Can mouthwash (mouth rinse) cause oral cancer (carcinoma)?

From the Guidelines

There is no conclusive evidence that regular mouthwash use causes cancer, and the oral health benefits of using mouthwash as part of a complete oral hygiene routine outweigh any theoretical risks. When considering the potential risks, it's essential to note that alcohol-based mouthwashes may pose a slightly higher risk due to the irritant effects of alcohol on oral tissues and its potential to enhance the penetration of carcinogens into oral mucosa, as suggested by studies on alcohol consumption and cancer risk 1. However, the most recent and relevant guideline for oral care, particularly in the context of managing oral mucosal injury, recommends using an alcohol-free mouthwash for rinsing the mouth, which can help minimize potential irritation and risks 1. Key points to consider include:

• The lack of a definitive causal relationship between mouthwash use and cancer, as established by more recent research
• The potential benefits of choosing alcohol-free mouthwash alternatives, which provide similar antibacterial benefits without the irritation from alcohol
• The importance of following the American Dental Association's guidelines for safe mouthwash use
• The significance of major risk factors for oral cancer, such as tobacco use and heavy alcohol consumption, which outweigh any theoretical risks associated with mouthwash use. Given the current evidence, the use of alcohol-free mouthwash is a prudent choice for those concerned about potential risks, and it is essential to weigh these considerations in the context of overall oral health and hygiene practices.

From the Research

Mouthwash and Cancer Risk

• The relationship between mouthwash use and cancer risk has been studied in several research papers 2, 3, 4, 5, 6.
• A systematic review published in 2020 found that the use of alcohol-based mouthwash may be associated with an increased risk of oral cancer, particularly when used at high frequencies 2.
• However, the review also noted that it cannot be guaranteed that mouthwash use is an independent risk factor for head and neck cancer, and that the risk may increase when combined with other carcinogenic risk factors 2.

Periodontal Disease and Oral Cancer

• Research has also explored the link between periodontal disease and oral cancer, with one study finding that periodontitis can be an individual risk factor for oral cancer development 3.
• The study found that patients with periodontal disease had a higher incidence of oral cancer, and that the severity of periodontitis correlated with the appearance of oral squamous cell carcinoma 3.
• Another study published in 2018 discussed the importance of periodontal treatment in cancer patients, highlighting the need for personalized care and preventive maintenance to minimize cancer risks 4.

Oral Hygiene and Implant Outcomes

• A study published in 2021 investigated the correlations between patient-performed implant hygiene and peri-implant success and disease, finding that lack of interproximal cleaning and the presence of plaque/calculus were significantly associated with peri-implant disease 5.
• The study also found that patients reported mixed recall of implant oral hygiene instructions, and that local prosthetic factors affecting cleaning accessibility significantly reduced implant success 5.

Dental Implant Survival in Irradiated Oral Cancer Patients

• A systematic review published in 2013 evaluated the effect of radiation therapy on osseointegrated dental implant survival in oral cancer patients, finding that overall implant survival rates were comparable for pre- and postimplantation radiation therapy 6.
• The review noted that the anatomical site of implant placement was a significant variable affecting implant survival, with better survival rates in the mandible compared to the maxilla and grafted bone 6.