When it comes to mouthwash, it's easy to go down the wrong path.
"There (are) so many different types of mouthwashes on the market today, which makes it very difficult to choose which one is right for you," Dr. Sheila Yaghmai, clinical assistant professor at the UCLA School of Dentistry, tells TODAY.com.
That's why she recommends patients chat with their dentist or dental hygienist about whether they could benefit from using mouthwash first. Once the professionals give the go-ahead, then patients can discuss which type they should purchase.
It's not just about which tools patients should use, though, Dr. Ruchi Sahota, a dentist based in Fremont, California and spokesperson for the American Dental Association (ADA), tells TODAY.com. For her patients who are concerned about issues like bad breath or teeth stains, the challenge is making sure they're using those tools correctly, she says.
"Sometimes the key to treating those concerns is just using what you're already using in a better way," she explains. That's another reason to check in with your dentist before going out to buy something new.
When the time comes to pick up a bottle of mouthwash, here's what experts want you to know about choosing the right one.
Therapeutic mouthwashes
When choosing the best mouthwash for you, first think think about the specific issues you're trying to address.
If you're trying to tackle an oral health issue (you want to prevent cavities or reduce gingivitis symptoms, for instance),you should opt for what's called a therapeutic mouthwash, Sahota explains. These contain active ingredients designed to manage those specific issues.
You should also look for the ADA Seal of Acceptance on the bottle, she adds, which indicates that the product's health claims have been independently assessed by the ADA. "That seals says that the product has been very thoroughly tested," Sahota says, and "it's not easy to get." (See a list of ADA-accepted mouthwashes here.)
Also note that, while some therapeutic mouthwashes are available over-the-counter, there are others that you can only get through your dentist.
To prevent cavities...
"If you're looking for anti-cavity, you would look for fluoride," Yaghmai says.
The active ingredient in the product should be sodium fluoride, which works by remineralizing enamel that has been weakened, she explains. "It attaches itself to the areas of enamel that have eroded and fills those gaps," Yaghmai continues, which prevents new cavities from forming.
Fluoride is a naturally-occurring mineral and "it's remarkably common," Sahota says. However, it's important not to swallow fluoride-containing mouthwash, she says, so children who aren't able to spit yet should not use it.
To reduce plaque and gingivitis...
If your gums are swollen and red and sometimes bleed when you brush or floss, you may have gingivitis, which is an early stage of gum disease. Left untreated, it can progress to periodontitis, the more severe form of gum disease.
Gingivitis develops when bacteria are left on the teeth to form plaque and tarter at the gum line, which further irritates the gums, the Mayo Clinic explains. Proper flossing and brushing technique can greatly help prevent these issues, but an antiseptic mouthwash that kills bacteria can also be helpful.
You might see active ingredients like cetylpyridinium chloride or certain essential oils in over-the-counter products, Yaghmai explains. Your dentist may also prescribe an antiseptic mouthwash containing chlorhexidine for this purpose, the experts say, which you should use according to the dentist's specific instructions to avoid side effects.
However, if you have gum issues, you can still benefit from using a fluoride-containing mouthwash, Sahota says. "Oftentimes, if you do have gingivitis or plaque issues, eventually you'll have a cavity issue," she explains.
To manage bad breath...
Bad breath can have many causes, including some serious illnesses. If your bad breath is due to poor oral hygiene or an overgrowth of bacteria in the mouth, then a mouthwash may help.
"There (are) specific mouthwashes that are good for that reason," Yaghmai says. "An anti-cavity mouthwash is not going to take care of bad breath."
Some mouthwashes may temporarily mask the smell and give your mouth a fresher feeling, but they won't provide long-term results, the ADA says. For that, you'll likely need an antimicrobial mouthwash containing essential oils, chlorine dioxide, cetylpyridinium chloride or chlorhexidine.
To whiten teeth...
Some ADA-accepted mouthwashes can whiten teeth, the experts say. These typically contain hydrogen peroxide as their active ingredients and can whiten certain types of staining on teeth. Or dentists may give their patients products containing another whitening ingredient, carbamide peroxide, the ADA explains.
Cosmetic mouthwashes
The other major category, cosmetic mouthwashes, can provide some short-lived freshening effects. But these won't address oral health issues because they simply mask odor rather than use active ingredients that tackle tooth decay, gingivitis and bacteria.
"The cosmetic ones (provide) a temporary control on things like bad breath," Sahota says. "They give you a nicer taste, but they don't necessarily reduce your risk of cavities or the early stages of gum disease."
"If a product doesn’t kill bacteria associated with bad breath, then its benefit is considered to be solely cosmetic," according to the ADA.
Alcohol vs. non-alcohol mouthwashes
Many mouthwashes contain alcohol and that's not necessarily a problem. In some products, the alcohol acts as an inactive ingredient to help the essential oils work more effectively, Yaghmai explains.
But some people may still want to avoid alcohol in their mouthwash, the experts say.
Children, for instance, should not use an alcohol-containing mouthwash. "The alcohol content can be unsafe if they are accidentally swallowing large amounts," Sahota explains. Additionally, people with substance use issues may want to avoid having mouthwash with alcohol around the home due to the potential for misuse.
And there are emerging concerns around the way alcohol in mouthwash may change the delicately balanced oral microbiome, Yaghmai says, as well as how it may increase the risk for oral cancers. The are no conclusive links yet, she says, but researchers are investigating these possibilities. For those reasons, “I would probably go alcohol-free,” Yaghmai adds.
Alcohol in mouthwash can also dry the mouth out, which affects the balance of bacteria in the mouth and contributes to bad breath, TODAY.com explained previously.
Finally, if your mouthwash burns when you use it and you find the feeling unpleasant, try an alcohol-free one instead. "Usually the ones that cause a burning sensation have alcohol in them," Sahota says.
How to use mouthwash properly
If you're going to use a mouthwash, there are some key tips to keep in mind, the experts say.
First, remember that mouthwash should be an add-on to your usual brushing and flossing routine. It is not a replacement for those essential steps. "We've got to use it as (part of) a trifecta," Sahota says, including brushing with fluoridated toothpaste twice a day and cleaning between our teeth with floss or a water flosser at least once a day.
Sahota prefers to floss, brush, then rinse with mouthwash, but says there's really no evidence that one order is more effective than any other —as long as you're consistent. "Just do what makes you want to do it," she says.
If you have the time to spare and you're using a non-fluoride mouthwash, Yaghmai says, you could wait 20 minutes after brushing to use your mouthwash so that you're not rinsing away the fluoride in your toothpaste.
Second, follow the instructions on the bottle. Different products may require you to use them for different periods of time and at different frequencies throughout the day. For example, one may call for you to use it once a day for a minute while another requires twice a day for 30 seconds. This is especially important for prescription mouthwashes, which can cause staining if not used correctly, Yaghmai says.
Finally, remember that you're not alone in this.
"Have this discussion with your dentist," Sahota says. "It's so important to make sure that we're using the tools that are effective in our mouth and that we're using the correct technique."
