From the Guidelines
Non-alcohol mouthwash is recommended over alcohol-based mouthwash for most people, as it is gentler and equally effective, reducing the risk of dry mouth, irritation, and burning sensations. According to a study published in the Annals of Oncology 1, expert opinion suggests that patients should rinse their mouth with a bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times a day to prevent stomatitis. This recommendation is based on the idea that alcohol in mouthwash can cause dry mouth, irritation, and burning sensations, especially for those with sensitive mouths or recovering from oral surgery.
Some may argue that alcohol-based mouthwashes are more effective in killing bacteria, but a study published in Periodontology 2000 1 found that natural product-based oral topical rinses and toothpastes, such as Trifala and Ela Decoction, can be equally effective as chlorhexidine mouthwash in preventing periodontal diseases. The most important factor is consistent use—rinsing for 30-60 seconds twice daily after brushing and flossing.
Key points to consider when choosing a mouthwash include:
- The presence of alcohol, which can cause dry mouth and irritation
- The presence of antibacterial agents, such as chlorhexidine, which can be effective in preventing periodontal diseases
- The individual's specific needs, such as sensitivity or dry mouth
- The recommendation of a dentist or healthcare professional, who can advise on the best mouthwash for a specific condition or needs.
In general, non-alcohol mouthwashes are a good option for most people, as they are gentler and equally effective, reducing the risk of dry mouth, irritation, and burning sensations. However, for specific conditions like periodontal disease, prescription mouthwashes containing chlorhexidine may be recommended by a dentist regardless of alcohol content.
From the Research
Comparison of Alcohol-Based and Non-Alcohol Mouthwashes
- The study 2 found that both alcohol-based and alcohol-free mouth rinses were effective and safe at their prescribed dosages, with no statistically significant adverse responses at clinical and cytological levels.
- Another study 3 compared the effectiveness of three different mouthrinses (chlorhexidine with or without alcohol and C31G) in plaque control and early wound healing after periodontal surgery, and found that the alcohol-based chlorhexidine mouthwash was more effective than the alcohol-free chlorhexidine and C31G mouthrinse on plaque control.
- However, the study 3 also found that the healing response was not significantly different among groups at day 7, but at day 14, the group using the alcohol-based chlorhexidine mouthwash demonstrated the lowest bacterial counts levels and significantly better healing compared to the group using the alcohol-free chlorhexidine mouthwash.
Efficacy of Mouthwashes in Reducing Plaque and Gingivitis
- The study 4 found that both chlorhexidine and hydrogen peroxide mouthwashes significantly reduced the gingival index, but the chlorhexidine mouthwash was more effective in reducing the pocket depth and improving the clinical attachment level.
- The study 5 found that a 0.1% chlorhexidine mouthwash slightly reduced the gingival inflammation associated with periodontitis, but had limited beneficial effects in the treatment of periodontitis patients.
- A meta-analysis 6 found that the adjunctive use of chlorhexidine mouthrinse with mechanical scaling and root planing resulted in slightly greater probing depth reduction than did scaling and root planing alone, but the difference was statistically significant only at 40 to 60 days and 180 days of follow-up.
Safety and Cytotoxicity of Mouthwashes
- The study 2 found that both alcohol-based and alcohol-free mouth rinses were safe and did not cause any significant cytotoxicity or genotoxicity at their prescribed dosages.
- The study 3 found that the alcohol-based chlorhexidine mouthwash was more effective than the alcohol-free chlorhexidine and C31G mouthrinse on plaque control, but did not report any significant adverse effects or cytotoxicity.