Mouthwash

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Finished mouthwash dosed in the corresponding cap.

A mouthwash (also known as mouthwash ) is a mainly antiseptic liquid that is used for prophylaxis in the mouth .

Mouthwashes differ from mouthwashes in that, depending on the ingredients used, they can effectively prevent tooth decay , plaque , gingivitis and tooth erosion .

The Stiftung Warentest describes the use of a mouthwash as useful for people who do not achieve perfect cleaning results with brushes , paste and dental floss .

Most mouthwashes are effective in improving prophylaxis in conjunction with common oral hygiene practices such as brushing your teeth by reducing the build-up of bacteria that are responsible for tooth decay and inflammation of the gums . The most effective components are fluoride compounds , which promote the remineralization of the tooth enamel , or essential oils , which have an antiseptic effect.

Mouthwashes can be effective in improving oral hygiene, but are generally not a substitute for brushing your teeth.

However, some medical mouthwashes are suitable to completely replace brushing your teeth for a limited period of time, for example before or after oral or maxillofacial surgery . However, these have side effects that usually rule out long-term use.

history

The first mouthwash was developed by Karl August Lingner in Dresden in 1892 , shortly after bacterial germs were recognized as the cause of dental diseases. His mouthwash called "mouthwash" was marketed under the brand name Odol , under which it is still available today. With his modern sales strategies, Lingner was so successful that his product dominated the market for a long time without competition.

Mouthwash compositions have evolved over time. At first, it only worked to prevent bad breath. Mouthwashes now contain a large number of effective ingredients that are intended to ensure the most varied of goals in the context of oral health .

composition

The composition of the mouthwashes is quite different. Ingredients are about propanediol , ethanol , water , zinc compounds , metal ions , quaternary ammonium compounds , sanguinarine , chlorhexidine , phenol compounds , flavoring agents , essential oils , salicylic acid , sorbitan esters , sodium saccharin , arginine , calcium carbonate , potassium nitrate , cetylpyridinium chloride , strontium chloride , oxalate , Aloe vera , mint , sage or chamomile . Some medical mouthwashes contain chlorhexidine. It often contains fluorides to remineralize and harden tooth enamel. Some mouthwashes contain alcohol as a solubilizer in order to combine the essential oils contained in part with water to form a solution. The alcohol content can be up to 30%.

application

With concentrated mouthwashes, the consumer creates a solution himself by mixing the concentrate with water according to the manufacturer's instructions. In the case of undiluted mouthwashes, the cap of the bottle serves as a dosing vessel. The mouth and throat area is thoroughly rinsed with the mouthwash. As a result, areas in the oral cavity (e.g. interdental spaces) are reached that are not accessible or only with difficulty for the toothbrush.

effect

In contrast to pure mouthwashes, mouthwashes can effectively prevent tooth decay , dental plaque , gingivitis and tooth erosion, depending on the ingredients used . They can also have a preventive effect against infections , stabilize the microbial oral flora , reduce tooth neck hypersensitivity and support both wound healing and salivary function .

The most intensively clinically examined active ingredients so far are the fluoride compounds, which are also contained in most toothpastes . Fluoride compounds such as sodium or amine fluoride form a calcium fluoride- like layer on the tooth surface , which releases fluoride ions when the pH value in the mouth drops , which enables the teeth to be remineralized . They help proven that, from the enamel dissolved calcium phosphates integrate more quickly into the enamel. In addition, fluorides penetrate plaque-forming bacteria in higher concentrations and inhibit their reproduction. Several studies suggest that amine fluoride is more effective than sodium fluoride, especially when combined with tin fluoride . However, amine fluoride is significantly more expensive as a raw material than sodium fluoride, which is cited by some experts as the reason why it is not used at all in many mouthwashes or is used in a lower dose despite its better effect

Even if the intake of fluorides via toothpastes containing fluoride is generally regarded as sufficient, an additional fluoride mouthwash solution is regarded as advantageous, especially for high-risk patients. However, it should be noted that the effect of fluoride cannot be increased linearly at will, i. H. From a certain intake of fluorides, a further intake is no longer beneficial, but also does no harm. In order to achieve the greatest effect of the fluoride-containing mouth rinse, the general recommendation is to use an amount of 10 ml for one to two minutes after brushing your teeth. After rinsing, you should refrain from eating and drinking for 15 minutes.

