The choices we make regarding toothpastes and mouthwashes are influenced by a variety of factors, including marketing campaigns, commercials, and brand names that promise dazzling smiles and oral health benefits.
While these promotions shape our expectations, it’s important to recognize that the primary factor in effective oral hygiene is establishing a proper brushing technique and routine.
Mouthwashes like Listerine provide helpful antibacterial and therapeutic benefits; but their primary purpose is to augment your mechanical brushing and flossing routine, not replace it.
The swishing motion can penetrate crevices a toothbrush bristle misses to some degree. However, mouthwash alone does not fully remove sticky plaque biofilm or debris lodged between teeth or beneath the gumline.
But when used alongside diligent daily brushing and flossing, it offers additional antibacterial activity and extra fluoride to boost your oral hygiene efforts.
If you plan on starting the use of a medicated mouthwash, it’s important to learn about the active ingredients, especially those with specific therapeutic effects:
Therapeutic Agents in Mouthwash
Mouthwashes are oral rinse solutions that have health and cosmetic benefits for the teeth and gums. There are two main types:
a. Cosmetic Mouthwashes
These over-the-counter mouthwashes help freshen breath, wash away debris, and leave a pleasant taste in the mouth. But they don’t contain active ingredients to treat dental conditions.
b. Therapeutic Mouthwashes
These contain added ingredients like fluoride, antibacterials, or essential oils that help prevent cavities, reduce plaque, or manage gum disease. They provide extra oral health benefits.
One or more therapeutic agents are usually added to mouthwashes, such as fluorides to prevent caries, as well as agents to facilitate stain and calculus removal, and prevention of gingivitis, sensitive teeth and gum problems.
Here are some common therapeutic agents:
A. Anti-Caries Agents
When it comes to medicated mouthwashes, anti-caries agents play a pivotal role in promoting dental health. These agents are designed to combat the formation and progression of tooth decay, offering a variety of benefits.
Anti-caries agents in mouthwash, such as fluoride and xylitol, play a significant role in promoting gum health by addressing the underlying factors that contribute to gum issues:
a. Fluoride
Fluoride stands as a cornerstone in the prevention of dental caries. Its effectiveness is well-established, making it a staple ingredient in toothpaste and many mouthwashes. Sodium fluoride (NaF) is the prevalent form, accompanied by alternatives like mono-fluoro-phosphate (MFP) and stannous fluoride (SnF). The fluoride concentration in toothpaste typically ranges between 0.10-0.15%, and it’s most potent when not rinsed away immediately after brushing.
Fluoride’s caries-fighting prowess is rooted in several theories:
- Enamel Incorporation – Fluoride becomes part of the enamel during tooth development, forming fluorhydroxyapatite (FAP). This reduces the apatite’s solubility, theoretically leading to lasting caries resistance.
- Anti-Bacterial Action – Fluoride exerts anti-bacterial effects by forming hydrogen fluoride (HF) in acidic environments. HF can penetrate bacterial cell membranes, disrupting cellular function. This interference hampers cellular growth by affecting enzymes and altering the cell’s pH balance.
- Calcium Fluoride (CaF2) Formation – After brushing or rinsing with fluoride, CaF2 forms as a fluoride reservoir. When pH drops, fluoride and calcium are released into plaque fluid. Fluoride permeates enamel pores, creating fluoroapatite (FAP) that resists acid attacks better than hydroxyapatite (HA). Fluoride accelerates remineralization, shortening the demineralization period.
b. Xylitol
Xylitol, a sugar alcohol, takes an unconventional route in caries prevention. It resists fermentation by oral microorganisms and hampers carbohydrate metabolism in various bacteria. This reduces acid formation from glucose and reduces bacterial buildup in both plaque and saliva. However, the effectiveness of xylitol in curbing caries varies among studies.
c. Calcium/Phosphate and Sodium Bicarbonate
Medicated mouthwashes may include calcium and phosphate, elevating their levels in the oral cavity. This supplementation aims to boost remineralization and fluoride uptake, contributing to overall dental health.
Additionally, sodium bicarbonate, known for its ability to increase salivary pH, emerges as an ally in caries prevention. By increasing saliva’s alkalinity, it creates an unfavorable environment for aciduric bacteria, impeding their growth. Moreover, sodium bicarbonate lessens enamel solubility and supports enamel remineralization.
B. Anti-plaque Agents
Anti-plaque agents found in mouthwash can indirectly contribute to gum health by targeting the factors that lead to plaque formation and bacterial growth, which are closely linked to gum problems and inflammation.
