When should I dilute my mouthwash?

When to Dilute Mouthwash

You should dilute 0.2% chlorhexidine mouthwash by up to 50% to reduce the soreness that can accompany this treatment. 1

Specific Dilution Guidelines by Mouthwash Type

Chlorhexidine Mouthwash

• Standard recommendation: Dilute 0.2% chlorhexidine mouthwash by up to 50% with water to reduce soreness while maintaining effectiveness 1
• Usage after dilution: Use 10 mL twice daily as an antiseptic oral rinse to reduce bacterial colonization of the mucosa
• Duration: Rinse for approximately 30 seconds (though most frequent users typically rinse for only 13-17 seconds) 2
• Do not dilute: Surgical hand scrub and healthcare personnel handwash formulations of chlorhexidine should NOT be diluted 3

Other Mouthwash Types

• Hydrogen peroxide mouthwash (e.g., 1.5% Peroxyl): No dilution required, use 10 mL twice daily 1
• Benzydamine hydrochloride: No dilution required, use every 3 hours, particularly before eating 1
• Mucoprotectant mouthwash (e.g., Gelclair): No dilution required, use three times daily 1
• Topical corticosteroid mouthwash (e.g., betamethasone sodium phosphate): No dilution required, use as a 3-minute rinse-and-spit preparation four times daily 1

Proper Mouthwash Usage Technique

1. Measure the correct amount: Typically 10-15 mL (follow product-specific instructions)
2. Rinse vigorously: Helps maintain moisture in the mouth and removes debris 1
3. Duration: Ideally 30-60 seconds, though research shows most people only rinse for 13-20 seconds 2
4. Gargling: When appropriate, gargle for approximately 4 seconds after rinsing 2
5. Timing: Use antiseptic mouthwashes 30-45 minutes after brushing for optimal effect 1

Common Pitfalls to Avoid

• Insufficient dilution: Not diluting chlorhexidine when experiencing soreness can lead to reduced compliance and effectiveness
• Excessive dilution: Diluting beyond 50% may reduce antimicrobial efficacy
• Improper timing: Using mouthwash immediately after brushing may wash away beneficial ingredients from toothpaste
• Inadequate duration: Most users rinse for much shorter periods than recommended (17 seconds vs. recommended 60 seconds) 2
• Skipping gargling: Over 35% of users don't gargle at all, potentially reducing effectiveness for throat-related conditions 2

Special Considerations

• Alcohol-containing mouthwashes: Generally safe for most people but contraindicated for infants, alcohol addicts, and patients with mucosal injuries 4
• Patients with oral inflammation: Dilution is particularly important for patients with Stevens-Johnson syndrome/toxic epidermal necrolysis or other inflammatory oral conditions 1
• Long-term use: Consider potential risks of dysbiosis of oral microbiota and antimicrobial resistance with prolonged use 5

Remember that mouthwashes should be used as an adjunct to, not a replacement for, proper mechanical oral hygiene measures such as brushing and flossing.