Is Mouthwash Bad for You? Best Mouthwash + Risks and Alternatives

Updated on

by

Hi, I’m Dr. B, practicing functional dentist for 35 years. I graduated from the Dugoni School of Dentistry in San Francisco, CA in 1987 and am a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry (Chicago, IL), American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. I'm on a mission to empower people everywhere with the same evidence-based, easy-to-understand dental health advice that my patients get. Learn more about Dr. B

We’ve all seen the commercials — just 30 seconds of swishing mouthwash and your teeth will be whiter, your gums will be healthier, and all your bad breath problems will disappear! Except… That’s not really what’s happening.

In fact, I consider mouthwash to be one of the top dental mistakes made by both dentists and their patients.

Marketing propaganda aside, it’s important to understand that mouthwash isn’t just a way for manufacturers to make more money. Not only will mouthwash not live up to the claims spouted in expensive commercials and on flashy labels, but conventional mouthwash can actually make your dental and oral health problems worse.

A 2019 study underscores that even conventional dental science rejects the importance of mouthwash. They state:

“Technological advancements have revolutionized our understanding of the complexity and importance of the human microbiome. This progress has… underscored the dilemmas, such as dysbiosis and increasing antibiotic resistance, associated with current, broad-spectrum treatment modalities.

“Remodeling of the dental plaque community is expected to have significant advantages compared to conventional broad-spectrum mouthwashes, as the intact, surviving community is apt to prevent reinfection by pathogens.”

In plain terms, this means that mouthwash and other bacteria-killing options developed to prevent and heal dental disease don’t work. They don’t work because they harm the most important immunity tool your oral health has: the oral microbiome.

Let’s look at issues with using popular mouthwashes, how to choose a better mouthwash, and a better way to promote good oral health.

Disclosure:
Ask the Dentist is supported by readers. If you use one of the links below and buy something, Ask the Dentist makes a little bit of money at no additional cost to you. I rigorously research, test, and use thousands of products every year, but recommend only a small fraction of these. I only promote products that I truly feel will be valuable to you in improving your oral health.

The Problems with Conventional Mouthwash

Following are the major problems with the popular mouth rinses found on grocery and drugstore shelves:

Mouthwash wrecks your oral microbiome

Think of mouthwash as the equivalent of unnecessary antibiotics in your mouth. In the same way that antibiotics totally disrupt the balance of bacteria in your gut (which can lead to poor immune function and a host of other problems), mouthwash destroys all bacteria indiscriminately.

And just like you need them for gut health, you need good bacteria to support your oral microbiome, which can decrease the risk for common issues like cavities, gingivitis, and bad breath.

Mouthwash dries out your mouth

It’s incredibly important to have sufficient saliva in your mouth, as it supports the process of remineralization, helping you prevent and reverse cavities naturally. Unfortunately, mouthwash disrupts the mouth’s natural production of saliva.

Toothpaste contains anionic compounds to kill bacteria that remain after brushing; meanwhile, the high alcohol content in mouthwash contains cationic compounds that neutralize what your toothpaste has left behind. The reaction between these two types of compounds creates a drying effect in your cheeks and mouth.

Some people even experience painful reactions because of this reaction, including sloughing of skin inside the mouth.

Mouthwash may actually cause more cavities

Contrary to popular belief, the killing of “99.9% of germs” does not actually aid your dental health by preventing cavity formation.

First of all, your oral microbiome exists to help support the natural remineralization of your teeth. If you kill all the bacteria in your mouth (both good and bad), you eliminate a critical part of the equation in reversing tooth decay.

Saliva is another key component of the remineralization process, and as previously explained, saliva is typically reduced with mouthwash use. Saliva serves to disorganize the oral bacteria that can cause decay, while also depositing important minerals like phosphorus, magnesium, and vitamin K2 onto the teeth.

Mouthwash doesn’t truly correct bad breath

Don’t let the minty flavor fool you; conventional mouthwash may taste good, but they don’t actually reverse halitosis. Because the alcohol in mouthwash dries out your oral environment, you inadvertently rob your mouth of the saliva and good bacteria it needs to manage breath.

