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Mouthwash is still often underestimated these days. Many think it just freshens the breath. However, mouthwash can provide solid protection against tooth decay, plaque and gum disease. Thanks to its antibacterial properties, mouthwash can be a useful addition to daily dental care.
In our mouthwash test 2021 we have summarised all the essential information about mouthwash. You will learn about important criteria for evaluating mouthwash and the different types. We also answer any potential questions you might have before buying a mouthwash.
- 1 Weekly newsletter with the best personal finance tips
- 2 The most important facts
- 3 The Best Mouthwash: Our Picks
- 4 Buying and evaluation criteria for mouthwash
- 5 Guide: Frequently asked questions about mouthwash answered in detail
The most important facts
- Mouthwash can have antiseptic effects, effectively preventing tooth decay, plaque and gum disease, as well as providing protection against bad breath.
- You can buy mouthwash as a ready-to-use solution, concentrate or even in tablet form. There are several criteria you should look for when deciding what to buy, such as the ingredients.
- Mouthwashes can be a helpful addition to your daily dental and oral care routine. However, thorough brushing and regular visits to the dentist should not be neglected.
The Best Mouthwash: Our Picks
Buying and evaluation criteria for mouthwash
There are many different types of mouthwash on the market. You should always compare the offers before you decide on one. You can find out which product is best for you by looking at the following aspects:
In the following sections, we explain what you should look for in the individual purchase criteria.
Generally, you will find the same ingredients in most mouthwashes. However, these can vary depending on the manufacturer, the type and also the specific area of application. The proportion of the different substances can also vary, of course.
The most common ingredients are purified water, sorbitol, propylene glycol, xylitol, sodium, benzoic acid, eucalyptol, methyl salicylate, thymol and menthol. You probably won't be able to do much with these.
The biggest difference in ingredients is a mouthwash with or without alcohol, chlorhexidine and fluoride. There are fewer and fewer mouthwashes with alcohol, as it is often perceived as too aggressive. Chlorhexidine and fluoride have both positive and negative effects, which you can read more about in the guide below.
In addition to the ingredients mentioned above, most mouthwashes also contain various fragrances to make the smell as pleasant as possible for the consumer.
Typical fragrances in mouthwashes are peppermint, sage, chamomile and tea tree oil. In the case of mouthwashes containing alcohol, some product reviews have stated that the solution also smells unpleasantly strongly of alcohol.
But even mouthwash without alcohol can have an unpleasant odour, because just because the manufacturer claims a certain scent doesn't mean it's true. It's best to read customer reviews before buying a mouthwash.
The taste of mouthwash is primarily related to the smell of the solution, of course. However, you should also read the product reviews here, as a good smell does not necessarily mean a pleasant taste.
In terms of taste, mouthwashes naturally come in the same flavours as the smell, such as mint or sage. Some mouthwashes also come in ginger, lime and berry flavours. The latter is mainly used in mouthwashes for children.
You can choose a mouthwash according to your preferences for both smell and taste.
The packaging of the mouthwash is not directly related to the product, but it can be a decisive factor in the purchase decision.
Generally, mouthwashes are filled in either glass or plastic packaging. Glass packaging is of course the more environmentally friendly alternative. Plastic packaging, on the other hand, is lighter and less likely to break if you accidentally drop the mouthwash.
Not only the material but also the closure of the packaging plays a role. The closure should be robust and airtight, but still easy to unscrew. Practical features are also a childproof closure and one that also serves as a measuring cup.
Guide: Frequently asked questions about mouthwash answered in detail
Because there are so many mouthwash options to choose from, it can be difficult to decide which one to buy. To make your purchase decision as easy as possible, we have answered all the important questions you might have below.
What is mouthwash and how does it work?
However, mouthwashes should not and cannot replace daily tooth brushing, but rather complement it. In the following sections, we will explain the different effects in more detail.
Mouthwash can have a virucidal effect, which means that it can kill different viruses. A team of scientists analysed the effect of eight commercially available mouthwashes on the SARS-CoV-2 coronavirus under laboratory conditions.
For this, three different SARS-CoV-2 isolates were mixed with a mimic of nasal secretions and treated with mouthwash for 30 seconds. The result showed that different SARS-CoV-2 strains were found to be highly sensitive to the different mouthwashes (2).
However, clinical studies are yet to be conducted to determine the virucidal properties of mouthwash in vivo.
Mouthwashes may also have the ability to kill different strains of bacteria. This effect is called bactericidal.
In this way, the mouthwash can distinguish foreign, harmful bacteria from our own bacterial flora, so that important bacteria for our health and oral hygiene are preserved (3).
Mouthwashes can also reduce and prevent inflammation. This anti-inflammatory effect goes hand in hand with the virucidal and bactericidal properties of mouthwash (4).
Anti-inflammatory agents are also called anti-inflammatories.
Viruses and bacteria are often the cause of inflammation (5).
