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                                                        DR. DAN PETERSON

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Mouth rinses serve a variety of purposes.

     Whether it's to mask bad breath, fight cavities or prevent the buildup of plaque, the sticky material that contains germs and can lead to oral diseases, mouth rinses serve a variety of purposes. Or so we think.

     Though they may leave your mouth with a clean, fresh taste, some rinses can be harmful, concealing bad breath and unpleasant taste that are signs of periodontal diseases which cause inflammation and degeneration of the supporting structures of the teeth and tooth decay. Your dentist will tell you, most mouth rinses just don't wash.

Alcohol or mint based mouthwashes only temporarily mask ordor and sugars, gum and mints actually feed the bacteria that cause bad breath.

What are the differences in rinses?
Rinses are generally classified by the U.S. Food and Drug Administration (FDA) as either :
bulleta combination of the two. 

     Cosmetic rinses are commercial over-the-counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth and refresh the mouth with a pleasant taste. 

Consumer Reports tested 15 OTC mouthrinses, all worked for at least 10 minutes
 but none worked at the end of two hours.

     Therapeutic rinses have the benefits of their cosmetic counterparts, but also contain an added active ingredient that helps protect against some oral diseases. Therapeutic rinses are regulated by the FDA and are voluntarily approved by the American Dental Association (ADA). 

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     Therapeutic rinses also can be categorized into types according to use: 

  1. antiplaque/antigingivitis rinses 
  2. anticavity fluoride rinses.

Should I use a rinse?
    That depends upon your needs. Most rinses are, at the very least, effective oral antiseptics that freshen the mouth and curb bad breath for up to three hours. Their success in preventing tooth decay, gingivitis (inflammation of the gingival gum tissue) and periodontal disease is limited, however.

     Rinses are not considered substitutes for regular dental examinations and
 proper home care. 

    Dentists stress a regimen of brushing with a fluoride toothpaste followed by flossing, along with routine trips to the dentist, should be sufficient in fighting tooth decay and periodontal disease.

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Which type should I use?
     Again, that depends upon your needs. 

     While further testing is needed, initial studies have shown that most over-the-counter antiplaque rinses and antiseptics aren't much more effective against plaque and periodontal disease than rinsing with plain water. Most dentists are skeptical about the value of these antiplaque products, and studies point to only a 20 to 25 percent effectiveness, at best, in reducing the plaque that causes gingivitis.

     Anticavity rinses with fluoride, however, have been clinically proven to fight up to 50 percent more of the bacteria that cause cavities. 

     Nevertheless, many dentists consider the use of fluoride toothpaste alone to be more than adequate protection against cavities.  We recommend Act mouth rinse.

     Dentists will prescribe certain rinses for patients with more severe oral problems such as caries, periodontal disease, gum inflammation and xerostomia (dry mouth). 

     Patients who've recently undergone periodontal surgery are often prescribed these types of rinses. Likewise, many therapeutic rinses are strongly recommended for those who can't brush due to physical impairments or medical reasons.


Pros of using mouthwashes:

Pros are:

bullet improved health of gums
bullet germ killing effects
bullet fresh taste
bullet cavity prevention,

Cons  of using mouthwashes:

bullet altered taste
bullet tooth staining
bullet drying of oral tissues in the mouth
bullet burning sensation
bullet ulcers
What are the proper steps when using mouth rinses?
bullet Before using a mouth rinse, brush and floss teeth.
bullet Measure the proper amount of rinse recommended on the container or by a dentist.
bullet Close lips and, keeping teeth slightly apart, swish liquid around the mouth.
bullet Thirty seconds is the suggested rinsing time.
bullet Finally, spit liquid from mouth thoroughly.
bullet Do not rinse, eat, or smoke for thirty minutes after using a mouthwash. Doing so will diminish the effects of the mouthwash


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When and how often should I rinse?
     If it's an anticavity rinse, dentists suggest the following steps, practiced after every meal:
bullet brush
bullet floss
bullet then rinse.

      Teeth should be as clean as possible before applying an anticavity rinse to reap the full preventive benefits of the liquid fluoride. 

    The same steps can be followed for antiplaque rinses.  If ever in doubt, consult your dentist or follow the instructions on the bottle or container. Be sure to heed all precautions listed.

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What is the proper way to rinse?

  1. First, take the proper amount of liquid as specified on the container or as instructed by your dentist into your mouth. 
  2. Next, with the lips closed and the teeth kept slightly apart, swish the liquid around with as much force as possible using the tongue, lips, and sucking action of the cheeks. 
  3. Be sure to swish the front and sides of the mouth equally. Many rinses suggest swishing for 30 seconds (one minute for the fluoride rinses)
  4. Finally, rinse the liquid from your mouth thoroughly.
  5. Choose one that is based on your individual needs. For example, if they have a dry mouth, but want a nice taste, they should look for a non-alcohol mouthwash so their tissues stay moist. “If you often have cavities, you should use a fluoride rinse.
  6. It is best to consult your dentist about the best mouth rinse to meet the needs of your mouth.

