oral burning sensation or ulceration. chlorhexidine digluconate and hexetidine (antiseptic) chlorhexidine digluconate is a chemical antiseptic and is used in a 0.05–0.2% solution as a mouthwash. there is no evidence to support that higher concentrations are more effective in controlling dental plaque and gingivitis. a randomized clinical trial conducted in rabat university in morocco found better results in plaque inhibition when chlorohexidine with alcohol base 0.12% was used, when compared to an alcohol-free 0.1% chlorhexidine mouthrinse. chlorhexidine has good substantivity (the ability of a mouthwash to bind to hard and soft tissues in the mouth). it has anti-plaque action, and also some anti-fungal action. it is especially effective against gram-negative rods. the proportion of gram-negative rods increase as gingivitis develops, so it is also used to reduce gingivitis. it is sometimes used as an adjunct to prevent dental caries and to treat periodontal disease, although it does not penetrate into periodontal pockets well. chlorhexidine mouthwash alone is unable to prevent plaque, so it is not a substitute for regular toothbrushing and flossing. instead, chlorhexidine mouthwash is more effective when used as an adjunctive treatment with toothbrushing and flossing. in the short term, if toothbrushing is impossible due to pain, as may occur in primary herpetic gingivostomatitis, chlorhexidine mouthwash is used as a temporary substitute for other oral hygiene measures. it is not suited for use in acute necrotizing ulcerative gingivitis, however. rinsing with chlorhexidine mouthwash before and after a tooth extraction may reduce the risk of a dry socket. other uses of chlorhexidine mouthwash include prevention of oral candidiasis in immunocompromised persons, treatment of denture-related stomatitis, mucosal ulceration/erosions and oral mucosal lesions, general burning sensation and many other uses. chlorhexidine mouthwash is known to have minor adverse effects. chlorhexidine binds to tannins, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth. a systematic review of commercial chlorhexidine products with anti-discoloration systems (adss) found that the adss were able to reduce tooth staining without affecting the beneficial effects of chlorhexidine. chlorhexidine mouthwash can also cause taste disturbance or alteration. chlorhexidine is rarely associated with other issues like overgrowth of enterobacteria in persons with leukemia, desquamation, irritation, and stomatitis of oral mucosa, salivary gland pain and swelling, and hypersensitivity reactions including anaphylaxis. hexetidine also has anti-plaque, analgesic, astringent and anti-malodor properties, but is considered an inferior alternative to chlorhexidine. edible oils in traditional ayurvedic medicine, the use of oil mouthwashes is called "kavala" ("oil swishing") or "gandusha", and this practice has more recently been re-marketed by the complementary and alternative medicine industry as "oil pulling". its promoters claim it works by "pulling out" "toxins", which are known as ama in ayurvedic medicine, and thereby reducing inflammation. ayurvedic literature claims that oil pulling is capable of improving oral and systemic health, including a benefit in conditions such as headaches, migraines, diabetes mellitus, asthma, and acne, as well as whitening teeth. oil pulling has received little study and there is little evidence to support claims made by the technique's advocates. when compared with chlorhexidine in one small study, it was found to be less effective at reducing oral bacterial load, and the other health claims of oil pulling have failed scientific verification or have not been investigated. there is a report of lipid pneumonia caused by accidental inhalation of the oil during oil pulling. the mouth is rinsed with approximately one tablespoon of oil for 10–20 minutes then spat out. sesame oil, coconut oil and ghee are traditionally used, but newer oils such as sunflower oil are also used. essential oils phenolic compounds and monoterpenes include essential oil constituents that have some antibacterial properties, such as eucalyptol, eugenol, hinokitiol, menthol, phenol, or thymol. essential oils are oils which have been extracted from plants. mouthwashes based on essential oils could be more effective than traditional mouthcare as anti-gingival treatments. they have been found effective in reducing halitosis, and are being used in several commercial mouthwashes. fluoride (anticavity) anti-cavity mouthwashes use sodium fluoride to protect against tooth decay. fluoride-containing mouthwashes are used as prevention for dental caries for individuals who are considered at higher risk for tooth decay, whether due to xerostomia related to salivary dysfunction or side effects of medication, to not drinking fluoridated water, or to being physically unable to care for their oral needs (brushing and flossing), and as treatment for those with dentinal hypersensitivity, gingival recession/ root exposure. flavoring agents and xylitol flavoring agents include sweeteners such as sorbitol, sucralose, sodium saccharin, and xylitol, which stimulate salivary function due to their sweetness and taste and helps restore the mouth to a neutral level of acidity. xylitol rinses double as a bacterial inhibitor, and have been used as substitute for alcohol to avoid dryness of mouth associated with alcohol. hydrogen peroxide hydrogen peroxide can be used as an oxidizing mouthwash (e.g. peroxyl, 1.5%). it kills anaerobic bacteria, and also has a mechanical cleansing action when it froths as it comes into contact with debris in mouth. it is often used in the short term to treat acute necrotising ulcerative gingivitis. side effects can occur with prolonged use, including hypertrophy of the lingual papillae. lactoperoxidase (saliva substitute) enzymes and non-enzymatic proteins, such as lactoperoxidase, lysozyme, and lactoferrin, have been used in mouthwashes (e.g., biotene) to reduce levels of oral bacteria, and, hence, of the acids produced by these bacteria. lidocaine/xylocaine oral lidocaine is useful for the treatment of mucositis symptoms (inflammation of mucous membranes) induced by radiation or chemotherapy. there is evidence that lidocaine anesthetic mouthwash has the potential to be systemically absorbed, when it was tested in patients with oral mucositis who underwent a bone marrow transplant. methyl salicylate methyl salicylate functions as an antiseptic, antiinflammatory, and analgesic agent, a flavoring, and a fragrance. methyl salicylate has some anti-plaque action, but less than chlorhexidine. methyl salicylate does not stain teeth. nystatin nystatin suspension is an antifungal ingredient used for the treatment of oral candidiasis. potassium oxalate a randomized clinical trial found promising results in controlling and reducing dentine hypersensitivity when potassium oxalate mouthwash was used in conjugation with toothbrushing. povidone/iodine (pvp-i) a 2005 study found that gargling three times a day with simple water or with a povidone-iodine solution was effective in preventing upper respiratory infection and decreasing the severity of symptoms if contracted. other sources attribute the benefit to a simple placebo effect. pvp-i in general covers "a wider virucidal spectrum, covering both enveloped and nonenveloped viruses, than the other commercially available antiseptics", which also includes the novel sars-cov-2 virus. sanguinarine sanguinarine-containing mouthwashes are marketed as anti-plaque and anti-malodor treatments. sanguinarine is a toxic alkaloid herbal extract, obtained from plants such as sanguinaria canadensis (bloodroot), argemone mexicana (mexican prickly poppy), and others. however, its use is strongly associated with the development of leukoplakia (a white patch in the mouth), usually in the buccal sulcus. this type of leukoplakia has been termed "sanguinaria-associated keratosis", and more than 80% of people with leukoplakia in the vestibule of the mouth have used this substance. upon stopping contact with the causative substance, the lesions may persist for years. although this type of leukoplakia may show dysplasia, the potential for malignant transformation is unknown. ironically, elements within the complementary and alternative medicine industry promote the use of sanguinaria as a therapy for cancer. sodium bicarbonate (baking soda) sodium bicarbonate is sometimes combined with salt to make a simple homemade mouthwash, indicated for any of the reasons that a saltwater mouthwash might be used. pre-mixed mouthwashes of 1% sodium bicarbonate and 1.5% sodium chloride in aqueous solution are marketed, although pharmacists will easily be able to produce such a formulation from the base ingredients when required. sodium bicarbonate mouthwash is sometimes used to remove viscous saliva and to aid visualization of the oral tissues during examination of the mouth.: 4 sodium chloride (salt) main article: salt rinse