Mouthwash is also said to have a protective effect against plaque. As a so-called plaque protector, it can prevent more serious problems in the oral cavity.
Prophylaxis can be ensured on the one hand by killing bacteria and on the other hand by remineralising the tooth enamel, which is done, among other things, by the fluoride content in the mouthwash (6).
Preventing gingivitis and periodontitis
Thanks to the bactericidal and anti-inflammatory effect of mouthwashes, they can specifically protect against gingivitis and periodontitis. Gingivitis is an inflammation of the marginal gums (gingiva), which in most cases is caused by bacteria and is the precursor to periodontitis (7).
In periodontitis, also called periodontosis, the inflammation spreads to the tissues and bones that surround and stabilise the teeth. The entire tooth bed (periodontium) is therefore affected. The inflammation often goes unnoticed and can lead to loosening and, in the worst case, loss of teeth (8).
What side effects can mouthwash have?
- Increased cancer risk: From a survey of 866 cancer patients and 1249 control participants, a correlation between regular use of mouthwashes and increased cancer risk was found. The more intensive the mouthwash use, the higher the risk. However, in many of the cases with increased cancer risk, tobacco and alcohol use was also recorded, which may have influenced the result (9). For example, a quantitative meta-analysis on this topic also showed no statistically significant association between mouthwash use and cancer risk (10).
- Tooth discolouration: Mouthwash can also lead to unsightly tooth discolouration in some cases. Healthy teeth naturally have a slightly yellowish tinge due to strong enamel. Tooth discolouration has a darker tone and may appear irregularly on the teeth. Chlorhexidine is presented as the responsible substance in most studies on tooth discolouration (11).
- Dental fluorosis: Because many types of mouthwash contain fluoride, there may be a risk of dental fluorosis. Dental fluorosis manifests itself as white discolouration on the surface of the tooth enamel and is caused by excessive fluoride intake. This side effect is usually only a visual problem, but in the worst case, it can also lead to a loss of tooth substance (12).
- Damage to the oral mucosa: Another side effect of mouthwash can be a damaged mucous membrane in the oral cavity. The statistical correlation between the use of mouthwashes and a damaged oral mucosa is quite low. Especially the ingredient sodium has often been mentioned in this context(13).
- Impaired taste sensation: Mouthwashes can also change or disturb the sense of taste. This effect could be confirmed clinically, even if only a small proportion of the test persons reported this side effect. The substance chlorhexidine was primarily associated with impaired taste perception (14).
The side effects of mouthwashes do not usually occur frequently. Some of them have been scientifically and clinically proven, but as with any other topic, studies can be found that prove the opposite.
What types of mouthwash are there?
|Ready-to-use solution||Mouthwash as a ready-to-use solution is probably the easiest way to use. The mouthwash is already properly dosed, so you don't have to do anything else with the solution. In many cases, the lid of the ready-to-use solution even serves as a measuring cup for the recommended amount.|
|Concentrate||This type of mouthwash is more concentrated than the ready-to-use solution, so you still need to dilute it in water before use. Most manufacturers recommend about three to five drops for a half-full glass of water. However, you can easily adjust the number of drops to suit your individual taste.|
|Tablets||A newer invention are tablets that you dissolve in water to make your mouthwash. The tablets are already dosed so that one tablet dissolved in about 20 millilitres of water is enough for a mouthwash. This alternative can be more practical than liquid mouthwashes in many cases. Caution: Mouthwash tablets are also easily confused with chewable tablets. So always read the instructions on the packaging carefully.|
You have to decide which type of mouthwash is right for you based on your preferences. Ready-to-use mouthwash is convenient if you don't have much time in the morning, for example.
One advantage of the concentrate is that it can be dosed individually, so you can determine the concentration of the mouthwash yourself. Mouthwash tablets are ideal for travelling because you don't have to pack a whole bottle, just the amount of tablets you need.
How often should I use mouthwash?
You should be careful here, though, because not all mouthwashes are the same. The solutions can contain different substances in different concentrations. Therefore, you should always check the ingredients first.
For example, mouthwashes with a high concentration of chlorhexidine or alcohol can have a very strong effect. So, with long-term use, side effects such as tooth discolouration or a damaged oral mucosa are quite possible if the mouthwash is used frequently.
What does mouthwash cost?
|Ready-to-use solution||Approximately 4 to 20 euros per litre|
|Concentrate||Approximately 30 to 90 euros per litre|
|Tablets||Approximately 50 to 130 euros per kilogram|
At first glance, mouthwash concentrate and tablets seem super expensive. But appearances are deceptive because with both variants you only need to use a very small amount of the product for a mouth rinse. With the concentrate, just a few drops are enough and a tablet usually only weighs about two to three grams.