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Are there any side effects to rinsing?
   Yes, and they vary depending on the type of rinse. Habitual use of antiseptic mouthwashes containing high levels of alcohol, which is most of your over the counters products (ranging from 18 to 26 percent) may produce:
bulleta burning sensation in the cheeks, teeth and gums. 
bulletit can cause intoxication if swallowed, used excessively, or used by children. 

For a child weighing only 26 pounds, 5 to 10 ounces of many OTC rinses 
containing alcohol can be potentially lethal.

     Many prescribed rinses with more concentrated formulas can lead to: 
bulletsodium retention
bulletroot sensitivity
bulletchanges in taste sensation 
bulletpainful mucosal erosions. 

    Most anticavity rinses contain sodium fluoride, which if taken excessively or swallowed, can lead over time to fluoride toxicity. Because children tend to accidentally swallow mouthwash, they should only use rinses under adult supervision. 

If you experience any irritating or adverse reactions to a mouth rinse, discontinue its use immediately and consult your dentist.

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Can I make a home-made rinse?
Yes. You can prepare at home three widely used alternatives to brand name cosmetic rinses:

  1. saline solution rinse
    1/2 tsp. salt + 8 oz water
  2. for a stronger solution
    1/2 tsp. salt + 4 oz water.
  3. sodium bicarbonate
    1/2 tsp. baking soda + 8 oz. water.

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What are the ingredients in rinses that make them work?
     Most over-the-counter rinses contain five standard components:

bulletan active bacteria- fighting ingredient such as quaternary ammonium compounds, boric and benzoic acid
bulletphenolic compounds;
bulleta flavoring agent such as saccharin or glycerin
bulletastringents like zinc chloride to provide a pleasant-tasting sensation and shrink tissues
bulletethyl alcohol, ranging from 18 to 26 percent; and water. Journal of the American Dental Association" indicated that mouthwashes "containing more than 25% alcohol could increase the risk of oral and pharyngeal cancers by about 50%.  Also the more alcohol content of the mouthrinse, the more sloughing.  The more sloughing, the more food for bacteria, leading to higher levels of bacteria which  increases sulfur levels  of bad breath.  Listerene has  triple the alcohol content of American beer, which is a 50% increase over table wine and about the same as fortified wines. Avoid alcohol based mouthrinses,  the alcohol actually makes periodontal disease WORSE.

     Rinses can also contain buffers to reduce acidity, dissolve mucous films and alleviate soft tissue pain. Anticavity rinses usually contain 0.05 percent sodium fluoride, or 0.1 percent stannous fluoride, as approved by the FDA.

Active ingredients in antiplaque rinses vary. Certain rinses contain Chlorhexidine (the most effective plaque-fighting drug yet tested, available only by prescription). Heavy metal salts or herbal extracts like sanguinaria, derived from the bloodroot plant.

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Breath RX offers you a safe and effective answer to bad breath control


DA Affirms Benefits of ADA-Accepted Antimicrobial Mouth Rinses and Toothpastes, Fluoride Mouth Rinses

Recently, the ADA’s Council on Scientific Affairs highlighted the oral health benefits of other ADA-Accepted products such as antimicrobial mouth rinses and toothpastes that can help prevent and reduce plaque and gingivitis, and fluoride mouth rinses that can provide extra protection against tooth decay over that provided by fluoride toothpaste alone. Gingivitis is an inflammation of the gums caused by the accumulation of plaque along the gum line.

It is important to note that the ADA’s daily oral hygiene recommendations have not changed—people should still brush twice a day with an ADA-Accepted fluoride toothpaste; clean between their teeth daily with an ADA-Accepted floss or ADA-Accepted interdental cleaner; eat a balanced diet and limit between meal snacks; and visit their dentist regularly for professional cleanings and oral examinations.

Antimicrobial mouth rinses and toothpastes

Antimicrobial mouth rinses and toothpastes reduce the bacterial count and inhibit the bacterial activity in dental plaque that can cause gingivitis, an early, reversible form of periodontal (gum) disease. ADA-Accepted antimicrobial mouth rinses and toothpastes have substantiated these claims by demonstrating significant reductions in plaque and gingivitis.

Fluoride mouth rinses

Fluoride mouth rinses are used to help reduce and prevent tooth decay. Clinical studies have demonstrated that use of a fluoride mouth rinse in addition to fluoride toothpaste can provide extra protection against tooth decay over that provided by fluoride toothpaste alone. The use of fluoride mouth rinse is not recommended for children six years of age and younger because they may swallow the rinse. Consumers should always check the manufacturer’s label for precautions and age recommendations and talk with their dentist about the use of fluoride mouth rinse.   6/07

Judge: Listerine No Replacement For Floss, Despite Claim By Ads

NEW YORK -- An advertising campaign that says the mouthwash Listerine is as effective as floss at fighting tooth and gum decay is false and misleading and poses a public health risk because it can undermine the message of dental professionals, a judge has ruled.

