OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• dental

• in general, mouthwashes should only be used for a short period of time to avoid adverse effects, and should never be the sole means of oral hygiene.

• a cationic bis-guanide with broad spectrum antimicrobial activity
• currently the most effective mouthwash for reducing plaque and gingivitis
• should be used after rinsing mouth with water or 0.5-2hrs after using toothpaste as it interacts with flouride and the detergent in toothpaste.
• not for long term use as stains soft tissue and teeth (including restorations), increases calculus deposition, has an unpleasant taste and alters taste sensation, and causes desquamation and mucosal irritation.
• may exacerbate oral discomfort in patients with chemotherapy-induced mucositis, xerostomia or ulcerative mucosal conditions.

• usually used added to chlorhexidine mouthwashes for its analgesic, anti-inflammatory and antimcrobial properties.
• recommended for radiation-induced oral mucositis as well as recurrent aphthous ulceration.

• include phenol-related oils such as thymol, eucalyptol, menthol and methyl salicylate in up to 26% alcohol)
• may assist in Mx of gingivitis
• not for patients with xerostomia, dental erosion due to low oral pH, or oral mucosal disease as ethanol-induced irritation and dryness may be an issue.
• not for children as accidental ingestion is an issue with high doses of ethanol.

• reduce gingival inflammation but may not be better than water rinses
• an alcohol-free two phase formulation appears to be useful for Rx of halitosis

• hydrogen peroxide ans sodium perborate are strong oxidants which reduce gingivitis and staining.

• ingestion may be an issue in patients with pre-existing thyroid disease

• low pH may risk dental erosion in long term use

• reduce dental caries and can be used in patients with xerostomia after irradiation and chemotherapy, and those undergoing fixed orthodontic treatment.
• not recommended for children < 6 yrs age as ingestion risk high.

• 1 teaspoon in a glass of water
• can be used in patients with xerostomia or oral ulcerative disease and reduces dental erosion.

• concentrations > 20% have detrimental oral effects:
  • epithelial detachment
  • keratosis
  • mucosal ulceration
  • gingivitis
  • petechiae
  • pain
  • risk of oral cancer (including pharynx and larynx)
    • 5x risk if use >20% ethanol mouthwash and this increases to 9x if also smoke
• avoid long term use!

• Aust Presc. Dec 2009