Painful Reaction After Using Crest Pro Health Mouthwash

Q:Hello Dr. B,
I’ve been using Crest Pro Health for several months now, and each time I use it I notice that the skin on the inside of my mouth sloughs off immediately after I finish brushing. I was wondering if this was potentially harmful.

I’ve checked the Crest website, and apparently, I’m not the only person to have this problem; however I haven’t been able to determine if it’s simply a side effect or if it may actually be harmful. Any suggestions?

Thanks!

- Kim M. from Albuquerque, NM

A:Most remember the DuPont advertising slogan, “Better things for better living…through chemistry.”

Quite the contrary. I have never been a fan of mouthwash. Besides taking up precious counter space in the bathroom and taking away a few precious minutes from your day (robbing you of flossing time) it is equal to only a very small percentage of the equation in keeping your teeth and mouth healthy.

It’s become common folklore that we can use mouthwash in a pinch instead of brushing or flossing. Listerine helped feed this notion by funding studies that suggested that this was true: “It’s clinically proven – a quick, easy rinse with Listerine Antiseptic twice a day is actually as effective as floss,” the flashy TV commercial states. Animation shows streams of Listerine flowing around teeth, magically removing bits of food and plaque. Many lawsuits later, it was determined that these advertisements were false and misleading.

Here’s why mouthwash cannot replace brushing and flossing. In your question, you indirectly bring up an important point – that mouthwash can only clean chemically. It relies on the chemicals to do the removing and killing of the bacteria in the mouth. A toothbrush and floss achieve the same effect by making actual contact with plaque and bacteria and disorganizing them, all with out chemicals. But the chemicals in mouthwash can make contact with the key surfaces only after you brush and floss!

For mouthwash to work, the teeth and the gums have to be exposed. If you use mouthwash without removing that layer of plaque on your teeth and gums first, the chemicals cannot make contact with the surfaces you’re trying to clean. This might make it sound like the best time to use mouthwash is right after brushing – but there’s a caveat!

Toothpaste contains anionic compounds that kill bacteria in the mouth – and these anionic compounds remain in your mouth even when you finish brushing and spit out your toothpaste. The caveat is that mouthwash contains cationic compounds, which act as surfactants and thus neutralize the anionic compounds from your toothpaste.

This neutralization effect caused by mouthwash is what I believe is causing your problem. It is drying out the protective layer of your cheeks and may even be the beginning of mouth ulcers. (Ulceration is a break-down, or hole, forming in your tissue.)

My recommendation to you is to discontinue using mouthwash altogether and choose a toothpaste without sodium lauryl-sulfate (which is the source of the anionic compounds). Immediately discontinue use of Crest Pro Health Care, which contains cetylpyridinium chloride (which contains the cationic charge). Brush and floss after every meal to maintain healthy teeth and gums – it’s old-fashioned and isn’t backed by any swanky advertising campaigns, but it works!

Mark Burhenne DDS

What experiences have you had with mouthwash? Join the discussion and leave a comment below!