Potential Erosive Effect of Mouthrinses on your Teeth

June 4, 2018

Mouthrinses are a common oral health adjunct among dental patients because the products are easy to use, can remineralize tooth structures, and possess antimicrobial properties. Their use is also often recommended to patients by clinicians and dental hygienists. Many mouthrinses are available, and it is important to understand their classification, components, benefits, and risks.

 

The Good Aspects:

 

Among the commercially available, over-the-counter mouthrinse products, those containing essential oils (EOs) and cetylpyridinium chloride (CPC) are dominating the market.

 

Over-the-counter mouthrinses containing EOs contain eucalyptol, methyl salicylate, and thymol as well as an alcohol content that varies from 20% to 27%. The mechanisms of action of an EO are the rapid disruption of enzymes that form biofilm, the creation of antioxidant activity, and the reduction of both the endotoxin levels and pathogenicity of the plaque. 

 

CPC mouthrinses have a broad antimicrobial spectrum but have shown less benefit than  EOs in controlling plaque reduction and gingivitis.  CPC is a quaternary ammonium compound that interacts with the bacterial wall, inhibiting cell growth and possibly bacterial metabolism.

 

The Bad Aspects: 

 

While mouthrinses are beneficial for reducing plaque and gingivitis, it is important that they do not increase the risk of dental erosion or root caries. The critical pH for enamel and dentin is the point at which tooth structure begins to dissolve. In enamel, the critical pH ranges from 5.2 to 5.5, whereas for root dentin it is much higher (6.7)

 

The pH values of many mouthrinses were tested more than 20 years ago, and the majority of the mouthrinses were acidic; some had a pH as low as 3.40.

 

Let's Break it Down: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Good: Essential Oils Based

Bad:    pH 3.43

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Good: Essential Oils Based

Bad:    pH 3.87

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Good: Essential Oils Based

Bad:    pH 3.98

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bad: 

Cetylpyridinium Chloride Based

 

Bad:  pH 5.18

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Good: 

Essential Oils and

Cetylpyridinium Chloride Based

Good:  pH 6.31

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bad:  

Cetylpyridinium Chloride Based

 

Good: pH 7.05

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Summary: The Bottom Line

 

The majority of the mouthrinses tested possess an acidic pH; however have the benefit of better plaque control by being essential oils based.  Those rinses which are less effective in plaque control, namely those that are cetylpyridinium chloride based, do have the benefit of having a less acidic pH and therefore may be better for people who generally have sensitive teeth or areas of dentin exposure either due to excessive areas of tooth wear or from acid erosion. 

 

If you're looking for the best plaque control, and do not have sensitive teeth or excessive areas of tooth wear, then stick with rinses that are EO based, ie. Listerine. 

 

If you suffer from sensitive teeth, but want a rinse that will provide adequate plaque control, Act Total Care seems to be a better choice than Crest Pro-health.

 

Scope Classic seems to be a poor choice overall.  

 

Finally, clinicians should use caution when recommending mouthrinses which are acidic in nature for those patients who have xerostomia (dry mouth), acid reflux, or have a diet high in acidic foods and drinks. 

 

The above information is based on the following study:

 

Potential erosive effect of mouthrinses on enamel and dentin Alex J. Delgado, DDS, MS, Anna Paula Dias Ribeiro, DDS, MS, PhD, Alejandro Quesada, DMD Luis E. Rodríguez, DMD, Rosa Hernández, DMD, Bonita Wynkoop, DDS, Deborah A. Dilbone, DMD. 

 

Received: August 10, 2017 Revised: October 28, 2017 Accepted: November 21, 2017. 

Academy of General Dentistry 

 

 

 

 

 

 

 

 

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