrive in the mouth and can cause various oral health problems such as tooth decay, gingivitis and halitosis. And not all mouthwashes are the same.[iii] Many contain antimicrobial ingredients like chlorhexidine (CHX) or cetylpyridinium chloride (CPC) that work to kill microorganisms, reducing the risk of oral infections. By rinsing with mouthwash regularly, patients can contribute to maintaining a healthier balance of oral flora.

CHX is a broad-spectrum antiseptic agent effective against gram-positive and gram-negative bacteria, yeasts and viruses. It is bacteriostatic at very low concentrations (0.02-0.06%) and bactericidal at higher concentrations (0.12-0.20%). In addition to its immediate bactericidal effect, CHX also binds to the oral mucosa resulting in a slow and prolonged antibacterial effect.[iv]

CPC is both a bactericidal and bacteriostatic and rapidly kills gram-positive bacteria and yeast, in particular. While less effective than CHX in reducing plaque and gingival inflammation, it provides an additive effect when combined with CHX, increasing the CHX antimicrobial activity.iv

In recent years, there has been a rise in the use of herbs and plant extracts in both toothpastes and mouthwashes. Some used for their natural phytochemicals include aloe, turmeric, eucalyptus, liquorice and tea tree oil.iv

Mouthwash can be a significant aid in maintaining healthy gingiva. Gingivitis is a common oral health problem characterised by inflammation and infection of the gums. Mouthwash containing antibacterial agents helps kill the bacteria that cause gum disease and reduces inflammation.[v] Indeed, after four to six weeks of use (along with regular brushing) a chlorhexidine mouthrinse can reduce both gingivitis and the build-up of plaque.ivAdditionally, mouthwash can reach areas that brushing and interdental cleaning alone cannot, helping to remove plaque and prevent the build-up of tartar. By using mouthwash regularly, patients can lower their risk of gum disease and promote healthier gums.

Another significant benefit of using mouthwash is its effectiveness in combating halitosis. Bad breath is commonly caused by the breakdown of food particles in the mouth, poor oral hygiene, or the presence of bacteria. Mouthwash helps eliminate these causes by freshening breath with its flavour, often mint, and by temporarily killing the bacteria responsible for producing odours. There are different types of halitosis: intraoral, extraoral[vi] and transient halitosis.[vii] Several factors have been shown to affect bad breath (other than poor oral hygiene) including necrotic pulpal exposure, deep carious lesions, specific food items, oral infections, periodontal disease, faulty restorations, reduced salivary flow and smoking.[viii]

Mouthwash can be especially beneficial for those who have undergone dental procedures or suffer from certain conditions such as dry mouth. After dental procedures, using mouthwash can aid in the healing process by reducing the risk of infection.[ix] For individuals with dry mouth, mouthwash can help alleviate discomfort by moisturising the oral tissues and stimulating saliva production.[x] As you know, saliva is essential for maintaining oral health as it helps wash away food particles, neutralises acids, and prevents the growth of bacteria.

Patients may need reminding that the best time to rinse isn’t straight after brushing. Although this can feel like the best time to use mouthwash, it will actually wash away any residual fluoride left on the teeth from brushing. Dental professionals can advise that patients consider using a mouthwash at midday or after lunch.[xi]

Perio Plus+ from Curaprox offers a range of mouthwashes that addresses different oral care needs. Perio Plus +Forte is perfect for short-term use before and after invasive dental procedures while Perio Plus+ Regenerate supports tissue regeneration after dental surgery and treatment-related dry mouth. Both contain the line’s bespoke Citrox® antibacterial active which is made from the natural extract of bitter oranges combined with polylysine amino acids. 

The regular use of mouthwash offers numerous benefits for oral health. While it should not replace brushing and interdental cleaning, incorporating a mouthwash into a patient’s daily oral hygiene routines can significantly improve the overall health of their mouth.

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[i] Hong Ker-Yung, Ghafari Avin, Mei Yixue, Williams Jennifer S., Attia Dina, Forsyth Jourdyn, Wang Kevin, Wyeld Trevor, Sun Chunxiang, Glogauer Michael, King Trevor J. Oral inflammatory load predicts vascular function in a young adult population: a pilot study. Frontiers in Oral Health 4 2023. DOI=10.3389/froh.2023.1233881   


[ii] British Heart Foundation [Accessed August 2023]

[iii] Radzki D, Wilhelm-Węglarz M, Pruska K, Kusiak A, Ordyniec-Kwaśnica I. A Fresh Look at Mouthwashes-What Is Inside and What Is It For? Int J Environ Res Public Health. 2022 Mar 25;19(7):3926. doi: 10.3390/ijerph19073926. PMID: 35409608; PMCID: PMC8997378. [Accessed August 2023]

[iv] Rajendiran M, Trivedi HM, Chen D, Gajendrareddy P, Chen L. Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases. Molecules. 2021 Apr 1;26(7):2001. doi: 10.3390/molecules26072001. PMID: 33916013; PMCID: PMC8037529.

[v] James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017 Mar 31;3(3):CD008676. doi: 10.1002/14651858.CD008676.pub2. PMID: 28362061; PMCID: PMC6464488.

[vi] Tangerman A, Winkel EG. Extra-oral halitosis: an overview. J Breath Res. 2010 Mar;4(1):017003. doi: 10.1088/1752-7155/4/1/017003. Epub 2010 Mar 2. PMID: 21386205.

[vii] Carda-Diéguez, M., Rosier, B., Lloret, S. et al. The tongue biofilm metatranscriptome identifies metabolic pathways associated with the presence or absence of halitosis. npj Biofilms Microbiomes 8, 100 (2022).

[viii] Tungare S, Zafar N, Paranjpe AG. Halitosis. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

[ix] Coello-Gómez A, Navarro-Suárez S, Diosdado-Cano JM, Azcárate-Velazquez F, Bargiela-Pérez P, Serrera-Figallo MA, Torres-Lagares D, Gutiérrez-Pérez JL. Postoperative effects on lower third molars of using mouthwashes with super-oxidized solution versus 0.2% chlorhexidine gel: A randomized double-blind trial. Med Oral Patol Oral Cir Bucal. 2018 Nov 1;23(6):e716-e722. doi: 10.4317/medoral.22622. PMID: 30341268; PMCID: PMC6260999.

[x] Niklander SE, Martínez M, Miranda A, Rodriguez M. Treatment alternatives for dry mouth: A scoping review. J Clin Exp Dent. 2022 Oct 1;14(10):e846-e853. doi: 10.4317/jced.59912. PMID: 36320676; PMCID: PMC9617261.

[xi] NHS

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