They might lead to the formation of mouth ulcers

The drying of your mouth results in more than bad breath. Because the neutralization of your toothpaste compounds and mouthwash compounds actually impacts your cheek’s protective layer, it’s possible that using conventional mouthwash can create ulceration, or the formation of a hole in your tissue.

Mouthwash is linked to oral cancer risk

While the science is still unclear, it seems likely that alcohol-containing mouthwashes may increase your risk for oral cancer. One underlying reason for this link may be the fact that people who smoke tend to use mouthwash more often to cover the odor, which exacerbates their risk for oral cancer. 

Mouthwash burns — and the “why” may surprise you. Part of the reason Listerine and other mouthwashes burn in the mouth is that they contain ingredients that are mildly irritating to the skin, like eucalyptol, menthol, thymol, and methyl salicylate.

The other reason is that these mouthwashes can’t entirely destroy all the germs in your mouth—instead, they dissolve the ingredients into your gums, teeth, and tongue, which causes that familiar burning sensation.

Mouthwash Ingredients to Avoid

As you can see, mouthwashes can create a host of problems, largely due to the ingredients they contain. Here’s a look at the worst offenders.

1. Alcohol

Conventional mouthwashes contain about 26% alcohol, in the form of ethanol. This is actually a higher percentage than what’s found in beer, and the alcohol is what causes drying of the mouth.

A dry mouth can then lead to worsened bad breath, sloughing of the skin on the inside of your cheeks, and an overly acidic pH in your mouth—all of which interfere with remineralization.

2. Chlorine Dioxide

Defined by the CDC as a “hazardous gas,” chlorine dioxide is a bleaching agent and antibacterial compound used in mouthwash to help whiten teeth. It’s also used to treat public water supplies in very small doses.

3. Chlorhexidine

Chlorhexidine is the main ingredient in mouthwash that serves as an antiseptic to kill bacteria. Unfortunately, it’s also a major allergen. The most common reaction to chlorhexidine is contact dermatitis, but, in rare cases, some people can go into anaphylactic shock when exposed to it.

4. Cocamidopropyl Betaine

Cocamidopropyl betaine is a surfactant (an ingredient used in personal care products to make them foam more) that may cause contact dermatitis allergic reactions. The Environmental Working Group (EWG) rates it as a “moderate hazard” as an ingredient.

5. Parabens

In varying degrees, parabens are endocrine disruptors that may also impact and encourage allergic reactions.

6. Poloxamer 407

This detergent ingredient in mouthwash is known to cause hyperlipidemia in animals, although human research is unclear whether the impact extends to humans.

7. Formaldehyde

Yes, you read that right—the stuff used to embalm bodies is found in many types of mouthwash. There are a number of dangers of formaldehyde exposure, including skin reactions, elevated cancer risk, respiration problems, and multi-system shutdown (at huge doses).

8. Saccharin

To avoid using refined sugar, mouthwashes will sometimes include saccharin as a substitute sweetener. The health risks of this ingredient are unclear — some sources suggest it’s a potential cancer risk, while others suggest it has no traceable health drawbacks.

At any rate, I personally try to stick to only the healthiest natural and non-nutritive (zero-calorie) sweeteners, such as stevia.

Are All-Natural Mouthwashes Okay?

I’m not typically a fan of mouthwashes, but there are some natural options out there that are much safer than conventional options.

Be advised that, like their conventional counterparts, natural mouthwashes cannot truly whiten teeth or permanently freshen breath.

If you don’t want to give up mouthwash as a part of your daily dental hygiene routine, try one of the best natural mouthwashes on the market:

1. Aesop Mouthwash

Aesop is a skincare line in Australia. Their mouthwash is free of alcohol and contains clove bud, aniseed, and spearmint essential oils. Because some of these essential oils are antibacterial and can cause an imbalance in the oral microbiome, I don’t recommend using it too often.

