Experts explain risks of frequent mouthwash use
In Singapore, Channel NewsAsia, citing dental experts, reports that occasional use of over-the-counter mouthwash, such as once a week or once a month, is unlikely to harm oral health or overall health. At the same time, using certain products several times a day for months or years may have negative consequences.
Possible impact on the microbiome
Mouthwashes are divided into therapeutic and cosmetic types. Therapeutic products contain active components that kill bacteria and may help with bad breath, gum disease or tooth decay. Cosmetic mouthwashes mainly mask odour temporarily and do not contain bactericidal active substances.
Limited research suggests that some products, including therapeutic mouthwashes containing the antiseptic chlorhexidine, may alter the oral microbiome and some of its normal functions. In a small 2020 study, 36 healthy adults in the United Kingdom rinsed their mouths twice daily for seven days with a placebo, followed by a chlorhexidine product. Chlorhexidine use was associated with significant changes in the salivary microbiome, greater acidity in the mouth and fewer bacteria associated with healthy blood pressure.
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It remains unclear whether other antiseptic ingredients, including cetylpyridinium chloride, essential oils, iodine or hydrogen peroxide, affect the microbiome in the same way. Periodontist Richard Nejat noted that logic and limited data suggest a possible effect with long-term use, so such products should be avoided unless there is a need to treat a specific dental problem.
How to choose a product
Some studies have also found an association between regular mouthwash use, such as twice daily for years, and an increased risk of type 2 diabetes and high blood pressure. However, Vivek Thumbigere-Math, an associate professor of periodontology at the University of Maryland, stressed that these studies have significant limitations and do not prove a causal relationship.
Alcohol-containing products or peroxide-based mouthwashes may irritate the gums, tongue, inner cheeks and other soft tissues. For people with dry mouth, ulcers, or sensitive gums or teeth, experts advise choosing alcohol-free products. For those at high risk of tooth decay, a fluoride mouthwash may be useful, as it mainly strengthens enamel rather than kills bacteria. At the same time, mouthwash does not replace toothbrushing, flossing and regular professional hygiene.