Here’s how these anti-plaque agents support gum health:
a. Sodium Lauryl Sulphate (SLS)
SLS inhibits the enzymes glucosyltransferase and fructosyltransferase, which play a role in the formation of plaque. By limiting the activity of these enzymes, SLS can help reduce the buildup of plaque on teeth and gums. This reduction in plaque can contribute to healthier gums and prevent the development of gum-related issues.
b. Triclosan
Triclosan is an antiseptic agent with broad-spectrum efficacy against various bacteria, including those that contribute to plaque formation. It acts by disrupting the microbial cytoplasmic membrane and causing lysis of microorganisms. While its primary function is to inhibit bacterial growth, triclosan also has anti-inflammatory effects by affecting the eicosanoid-cascade. By reducing bacterial load and inflammation, triclosan indirectly supports gum health.
c. Metal-ions (Zinc and Stannous)
Zinc and stannous ions are added to dental preparations to inhibit bacterial growth, restrict plaque formation, and affect bacterial metabolism. These ions limit the ability of plaque bacteria to convert carbohydrates to acids, which helps maintain a less acidic oral environment. By reducing acid production and bacterial growth, zinc and stannous ions indirectly contribute to gum health by preventing the conditions that lead to gum inflammation and disease.
d. Essential Oils
Essential oils like thymol, menthol, eucalyptol, and methyl salicylate possess antibacterial properties that alter the bacterial cell wall. Mouth rinses containing these oils have been shown to significantly reduce plaque and gingivitis. By targeting the bacteria responsible for plaque formation, essential oils help maintain a healthier oral environment that supports gum health.
e. Chlorhexidine
Chlorhexidine is a potent anti-plaque agent with prolonged broad-spectrum antimicrobial activity. It disrupts bacterial cell membranes, metabolism, and transport, leading to bacterial leakage and lysis. Chlorhexidine’s effectiveness against both Gram-positive and Gram-negative bacteria, as well as its antiviral properties, can contribute to a healthier oral microbiome. While typically used as an adjunct to tooth brushing, chlorhexidine’s plaque-inhibiting potential indirectly supports gum health by reducing bacterial load and inflammation.
C. Anti-Calculus Agents
Anti-calculus agents found in mouthwash contribute to gum health by targeting the formation and buildup of dental calculus (tartar), which is a key factor in gum problems and periodontal disease. These agents work to delay the calcification of dental plaque, leading to easier plaque removal through regular tooth brushing.
Here are the agents that support gum health in this context:
a. Pyrophosphate
Pyrophosphates help prevent tartar (calculus) from forming on the teeth. They have a strong attraction to the hydroxyapatite that makes up tooth enamel.
When pyrophosphates in toothpaste interact with the enamel surface, they block proteins and minerals from depositing on teeth and forming new tartar. This disrupts the early formation of calculus.
However, pyrophosphates can be broken down quickly in the mouth by saliva enzymes and bacteria. To extend the tartar-blocking activity, pyrophosphate rinses and toothpastes include agents that inhibit the enzymes. Fluoride also helps protect pyrophosphates from breaking down.
Pyrophosphate mouthwashes help keep calculus under control by interacting with enamel and preventing the initial attachment of plaque minerals. This maintains healthier gums by avoiding mineral buildup along the gumline. Using pyrophosphate toothpaste can be especially helpful if you are prone to heavy tartar formation.
b. Zinc
Zinc, known for its anti-plaque properties, also contributes to inhibiting calculus formation by preventing the growth of calculus crystals. By helping to prevent the buildup of calculus, zinc indirectly contributes to the prevention of gum-related problems and supports overall oral well-being.
D. Anti-aphtous Agents
Anti-aphtous agents found in certain toothpastes and mouthwashes offer benefits to individuals experiencing recurrent aphtous ulcers (RAU), which are painful sores or ulcers that develop inside the mouth:
a. Aminoglucosidase and Glucose Oxidase
Some people experience recurrent mouth ulcers or canker sores inside their mouth. These painful sores can make eating, drinking, and brushing very uncomfortable. Special oral care products can help reduce these mouth ulcers.
Enzymatic toothpastes and mouthwashes that contain aminoglucosidase and glucose oxidase enzymes have been shown to help inhibit mouth ulcers. Unlike regular toothpastes, they don’t contain sodium lauryl sulfate which can irritate mouth sores.
