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Posted on August 15, 2014
Mouthwash for children; benefit or snake oil?

The foundation of any oral health program is going to have to center on the regular and frequent removal of plaque. There is simply no substitute for brushing teeth to physically remove the bacterial and acidic plaque for your kids. But in the real world, what can you do if the brushing is not perfect or your child seems more prone to cavities? And what about nasty breath coming from my little angel? For the answers to these questions, Parents often turn to mouthwashes. The marketing gurus of the world are aware of this and have begun to compete for that business. I took a little trip down the grocery store aisle recently to give parents a little review about what’s out there and what they really accomplish.

First let’s do a little orientation. Toothpaste, in all its forms and colors, really only have three main components: Fluoride (anticavity), silica (abrasives to scour teeth), and detergents (foam to lift plaque away and down the sink). Fluoride is the only active ingredient in most toothpastes, meaning it has been clinically shown to prevent cavities. The rest of those ingredients, in both toothpaste and mouthwash, have not had enough scientific studies to warrant the FDA to support their claim. In other words, the rest is marketing! That’s why reading the labels is more important than the covers.

Fluoride comes in toothpaste at 0.243%, that’s equal to about 1100 parts per million or 11mg/liter of fluoride compared to water which is at 1ppm or 1mg/liter of fluoride. This is important to know comparing toothpaste to mouthwash, because if the mouthwash has less fluoride that the toothpaste, what will mouthwash do better that toothpaste? Nothing, UNLESS your child is brushing twice a day with toothpaste(the foundation) and rinsing at separate times with mouthwash to increase the oral exposure to fluoride. In most households, doing oral care three or four times a day is simply not at reality and what you may be doing is rinsing expensive mouthwash down the sink, or diluting the effects of your toothpaste! With that in mind, I usually DO NOT recommend mouthwash for a child more prone to cavities. I set up the child up with prescription strength toothpaste or other protocols you can ask your dentist about designed to lower the cavity risk. If you would like me to help you, just send me an email with questions.

Without further ado, a review on mouthwashes in no particular order:

ACT Mouthwash: This product has been around and has good brand recognition. In comes in child and adult but the only difference is in flavor choice, not strength. Both child and adult mouthwashes have Sodium Fluoride at 0.05%. This fluoride concentration is one fifth the concentration of toothpaste. It also contains alcohol and cetylpyridium chloride (read scope) to act as a weak antibacterial and cosmetic breath freshener. Sorbitol and saccharin make it sweet which bacteria can use only a tenth as well as sugar. The Restoring ACT is even worse at only 0.02% fluoride. This would only give the minimal amount of boost to an oral hygiene program. And be careful about the adult flavor cinnamon, some people have a food allergy to cinnamon. The only thing I like about ACT is the neat dispenser top that only lets out 15ml at a time.

Crest ProHealth: This is a new mouthwash that, sadly, has the Crest name on it. Crest used to be synonymous with the ADA seal of approval, but the Pro Health is pure marketing and not honest. Pro Health only contains cetylpyridium chloride, that weak breath freshener, and no fluoride. This is nothing more than a cosmetic mouthwash despite all its claims. It is not appropriate for child use in my opinion.

Listerine: This company has flooded the market recently with new mouthwashes that are TOTALLY different from their old line. Regular Listerine is a mouthwash I recommend all the time. I like the essential oils that have been shown to reduce gum inflammation as well as the gold standard, prescription only Chlorhexidine. But, when Listerine markets to kids, they are not using that formula.

Smart Rinse: This is a fluoride mouthwash containing 0.02% fluoride. It is the weakest on the market and only 2ppm fluoride. Heck, most tap water is half as strong as this! I wouldn’t waste your money and think this mouthwash would be much use at all. Sure tastes good though!

Agent Cool Blue: This is not mouthwash at all but a disclosing agent. Remember those old red coat tablets the dentist would make you rinse with to show where you missed brushing? Well, Listerine put that concept into a product. If you want to test your kid’s brushing, have them rinse with this stuff after they brush and the missed areas turn blue. At least that is what is supposed to happen. A close read of the label shows they accomplish with blue stain with food coloring. Expensive food coloring. A much better idea would be to ask your dentist for the red coat tablets. And remember, Cool Blue has no fluoride!

Peroxyl: I had a Mom tell me her dentist sent her to the Pharmacy for this product, and she paid $12 for it. It is over the counter for $6 and still too expensive. Peroxyl is simply stabilized hydrogen peroxide in dilute form. Its intent is to speed healing by cleaning soft tissue cuts and ulcerations. It works okay, but can be made for CHEAP (dilute hydrogen peroxide with water 50/50 and swish the bubbles!).

Oasis: This mouthwash is marketed toward adults with dry mouth. It has glycerin which is a lubricator and is alcohol free. No fluoride, so it would mainly be to freshen breath without the drying effect of alchohol.

Plax: This product was the laughing stock of dental school from their claim it preventing cavities by 300% over brushing. Their use of statistics was appalling! Nevertheless, Plax is still around and it will make your teeth feel cleaner. The alcohol dries tissue to make it “zing”, the sorbital and glycerin coats your teeth to make them slick. The thing I did learn was Plax is the only mouthwash that contained tetrasodium pyrophosphate, a product touted to prevent calculus build up. That’s a nice touch, but probably not is the modality to make it effective.

There you have it! My kids love mouthwashes; they have fun pictures and seem grown up. But, the bottom line for me is it is no replacement for good brushing. And, we don’t spend money and products that don’t do anything for us, well except ice cream, movie popcorn, decaf latte’s ……

As always, don’t hesitate to write with questions. I am here to help. Yours, Dr. Greg Evans