From the Guidelines
Alcohol in mouthwash is the primary ingredient that could expose patients to an increased risk of mouth cancer. Many commercial mouthwashes contain ethanol (alcohol) in concentrations ranging from 5% to 27%, which acts as a solvent for other ingredients and provides a burning sensation that users associate with effectiveness. However, regular use of alcohol-containing mouthwash may damage the oral mucosa, making it more permeable to other carcinogens. Additionally, alcohol can be converted to acetaldehyde in the mouth, a known carcinogen that can damage DNA and proteins. According to the American Cancer Society head and neck cancer survivorship care guideline 1, it is recommended that primary care clinicians counsel head and neck cancer survivors to avoid tobacco, alcohol (including mouthwash containing alcohol), and other irritants.
Some key points to consider:
- Alcohol intake has both positive and negative health effects, and its consumption should be tailored to the individual cancer survivor 1.
- Many studies have found a link between alcohol intake and risk for some primary cancers, including cancers of the mouth, pharynx, larynx, esophagus, liver, breast, and probably colon cancer 1.
- For those concerned about this risk, alcohol-free mouthwash alternatives are widely available and equally effective for oral hygiene, containing antimicrobial agents like cetylpyridinium chloride or essential oils that can reduce plaque and gingivitis without the potential cancer risk.
- The relationship between alcohol-containing mouthwash and oral cancer appears strongest in people who already have other risk factors such as smoking or alcohol consumption, so these individuals should be particularly cautious about their mouthwash choices.
It is essential to prioritize the patient's health and well-being, considering their individual risk factors and medical history when making recommendations about mouthwash use. The most recent and highest quality study 1 supports the recommendation to avoid alcohol-containing mouthwashes, especially for head and neck cancer survivors.
From the Research
Components of Mouthwash and Oral Cancer Risk
- Alcohol is a common ingredient in many mouthwashes, and its potential link to oral cancer has been a topic of debate in the scientific community 2, 3, 4, 5, 6.
- Some studies suggest that the use of alcohol-based mouthwashes may increase the risk of developing oral cancer, although the evidence is not conclusive 3, 6.
- Other studies have found no statistically significant association between the use of mouthwashes and the risk of oral cancer, including those containing alcohol 2, 4, 5.
Alcohol Content in Mouthwash
- The alcohol content in mouthwashes can range from 5% to 26.9% 6.
- Some studies have investigated the relationship between the alcohol content in mouthwashes and the risk of oral cancer, but the results are inconsistent 3, 4, 5, 6.
- The use of mouthwashes with high alcohol content may increase the risk of oral cancer, particularly when used in combination with other carcinogenic risk factors 6.
Epidemiological Evidence
- Several epidemiological studies have investigated the relationship between mouthwash use and oral cancer risk, with conflicting results 3, 4, 5, 6.
- A meta-analysis of 18 studies found no statistically significant association between regular use of mouthwash and risk of oral cancer 4.
- Another systematic review and meta-analysis of 14 studies found no sufficient evidence to accept the proposition that the use of mouthwashes containing alcohol can influence the development of oral cancer 5.