September 21, 2020
One of the biggest advances made in controlling the plaque build-up in the oral cavity is the formulation of mouthwashes. These are chemicals that are held in the mouth, gargled and expectorated after a certain time period. During this process, the chemicals in the mouthwashes act in a way that plaque content significantly reduces.
Mouthwashes can be broadly classified as cosmetic and therapeutic. Cosmetic mouthwashes are the ones that do not carry any medical value. They solely act as mouth fresheners that carry a certain fragrance or flavour. Therapeutic mouthwashes on the other hand are widely beneficial when it comes to maintaining oral health. These can be either antibacterial or antiseptic in nature. This article discusses how both these therapeutic mouthwashes can be differentiated from one another.
Plaque is formed when certain species of bacteria colonise the tooth surface under conditions that promote their growth. If this growth of bacteria is not controlled, it can ultimately turn into a calculus, inflammate the gingiva and cause a swelling in the surrounding tissues. The act of toothbrushing and flossing is how we routinely control the growth of these microbes. In order to ensure even more efficacy of controlling plaque, mouthwashes can be used. The mouthwashes used in this case are antibacterial.
These mouthwashes contain cetylpyridinium chloride, delmopinol hydrochloride and essential oils. These constituents regress and inhibit the growth of the bacteria in the plaque. The plaque contains a thin layer called biofilm. Antibacterial mouthwashes act on this biofilm and prevent any other bacteria from attaching to the tooth surface. Essential oils act on the sulphide content in the oral cavity. These sulphur compounds are responsible for the bad breath that comes out of the mouth if oral hygiene is not maintained properly.
Antibacterial mouthwashes may or may not contain fluoride. Fluoride content in a tooth is necessary for it stay protected from caries. These mouthwashes can be used on a daily basis, twice a day. They have very less side-effects and are only rarely irritating to the gum tissues in the mouth.
In contrast to antibacterial mouthwashes that target only the bacterial species, antiseptic mouthwashes target spores, fungi and virus too. These contain chlorhexidine in a concentration of 0.2%. The most peculiar feature of chlorhexidine is its substantivity. This means that chlorhexidine can bind to certain proteins in the oral cavity and can gradually release their effect over a prolonged period of time. Thus, their anti-microbial action stays for a longer time.
The alcohol content of these mouthwashes helps it in eliminating a range of microbes from the oral cavity. These mouthwashes also contain sodium bicarbonate, triclosan, sodium chloride and other compounds that have an antiseptic activity. They have a great penetration power and can neutralize the acids in the mouth. When the acids are neutralized, it becomes difficult for a majority of microbes to survive in a lesser acidic environment.
The rich antiseptic content in these mouthwashes is thus used to tackle mouth ulcers, erosion of the lining of the oral cavity, infections, foul odour, etc. These mouthwashes are also used before and after oral surgeries in order to ensure a sterile mouth in both cases. Unlike antibacterial mouthwashes, antiseptic mouthwashes are prescribed for 2 to 4 weeks and need to be taken in amounts ranging between 10-15 ml. They should be expectorated after 30 seconds and should be used twice daily.
Antiseptic mouthwashes are said to cause staining of the teeth (even on dentures), susceptibility to calculus, dryness of the mouth and altered taste. The alcohol content might be irritant at times and red lesions have been reported in the past. However, these mouthwashes can be diluted in water to adjust for the irritation. Moreover, these side-effects are rare and if followed as per instructions, they can be immensely useful as broad-spectrum therapeutic agents. Antiseptic mouthwashes can also be used during pregnancy. This is because chlorhexidine is poorly absorbed by the inner linings of the vital organs and hence do not reach the foetus.
Thus, antibacterial and antiseptic mouthwashes need to be prescribed by the dentist based on the condition of the oral cavity. If the target is plaque control, an antibacterial mouthwash will do the trick. But, if a more severe condition is present, an antiseptic mouthwash can be fruitful in combating a range of pathogens.