mouthwash mouthwash mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth. range of mouthwashes by listerine usually mouthwashes are antiseptic solutions intended to reduce the microbial load in the mouth, although other mouthwashes might be given for other reasons such as for their analgesic, anti-inflammatory or anti-fungal action. additionally, some rinses act as saliva substitutes to neutralize acid and keep the mouth moist in xerostomia (dry mouth). cosmetic mouthrinses temporarily control or reduce bad breath and leave the mouth with a pleasant taste. rinsing with water or mouthwash after brushing with a fluoride toothpaste can reduce the availability of salivary fluoride. this can lower the anti-cavity re-mineralization and antibacterial effects of fluoride. fluoridated mouthwash may mitigate this effect or in high concentrations increase available fluoride, but is not as cost effective as leaving the fluoride toothpaste on the teeth after brushing. a group of experts discussing post brushing rinsing in 2012 found that although there was clear guidance given in many public health advice publications to "spit, avoid rinsing with water/excessive rinsing with water" they believed there was a limited evidence base for best practice. use common use involves rinsing the mouth with about 20–50 ml (2/3 fl oz) of mouthwash. the wash is typically swished or gargled for about half a minute and then spat out. most companies suggest not drinking water immediately after using mouthwash. in some brands, the expectorate is stained, so that one can see the bacteria and debris. mouthwash should not be used immediately after brushing the teeth so as not to wash away the beneficial fluoride residue left from the toothpaste. similarly, the mouth should not be rinsed out with water after brushing. patients were told to "spit don't rinse" after toothbrushing as part of a national health service campaign in the uk. a fluoride mouthrinse can be used at a different time of the day to brushing. gargling is where the head is tilted back, allowing the mouthwash to sit in the back of the mouth while exhaling, causing the liquid to bubble. gargling is practiced in japan for perceived prevention of viral infection. one commonly used way is with infusions or tea. in some cultures, gargling is usually done in private, typically in a bathroom at a sink so the liquid can be rinsed away. dangerous misuse if one drinks mouthwash, serious harm and even death can quickly result from the high alcohol content and other harmful substances in mouthwash. it is a common cause of death among homeless people during winter months, because a person can feel warmer after drinking it. effects the most-commonly-used mouthwashes are commercial antiseptics, which are used at home as part of an oral hygiene routine. mouthwashes combine ingredients to treat a variety of oral conditions. variations are common, and mouthwash has no standard formulation, so its use and recommendation involves concerns about patient safety. some manufacturers of mouthwash state that their antiseptic and antiplaque mouthwashes kill the bacterial plaque that causes cavities, gingivitis, and bad breath. it is, however, generally agreed that the use of mouthwash does not eliminate the need for both brushing and flossing. the american dental association asserts that regular brushing and proper flossing are enough in most cases, in addition to regular dental check-ups, although they approve many mouthwashes. for many patients, however, the mechanical methods could be tedious and time-consuming, and, additionally, some local conditions may render them especially difficult. chemotherapeutic agents, including mouthwashes, could have a key role as adjuncts to daily home care, preventing and controlling supragingival plaque, gingivitis and oral malodor. minor and transient side effects of mouthwashes are very common, such as taste disturbance, tooth staining, sensation of a dry mouth, etc. alcohol-containing mouthwashes may make dry mouth and halitosis worse, as they dry out the mouth. soreness, ulceration and redness may sometimes occur (e.g., aphthous stomatitis or allergic contact stomatitis) if the person is allergic or sensitive to mouthwash ingredients, such as preservatives, coloring, flavors and fragrances. such effects might be reduced or eliminated by diluting the mouthwash with water, using a different mouthwash (e.g. saltwater), or foregoing mouthwash entirely. prescription mouthwashes are used prior to and after oral surgery procedures, such as tooth extraction, or to treat the pain associated with mucositis caused by radiation therapy or chemotherapy. they are also prescribed for aphthous ulcers, other oral ulcers, and other mouth pain. "magic mouthwashes" are prescription mouthwashes compounded in a pharmacy from a list of ingredients specified by a doctor. despite a lack of evidence that prescription mouthwashes are more effective in decreasing the pain of oral lesions, many patients and prescribers continue to use them. there has been only one controlled study to evaluate the efficacy of magic mouthwash; it shows no difference in efficacy between the most common magic-mouthwash formulation, on the one hand, and commercial mouthwashes (such as chlorhexidine) or a saline/baking soda solution, on the other. current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief and in shortening the healing time of oral mucositis from cancer therapies. history listerine advertisement, 1932 swedish ad for toiletries, 1905/1906 sterisol mouthwash (1963) the first known references to mouth rinsing is in ayurveda for treatment of gingivitis. later, in the greek and roman periods, mouth rinsing following mechanical cleansing became common among the upper classes, and hippocrates recommended a mixture of salt, alum, and vinegar. the jewish talmud, dating back about 1,800 years, suggests a cure for gum ailments containing "dough water" and olive oil. the ancient chinese had also gargled salt water, tea and wine as a form of mouthwash after meals, due to the antiseptic properties of those liquids. before europeans came to the americas, native north american and mesoamerican cultures used mouthwashes, often made from plants such as coptis trifolia. indeed, aztec dentistry was more advanced than european dentistry of the age. peoples of the americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as teething and mouth ulcers. anton van leeuwenhoek, the famous 17th century microscopist, discovered living organisms (living, because they were mobile) in deposits on the teeth (what we now call dental plaque). he also found organisms in water from the canal next to his home in delft. he experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. next he tried rinsing the mouth of himself and somebody else with a mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. he concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms. in 1892, german richard seifert invented mouthwash product odol, which was produced by company founder karl august lingner (1861–1916) in dresden. that remained the state of affairs until the late 1960s when harald loe (at the time a professor at the royal dental college in aarhus, denmark) demonstrated that a chlorhexidine compound could prevent the build-up of dental plaque. the reason for chlorhexidine's effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours. since then commercial interest in mouthwashes has been intense and several newer products claim effectiveness in reducing the build-up in dental plaque and the associated severity of gingivitis, in addition to fighting bad breath. many of these solutions aim to control the volatile sulfur compound–creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste. for example, the number of mouthwash variants in the united states of america has grown from 15 (1970) to 66 (1998) to 113 (2012). research research in the field of microbiotas shows that only a limited set of microbes cause tooth decay, with most of the bacteria in the human mouth being harmless. focused attention on cavity-causing bacteria such as streptococcus mutans has led research into new mouthwash treatments that prevent these bacteria from initially growing. while current mouthwash treatments must be used with a degree of frequency to prevent this bacteria from regrowing, future treatments could provide a viable long-term solution. ingredients alcohol an example of a commercial mouthwash brand which is alcohol-free alcohol is added to mouthwash not to destroy bacteria but to act as a carrier agent for essential active ingredients such as menthol, eucalyptol and thymol, which help to penetrate plaque. sometimes a significant amount of alcohol (up to 27% vol) is added, as a carrier for the flavor, to provide "bite". because of the alcohol content, it is possible to fail a breathalyzer test after rinsing, although breath alcohol levels return to normal after 10 minutes. in addition, alcohol is a drying agent, which encourages bacterial activity in the mouth, releasing more malodorous volatile sulfur compounds. therefore, alcohol-containing mouthwash may temporarily worsen halitosis in those who already have it, or, indeed, be the sole cause of halitosis in other individuals. it is hypothesized that alcohol in mouthwashes acts as a carcinogen (cancer-inducing agent). generally, there is no scientific consensus about this. one review stated: there is now sufficient evidence to accept the proposition that developing oral cancer is increased or contributed to by the use of alcohol-containing mouthwashes. whilst many of these products may have been shown to be effective in penetrating oral microbial biofilms in vitro and reducing oral bacterial load, it would be wise to restrict their use to short-term therapeutic situations if needed. perhaps the use of mouthwashes that do not contain alcohol may be equally effective. further, mouthrinses should be prescribed by dentists, like any other medication. there may well be a reason for the use of alcohol-containing mouthrinses, but only for a particular situation and for a limited and controlled period of time. as such, patients should be provided with written instructions for mouthwash use, and mouthwash use should be restricted to adults for short durations and specific, clearly defined reasons. it is the opinion of the authors that, in light of the evidence currently available of the association of alcohol-containing mouthwashes with the development of oral cancer, it would be inadvisable for oral healthcare professionals to recommend the long-term use of alcohol-containing mouthwashes. the same researchers also state that the risk of acquiring oral cancer rises almost five times for users of alcohol-containing mouthwash who neither smoke nor drink (with a higher rate of increase for those who do). in addition, the authors highlight side effects from several mainstream mouthwashes that included dental erosion and accidental poisoning of children. the review garnered media attention and conflicting opinions from other researchers. yinka ebo of cancer research uk disputed the findings, concluding that "there is still not enough evidence to suggest that using mouthwash that contains alcohol will increase the risk of mouth cancer". studies conducted in 1985, 1995, 2003, and 2012 did not support an association between alcohol-containing mouth rinses and oral cancer. andrew penman, chief executive of the cancer council new south wales, called for further research on the matter. in a march 2009 brief, the american dental association said "the available evidence does not support a connection between oral cancer and alcohol-containing mouthrinse". many newer brands of mouthwash are alcohol-free, not just in response to consumer concerns about oral cancer, but also to cater for religious groups who abstain from alcohol consumption. benzydamine (analgesic) in painful oral conditions such as aphthous stomatitis, analgesic mouthrinses (e.g. benzydamine mouthwash, or "difflam") are sometimes used to ease pain, commonly used before meals to reduce discomfort while eating. benzoic acid benzoic acid acts as a buffer. betamethasone betamethasone is sometimes used as an anti-inflammatory, corticosteroid mouthwash. it may be used for severe inflammatory conditions of the oral mucosa such as the severe forms of aphthous stomatitis.: 209 cetylpyridinium chloride (antiseptic, antimalodor) cetylpyridinium chloride containing mouthwash (e.g. 0.05%) is used in some specialized mouthwashes for halitosis. cetylpyridinium chloride mouthwash has less anti-plaque effect than chlorhexidine and may cause staining of teeth, or sometimes an