What are the alternatives to mouthwash?
|Thorough brushing||Regular and thorough brushing is, of course, the basic building block of proper dental and oral care. If you brush your teeth very conscientiously and make sure you get every tooth and every nook and cranny, you give unwanted bacteria almost no chance to survive in your mouth.|
|Interdental brushes and dental floss||However, if you do have a few food particles left between your teeth and can't remove them with your toothbrush, interdental brushes and dental floss are an ideal addition. With these tools, you can easily and gently clean your interdental spaces.|
|Professional teeth cleaning||You can't go wrong with a professional teeth cleaning. Your teeth will be optimally cleaned by a specialist and also given prophylaxis. You should have your teeth professionally cleaned about twice a year. Some health insurance companies even cover some of the costs.|
|DIY mouthwash||You can also easily make your own mouthwash from natural ingredients. You can use camomile, sorrel, thyme, ribwort or sage. You can even buy ready-made extracts of these plants. For a DIY mouthwash, you only need to dissolve the plant (extracts) in lukewarm water.|
|Healthy diet||A healthy and nutritious diet can also play a crucial role. Foods such as garlic, onions, ginger, broccoli, tomatoes and chilli strengthen your immune system and protect your whole body against inflammation. Of course, this also includes strengthening your oral flora so that you are less susceptible to infections and diseases.|
Regular and thorough dental and oral care is very important. If you do this conscientiously, you should not have any problems with your teeth or gums.
However, regular visits to the dentist are essential. Mouthwash can prevent various diseases and alleviate symptoms, but it is not intended to combat serious oral diseases.
Image source: Yastremska/ 123rf.com
Hellwege K. Die Praxis der zahnmedizinischen Prophylaxe: ein Leitfaden für die Individualprophylaxe, Gruppenprophylaxe und initiale Parodontaltherapie. Georg Thieme Verlag, Stuttgart. 2003;6:141-142.
Meister T, Brüggemann Y, Todt D, Conzelmann C, Müller J, Groß R, Münch J, Krawczyk A, Steinmann J, Steinmann J, Pfaender S, Steinmann E. Virucidal Efficacy of Different Oral Rinses Against Severe Acute Respiratory Syndrome Coronavirus 2. The Journal of Infectious Diseases. 2020;222(8):1289–1292. doi:10.1093/infdis/jiaa471.
Steinberg D, Hirschfeld Z, Tayeb I, Ben-Yosef S, David A, Friedman M. The effect of parabens in a mouthwash and incorporated into a sustained release varnish on salivary bacteria. Journal of Dentistry. 1999;27(2):101-106. doi:10.1016/S0300-5712(98)00040-2.
Limsitthichaikoon S. Efficacy of Anthocyanin Mouthrinse for Oral Anti-inflammation From Orthodontic Treatment. Khon Kaen University. 2015. ClinicalTrials.gov Identifier: NCT02536781.
Naji M. A Clinical Trial to Test the Effect of Marketed Mouth Rinses on Decreasing Plaque and Gum Inflammation. All Sum Research Center Ltd. 2015. ClinicalTrials.gov Identifier: NCT02233998.
Ayad F. Clinical Study Comparing Dental Plaque and Gingivitis Reduction After Using One of Three Oral Hygiene Multi-component Regimens (Using of a Manual Toothbrush, a Toothpaste and a Mouthwash). 2015. ClinicalTrials.gov Identifier: NCT02366689.
Lynch M. A Four-Week Study to Measure the Effectiveness of an Experimental Mouthwash Used After Teeth Cleaning. 2011. ClinicalTrials.gov Identifier: NCT01462110.
Gkatzonis A. Effectiveness of Three Different Mouthrinses in Dental Plaque Control and Early Wound Healing. National and Kapodistrian University of Athens. 2017. ClinicalTrials.gov Identifier: NCT03119831.
Winn DM, Blot WJ, McLaughlin JK, et al. Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer. Cancer Res. 1991;51(11):3044-3047.
Gandini S, Negri E, Boffetta P, La Vecchia C, Boyle P. Mouthwash and oral cancer risk quantitative meta-analysis of epidemiologic studies. Ann Agric Environ Med. 2012;19(2):173-180.
Karpiński TM, Szkaradkiewicz AK. Chlorhexidine--pharmaco-biological activity and application. Eur Rev Med Pharmacol Sci. 2015;19(7):1321-1326.
Buzalaf MAR, Pessan JP, Honório HM, Ten Cate JM. Mechanisms of action of fluoride for caries control. Monogr Oral Sci. 2011;22:97-114. doi:10.1159/000325151
Pérez-López D, Varela-Centelles P, García-Pola MJ, Castelo-Baz P, García-Caballero L, Seoane-Romero JM. Oral mucosal peeling related to dentifrices and mouthwashes: A systematic review. Med Oral Patol Oral Cir Bucal. 2019;24(4):452-460. doi:10.4317/medoral.22939.
Richards D. Chlorhexidine mouthwash plaque levels and gingival health. Evid Based Dent. 2017;18(2):37-38. doi:10.1038/sj.ebd.6401232.