2. Oral Essentials

Made with Dead Sea salt, which is rich in minerals, Lumineux by Oral Essentials is a mouthwash created by dentists. The salt in it will help to aid in remineralization, while the holy basil oil it contains works as an adaptogen to help you reduce stress levels. It also contains aloe vera juice to soothe and heal the mouth.

Image alt

Oral Essentials

Buy Now!

3. Georganics Coconut Pulling Mouthwash

Leveraging the Ayurvedic principle of oil pulling, this mouthwash may come closest to improving bad breath long-term. The coconut oil it contains has antiviral, antifungal, and antibacterial properties that can destroy bad bacteria in the mouth while preserving the good bacteria.

My Pick
Image alt

Georganics Coconut Oil Pulling Mouthwash

Buy Now!

4. DIY Mouth Rinses

Homemade mouth rinses are a great alternative to both conventional and natural mouthwashes because you get to control exactly what goes in them. Try my Remineralizing Mouth Rinse if you’re looking to reverse tooth decay or my pH Balancing Mouth Rinse if you want to keep bacterial overgrowth and tooth decay at bay.

How to REALLY Eliminate Bad Breath, Stains, and other Issues

You’ll never truly fix issues with your teeth, gums, or breath without first fixing your diet. By eating an excess of refined carbohydrates, sugar, and acidic and processed foods, you create an oral environment that will cause an overgrowth of bad bacteria and the accompanying cavities, stains, imbalanced pH, and bad breath.

People often use mouthwash to eliminate bad breath, but the best way to get to the root cause of halitosis is to eat a diet high in calcium, vitamin D, pH Balancing Mouth Rinse, magnesium, and phosphorus, and to supplement to fill in any nutritional gaps.

You should also avoid:

  • Phytic acid (found in wheat, beans, rice, corn, etc.)
  • Simple starches (pasta, white bread, white rice)
  • Sugary foods or drinks
  • Dried fruits
  • Acidic foods and drinks

I also recommend tongue scraping. There is gunk on your tongue, and scraping it off is much more effective than trying to dissolve it with mouthwash.

Scraping your tongue is associated with some incredible benefits, from being able to taste your food better to improving digestive health. It also helps to prevent cavities and eliminate bad breath.

Overall, when your oral bacteria are in good balance and you practice good dental hygiene by brushing and flossing, your mouth is able to work as it should, balancing pH, disorganizing plaque, and supporting fresh breath.

Key Takeaways: Mouthwash

Conventional mouthwash is not nearly as helpful as it’s been purported to be. It destroys the bacterial balance in your mouth, dries out the skin, causes imbalances in pH levels, worsens bad breath, may cause mouth ulcers and increase your risk for oral cancer, and it may contribute to the development of gingivitis.

To avoid these potential consequences, work to get to the root cause of your dental issues and eliminate your need for mouthwash in the process. And if you must use a mouthwash, switch to an all-natural option, or try one of my favorite DIY recipes.

Learn More: 3 All-Natural Mouthwashes + 3 DIYs to Help Break Your Listerine Habit

4 References

  1. Baker, J. L., He, X., & Shi, W. (2019). Precision reengineering of the oral microbiome for caries management. Advances in dental research30(2), 34-39. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/31633390
  2. Warnakulasuriya, S. (2009). Causes of oral cancer–an appraisal of controversies. British dental journal207(10), 471. Abstract: https://www.researchgate.net/publication/40039456_Causes_of_oral_cancer_-_An_appraisal_of_controversies
  3. Warren, A., Benseler, V., Cogger, V. C., Bertolino, P., & Le Couteur, D. G. (2011). The impact of poloxamer 407 on the ultrastructure of the liver and evidence for clearance by extensive endothelial and Kupffer cell endocytosis. Toxicologic pathology, 39(2), 390-397. Full text: https://journals.sagepub.com/doi/full/10.1177/0192623310394212
  4. Montanaro, A. (1996). Formaldehyde in the workplace and in the home: exploring its clinical toxicology. Laboratory Medicine27(11), 752-758. Abstract: https://academic.oup.com/labmed/article/27/11/752/2503527