DISCUSSION
bad breath, caries, pain, mucositis, tooth
ADVERSE EVENTS, CARIES, ADHESION, PERIODONTAL DISEASE, MUCOSITIS, ASPIRATION PNEUMONIA
Recent years have seen rising interest in oral health management. Although the rate of mouthwash use is not necessarily higher in Japan than in other countries, it has tended to increase in recent years. Initially, most people thought that mouthwash was used to eliminate bad breath, and it was often lumped together with fragrances, so that rather than using it regularly, people tended to use it occasionally in a way that was greatly removed from the goal of health management. Recently, however, it has gradually come to be thought of differently, as awareness has spread of the necessity of oral function management. The main uses of mouthwash now include cleaning the mouth, retaining moisture, preventing caries and periodontal disease, and preventing bad breath.Since oral intake is not performed during maxillomandibular fixation, it is known that saliva secretion decreases and oral dryness becomes more severe. Additionally, it has been reported that oral bacterial flora changes during tube feeding, leading to an increase in aspiration pneumonia (Finucane & Bynum, The mouthwash investigated in this study is compounded with three medicinal ingredients. As a cationic surfactant, CPC exerts a bactericidal action by adsorption on the bacterial cell membrane, which increases its fluidity and causes it to break down (Hwang et al., In the present study, the effectiveness of this mouthwash was assessed in a specific environment resulting from maxillomandibular fixation. The results of the PCR experiments suggested that the use of a mouthwash containing active ingredients may suppress the adhesion of debris in comparison with the placebo group. During maxillomandibular fixation, all of the patients in this study carried out mechanical flossing with a Waterpik before using mouthwash. In both groups, the labial‐side tooth surfaces and mucosa were thus adequately cleaned by mechanical stimulation, but the present results showed that this alone was insufficient. The ammonia levels and buffering capacity of saliva were also affected by the mouthwash ingredients, despite Waterpik use. This may have been because the action of the Waterpik did not extend to the lingual‐side tooth surfaces or the tongue and other parts of the mucosa. A previous study found that the use of this mouthwash reduced debris adhesion to the sutures used in implant surgery, which supports the present results (Taninokuchi et al., Unlike oral medications, including antibiotics, mouthwash exerts direct local action to reduce systemic side effects. Therefore, mouthwash can be used continuously for a wide range of indications and used by a wide range of age patients. Barriers to the use of mouthwashes include irritation of the mucous membranes and their smell and taste. Therefore, taste and color can be important factors when choosing a mouthwash. In this study, the drug was used in patients ranging in age from 10 to 80 years and there were no adverse events such as mucositis or pain. In addition, there were no patients who were unable to use the product due to taste or odor preferences.The importance of oral management in the perioperative period is now recognized in both medicine and dentistry, and active interventions are now being performed (Bergan et al., During long‐term use, cost is another issue that must be resolved alongside taste preferences and irritation. The development of a versatile mouthwash for use not just in the perioperative period will be very important in terms of meeting a social need.