People who use these enzyme-containing products report smaller, less painful ulcers that heal faster and occur less often. This is because the enzymes help correct an imbalance in the mouth in a way that prevents the ulcers from forming as easily.
E. Anti-halitosis Agents
Bad breath, or halitosis, is a common problem that can originate from the gums, tongue, throat, or lungs. But bacteria on the teeth, gums, and tongue are a main culprit. As bacteria break down food in the mouth, they produce foul-smelling sulfur compounds that cause unpleasant breath odor.
Mouthwashes use ingredients called anti-halitosis agents to neutralize these odors and freshen breath. Popular examples include:
a. Zinc
Zinc inhibits the production of volatile sulfur containing compounds (VSCs) that cause bad breath. It interacts with the sulfur in amino acids and bacteria byproducts to prevent smelly sulfur gases forming. Zinc also sticks around in the mouth post-brushing to give longer lasting freshness and improved overall gum health.
b. Chlorine dioxide
This neutralizes sulfur gases and prevents bacteria from producing them, leaving a cleaner, fresher mouth.
c. Cetylpyridinium chloride (CPC)
The antibacterial properties of CPC reduce overall bacteria load, lowering VSC production.
d. Essential oils
Mint, eucalyptus, thyme, and tea tree oils have natural antibacterial effects to inhibit bacteria that cause malodor.
Impact of therapeutic agents on gum health
While the primary focus of anti-caries agents is on preventing tooth decay, these agents indirectly contribute to gum health through various mechanisms:
i. Reduced Bacterial Growth:
Fluoride and xylitol both possess anti-bacterial properties that inhibit the growth of harmful oral bacteria. By curbing the proliferation of bacteria like Streptococcus mutans, which are associated with cavities and gum problems, these agents help create an environment in the mouth that is less conducive to the development of gum issues.
ii. Enhanced Oral Environment:
Anti-caries agents like fluoride work to maintain an oral environment that is less acidic. This is crucial for gum health because acidic conditions can contribute to inflammation and gum disease. By preventing excessive acidity, these agents indirectly support the health of gums and oral tissues.
iii. Promotion of Remineralization:
Both fluoride and xylitol aid in remineralization, the process of repairing and strengthening tooth enamel. While the primary focus is on preventing cavities, stronger enamel also benefits the gums. Stronger teeth are more resistant to harmful bacteria and plaque buildup, which can have a positive impact on overall gum health.
iv. Balanced Microbiome:
By controlling the growth of harmful bacteria, these agents help maintain a more balanced oral microbiome. An imbalance in oral bacteria can lead to gum inflammation and disease. By fostering a healthier bacterial balance, anti-caries agents indirectly contribute to gum health.
v. Reduction in Plaque Formation:
Plaque, a sticky film of bacteria that forms on teeth, is a common precursor to both cavities and gum issues. The action of fluoride and xylitol in inhibiting bacterial growth and promoting enamel health contributes to a reduction in plaque formation. This, in turn, helps protect the gums from inflammation and disease caused by the presence of harmful bacteria.
vi. Reduction in mouth sores
For those prone to frequent, painful canker sores, using oral care products containing aminoglucosidase and glucose oxidase enzymes (anti-aphtous agents) can help improve gum health by reducing mouth ulcer episodes. This provides relief from the discomfort ulcers can cause while eating, drinking, and brushing.
Incorporating Medicated Mouthwash into Your Routine
Incorporating medicated mouthwash into your daily oral care routine is a straightforward yet impactful step. It complements the basic practices of brushing and flossing, enhancing their effects.
- When using medicated mouthwash, remember to follow the manufacturer’s instructions carefully.
- Gargling and swishing the mouthwash vigorously allows it to reach areas that might be challenging to access through brushing alone.
- The ideal timing for using medicated mouthwash is after brushing and flossing, ensuring a comprehensive clean for your oral cavity.
This routine practice not only aids in maintaining gum health but also contributes to a fresher and more pleasant breath.
Final Thoughts
Medicated mouthwash isn’t just another addition to your oral care arsenal – it’s a targeted solution for improving your gum health. Its carefully curated ingredients work in harmony to combat plaque, alleviate discomfort, and prevent cavities and erosion.
By making medicated mouthwash a consistent part of your daily routine, you empower yourself to enjoy stronger, healthier gums that form the foundation of your radiant smile.
References
https://www.duo.uio.no/bitstream/handle/10852/33076/Storehagen_Ose_Midha.pdf