Zinc compounds are said to have numerous positive effects on dental health. According to Stiftung Warentest, zinc compounds are supposed to prevent the formation of tartar. Various studies indicate that zinc can positively influence the remineralization of tooth enamel through fluoride and can inhibit plaque formation.

Mouth rinses for pain-sensitive teeth are designed to close open dentinal tubules . For example, they contain a special combination of arginine and calcium carbonate , potassium nitrate , strontium chloride or oxalate .

Mouthwashes based on essential oils have proven to be particularly effective against plaque . Effective ingredients here are, for example, methyl salicylate , thymol , cineol (eucalyptol) and menthol . The essential oils have the ability to penetrate the biofilm, also subgingivally . A bacteria-reducing effect can be achieved up to a pocket depth of 2 millimeters. Because of their good lipid solubility, essential oils can easily penetrate the bacterial cell membrane and thus intervene directly in their metabolism. The hydrophobic character of the oils also prevents bacterial aggregation and thus efficiently counteracts plaque accumulation . In a study, various mouthwashes were examined with regard to their effect on plaque-forming bacteria. The mouth rinses based on essential oils were superior to the mouth rinses based on amine fluoride / tin fluoride, triclosan and PVA / MA copolymers. Investigations into the effect of the mouth rinse on the bacterium Actinobacillus actinomycetemcomitans, one of the main germs of periodontitis, showed that the essential oil-based mouth rinse solution from the manufacturer Listerine kills the bacteria just as effectively in the planktonic stage as in the biofilm. This is remarkable in that bacteria usually develop resistance to antimicrobial agents through the formation of a biofilm. In another study it was shown that the essential oils are able to penetrate the biofilm (plaque) completely and kill bacteria up to the surface of the tooth.

With the exception of preparations containing chlorhexidine, mouth rinses cannot replace mechanical cleaning of teeth. They can be used as an additive and optimize oral hygiene and are most effective where mechanical cleaning is not sufficient, for example between the teeth.

Only preparations containing chlorhexidine can replace the toothbrush if the regular oral hygiene measures can be restricted or not carried out at all, e.g. B. after operations. Chlorhexidine is considered to be the most effective anti-plaque and anti-gingivitis active ingredient and applies in comparison to all other means of chemical plaque reduction such as metal ions (e.g. Cu 2+ , Zn 2+ and Sn 2+ ), quaternary ammonium compounds , phenolic Substances (e.g. triclosan), sanguinarine or fluoride as the most effective. Mouth rinses containing chlorhexidine are used, for example, to support healing after surgical interventions, but sometimes also prophylactically before surgical interventions in order to achieve a relative sterility or in the context of special dental therapies such as. B. periodontal therapy or full mouth disinfection . Rinsing twice a day with 10 ml of a 0.2 percent CHX solution has shown in numerous studies to reduce the formation of new plaques by 90 to 100%. However, long-term use in this concentration can lead to (reversible) superficial discoloration of the teeth, gums and dentures and also to changes in taste. The extent of the discoloration is greater, the higher the dose of chlorhexidine, the longer the application and the less mechanical cleaning with toothbrush and toothpaste is used during therapy. Any discoloration that has arisen can usually be removed by regular mechanical cleaning of the teeth with toothpaste. Such discolorations can be safely removed as part of professional teeth cleaning. For long-term home use, it is recommended to alternate chlorhexidine and a non-chlorhexidine mouthwash solution at weekly intervals in order to reduce the side effects mentioned. The brownish deposits on teeth and tongue stem from the fact that bacterial proteins are denatured when the bacterial cell membranes are destroyed and disulfide functions are reduced to thiol functions , which form dark-colored complexes with the iron (III) ions of saliva . Other discolorations could result from the fact that monosaccharides such as glucose and fructose dissolved in the saliva react with the amine functions of bacterial proteins ( Maillard reaction ). Lower concentrations for daily oral care can reduce these side effects; then, however, the desired effect is also limited, but still well documented. There are now also formulations that are supposed to prevent discoloration and taste irritation: "Anti Discoloration System". However, these formulations are relatively low-dose. The German Society for Dental, Oral and Maxillofacial Medicine advises against untargeted, long-term use for the purpose of prevention.

