Is alcohol-based mouthwash more effective than non-alcohol (alcohol-free) mouthwash?

From the Guidelines

Non-alcohol mouthwash is recommended over alcohol-based mouthwash for most people, as it provides comparable benefits without the potential side effects of dry mouth, irritation, and burning sensations. When considering the choice between alcohol-based and non-alcohol mouthwash, it's essential to weigh the pros and cons of each option. Alcohol-based mouthwashes, such as Listerine Original, effectively kill bacteria and provide a strong clean feeling, but may cause dry mouth, irritation, and burning sensations, especially for those with sensitive mouths or recovering from oral surgery 1. On the other hand, non-alcohol alternatives like Listerine Zero, Colgate Total, or Crest Pro-Health are gentler and equally effective for most people, making them better for daily use, dry mouth sufferers, children, and those in alcohol recovery. Some key points to consider when choosing a mouthwash include:

• The potential for alcohol-based mouthwashes to cause dry mouth, irritation, and burning sensations
• The effectiveness of non-alcohol mouthwashes in killing bacteria and providing a clean feeling
• The importance of using mouthwash after brushing and flossing, swishing for 30-60 seconds, and avoiding eating or drinking for 30 minutes afterward for best results
• The recommendation to use a bland, non-alcoholic mouthwash for patients with oral complications, as suggested by expert opinion 1
• The growing interest in natural oral health products, including herbal-based mouthwashes, which may offer additional benefits such as anti-inflammatory and anti-oxidant properties 1 Ultimately, the choice between alcohol-based and non-alcohol mouthwash depends on individual needs and preferences. However, based on the available evidence, non-alcohol mouthwash is the recommended choice for most people, as it provides comparable benefits without the potential side effects.

From the Research

Comparison of Alcohol-Based and Non-Alcohol Mouthwashes

• The effectiveness of alcohol-based and non-alcohol mouthwashes has been compared in several studies 2, 3, 4, 5.
• A study published in 2018 found that an alcohol-based 0.12% chlorhexidine (CHX) mouthwash was more effective than an alcohol-free 0.12% CHX mouthwash and C31G mouthrinse on plaque control in the absence of mechanical oral hygiene 3.
• Another study published in 2017 found that the adjunctive use of CHX mouthrinse with mechanical scaling and root planing (SRP) resulted in slightly greater probing depth reduction than did SRP alone 4.
• However, a study published in 2016 found that both CHX gluconate and hydrogen peroxide mouthwashes significantly reduced the gingival index, but there were no significant differences in the clinical attachment loss, plaque index, and pocket depth among the study groups 2.
• A study published in 2020 found that alcohol consumption was associated with an increased risk of periodontitis, which may be relevant to the use of alcohol-based mouthwashes 6.

Key Findings

• Alcohol-based mouthwashes may be more effective than non-alcohol mouthwashes in reducing plaque and improving wound healing 3.
• CHX mouthwashes, with or without alcohol, can be effective in reducing gingival index and pocket depth 2, 3, 4.
• The use of alcohol-based mouthwashes may be associated with an increased risk of periodontitis due to alcohol consumption 6.

Mouthwash Ingredients

• CHX is a common ingredient in mouthwashes, and its effectiveness has been compared to other ingredients such as hydrogen peroxide and C31G 2, 3, 4.
• Zinc acetate and chlorhexidine diacetate have been found to be effective in reducing halitosis 5.