U.S. District Judge Denny Chin said in a decision signed Thursday and made public Friday that he will order Pfizer, the maker of Listerine, to stop the advertising campaign.

"Dentists and hygienists have been telling their patients for decades to floss daily," Chin wrote. "They have been doing so for good reason. The benefits of flossing are real -- they are not a `myth.' Pfizer's implicit message that Listerine can replace floss is false and misleading."

The judge ruled after McNeil-PPC Inc., a subsidiary of Johnson & Johnson, filed a lawsuit saying that false claims in the advertising campaign that began last June posed an unfair threat against its sales of dental floss.

Pfizer in print ads had featured a Listerine bottle balanced equally on a scale opposite a floss container with the words: "Listerine antiseptic is clinically proven to be as effective as floss at reducing plaque and
gingivitis between the teeth."

The campaign also featured a television commercial titled the "Big Bang." In it, the commercial announces that Listerine is as effective as floss and that clinical tests prove it, though it does add that there is no
replacement for flossing.

The judge said "substantial evidence" demonstrates that flossing is important in reducing tooth decay and gum disease and that it cannot be replaced by rinsing with a mouthwash.

The judge also noted that the authors of articles on which Pfizer based its advertising campaign had emphasized that dental professionals should continue to recommend daily flossing and cautioned that they were not suggesting that mouthrinse be used instead of floss.
Listerine is NOT as affect as flossing and the ads stating this must be removed from T.V.!



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Commonly-used Rinses
bulletAntiplaque/antigingivitis Rinses
bulletTherapeutic Antiseptics
bulletPhenol products: Listerine1 (Dr Peterson does not recommend this product due to its alcohol content and it can stain teeth)., Chloraseptic, BreathRX
bulletChlorhexidine products2.: Peridex1.2., PerioGuard1.2., Corsodyl1.2.
bulletSanguinaria products: Viadent (we do NOT recommend this product)
bulletCosmetic antiplaque rinses: Plax (Dr. Peterson does not recommend, it is not approved by ADA) , Close-up Anti-Plaque, Oral-B Antibacterial
bulletTherapeutic Anticavity Fluoride Rinses Act1., Fluorigard1., Act ., Oral-B Anticavity Rinse1.
bulletCosmetic Breath Freshening Mouth Rinses Cepacol, Lavoris, Scope, Signal, Clear Choice, Rembrandt Mouth Refreshing Rinse
bulletTopical antibiotic rinses2.3.
bulletEnzyme rinses2.3.
bulletArtificial saliva rinses1.2.
bulletRinses that control tartar (The hard, crusted calcium deposits that form on teeth)3.
1. approved by the American Dental Association
2. available by prescription only
3. still undergoing tests

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^^ JADA, Vol 127, Sept 96, pg 1282.

February 06, 2008

Mouthwashes As Adjuncts To Oral Hygiene 

 There is a range of mouthwashes available to the consumer. Some of these are purely cosmetic, while others have been clinically proven to improve oral hygiene and reduce plaque, a major cause of periodontal diseases. The efficacy of  cetylpyridinium chloride as a mouthwash prior to toothbrushing does little to reduce plaque levels or improve oral health. Solely using mouthrinses as the only method of oral hygiene will be detrimental to their periodontal health.1  Chlorhexidine preparations have the slight advantage over essential oils with respect to plaque reduction. Unlike essential oil mouthwashes chlorhexidine preparations can stain teeth, are generally indicated for shorter-term use and can alter taste perceptions for up to several hours post rinsing. The percentage reduction from control of EO mouthwash and chlorhexidine groups after twice daily rinsing for six weeks 2: Overall plaque index at six weeks  Chlorhexidine 0.1 percent was 54 percent and Chlorhexidine 0.2% was 77 percent. Both agents have a range of uses in the management of oral conditions where plaque levels could be problematic.  Mouthwash can be used after mechanical methods  to further reduce plaque levels because mechanical plaque removal alone may not achieve these low scores on a regular basis.  

Another significant use of mouthwashes is to reduce malodour. Oral malodour is multifactorial in its origins but a main cause is metabolic products from bacteria residing in bacterial plaque, on the tongue or present in saliva. Studies have shown that both essential oil mouthwash (EOM) and those containing chlorhexidine are beneficial in the management of oral malodour and reduce levels of odourgenic bacteria. Chlorhexidine and EOM have been used successfully to ensure maintenance of gingival health around dental implants and reduce bacteria. 

 References 1 Seymour RA, Heasman PA. Pharmacological control of periodontal disease. II. Antimicrobial agents. J Dent. 1995 Feb;23(1):5-14. 2 Axelsson P & Lindhe J. Efficacy of mouthrinses in inhibiting dental plaque and gingivitis in man. J. Clin Periodontol 1987; 14: 205-212. 3 Ramfjord SP: Maintenance care for treated periodontitis patients. J. Clin Periodontol 1987; 14: 433-437.

~We have NO financial interest in any of these companies.

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