In long-term care (regular use for more than six weeks) and in patients with a treated pocket problem or with implants , however, there is at least one study in which the essential oils have proven to be more effective than chlorhexidine. However, these results must be assessed with caution, as compliance in the chlorhexidine comparison group may not have been ensured due to the side effects .

The permanent use of antiseptics in the oral cavity is controversial among some experts, as it can change the natural oral flora. Other experts consider mouthwashes to be stabilizing for the oral flora. The majority outweigh the opinions that rate the benefits as greater than the risks.

For a number of years there have been mouthwashes on the market that advertise “liquid” or “artificial tooth enamel” that is said to be able to “cure” even incipient tooth decay. Among other things, “nanoparticles” made of hydroxyapatite are advertised here. Although this active ingredient has been on the market in various products for a number of years and some in-vitro studies indicate an effect of this substance, there are currently no meaningful clinical studies that prove its effect in the living human body. In addition, the existing studies are rated as severely inadequate.

In summary, it can be stated that the majority of the mouthwashes offered are offered as cosmetic products and not as medical products within the framework of EC Regulation No. 1223/2009 . The distinction between cosmetic and medical mouthwashes has legal consequences in particular. In the case of medical products, for example, the effectiveness of a specific indication must be proven. This requires comparatively complex and expensive approval procedures, which, on the other hand, do not allow any judgment about how effective a product is compared to mouthwashes according to the Cosmetics Ordinance. Some experts therefore consider this difference to be of little relevance in practice, such as Michael Noack, Director of the Polyclinic for Dental Conservation and Periodontology, Center for Dental, Oral and Maxillofacial Dentistry at the University Clinic in Cologne: “Legal aspects are often more important than content. Finally, toothpastes with 1450 ppm fluoride work medically by preventing carious lesions. Nevertheless, or fortunately, the toothpastes are sold in the supermarket. "

There are countless active ingredients that can be contained in different combinations in different mouthwashes according to the Cosmetics Ordinance and for each of which an effect can be promised. When it comes to the composition of the solutions, the manufacturers are partly based on current research results as well as on their own studies. On the one hand, these freedoms mean that manufacturers of cosmetic mouthwashes can react very flexibly to new scientific findings or trends by being able to quickly change their recipes. On the other hand, the effectiveness of the substances used is not always clear; there is often a lack of meaningful clinical studies in order to make an assessment, especially in comparison with other products. In particular, non-branded manufacturers, for example private labels, change their recipes relatively frequently. As a result, when testing consumer magazines, the tested product was often changed by the manufacturer when the test results were published. Another disadvantage of the frequent recipe changes is that in the context of large clinical studies, branded products are often preferred that change their recipe comparatively rarely. The Listerine mouthwash is one of the most clinically researched mouthwashes in the world.

Legal framework

According to a ruling by the European Court of Justice , mouthwashes with the pharmacologically active ingredient chlorhexidine are treated as drugs and must be manufactured according to the relevant pharmaceutical standards. Otherwise, mouth rinses and mouthwashes are considered cosmetic products in accordance with Art. 2 Paragraph 1a of the EU Cosmetics Regulation 1223/2009.

literature

  • S. Zimmer, B. Stephan, C. Kolbe, G. Kaiser, T. Krage, M. Ommerborn, C. Barthel: Clinical effectiveness of dental floss compared to antimicrobial rinsing solutions . In: Oral prophylaxis & pediatric dentistry . tape 29 , no. 2 , 2007, ISSN  1614-2217 , p. 54–59 ( zahnheilkunde.de [PDF]).

Web links

Wiktionary: mouthwash  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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