When you walk down the oral health aisle at any drug store you’ll find no shortage of mouthwashes to choose from, but what are the benefits of mouthwash, and what are the risks?

While mouthwash is not a replacement for daily brushing and flossing, using mouthwash (also known as ‘mouth rinse’) can be a helpful addition to your daily oral hygiene routine. Given the wide range of ingredients in mouthwashes on the market, figuring out if you need one and which one to choose can be perplexing.

Broadly speaking, there are two types of mouthwash: cosmetic and therapeutic.

Cosmetic mouthwash may temporarily control bad breath and provide a fresh, pleasant taste, but that’s about it. Therapeutic mouthwash has active ingredients intended to help control or reduce specific conditions like bad breath, gingivitis, plaque, and tooth decay. Some active ingredients commonly found in therapeutic mouthwash include cetylpyridinium chloride, chlorhexidine, essential oils, fluoride, or peroxide. You may use a cosmetic mouthwash to mask bad breath, but you would need a therapeutic mouthwash to actually kill the bacteria that cause the bad breath.

So what are the benefits of mouthwash?

1. It helps remove debris

Mouthwash is a liquid so it offers the benefit of reaching areas that a toothbrush just can’t get to. Adding mouthwash to your brushing routine can clear debris and loosened plaque on your teeth that have been left behind. Rinsing with water would have the same benefit but one of the benefits of mouthwash is that it freshens your breath as well and that is very appealing to some people.

2. It can reduce the number of bacteria in the mouth

A therapeutic mouthwash can help prevent gum diseases such as gingivitis by reducing the amount of plaque and bacteria trapped in your mouth. The bacteria from gum infections can cause certain pregnancy complications when it enters a woman’s bloodstream and you can reduce this risk by rinsing with a mouthwash on a regular basis. A therapeutic mouthwash with fluoride can help reduce cavities and demineralization of your teeth when used on a regular basis as well.

3. It can whiten your teeth

A mouthwash won’t have quite the same impact as a whitening treatment, but one of the benefits of some therapeutic mouthwashes is a whitening effect over time. If that is your goal, look for a mouthwash that contains carbamide peroxide or hydrogen peroxide as one of the active ingredients. You do need to be careful which mouthwash you choose though because one of the most common side effects of antibacterial mouthwashes is tooth staining. If you’re stuck on which mouthwash to choose for whitening properties, ask your dentist because we are able to prescribe stronger mouthwashes than you’d find on store shelves.

On top of those 3 benefits, many people choose to use mouthwash purely because it makes their mouth feel fresh and clean, but there are some risks you should be aware of as well.

1. Oral cancer & dry mouth

Alcohol-based mouthwashes are the kind that you find in most grocery stores but they can have some serious side effects. The alcohol itself can dry out your mouth and lead to bad breath which is likely what you’re trying to avoid by using a mouthwash to begin with. There is an ongoing debate about whether alcohol-based mouthwashes increase your risk for oral cancer. This is still being researched and a recent systematic review and meta-analysis failed to find an association between alcohol-based mouthwash use and oral cancer but the jury is still out on this.

2. It could raise your blood pressure

There are studies that have indicated that regular use of mouthwash could increase your blood pressure because it eliminates some of the beneficial bacteria found in the mouth. Not all bacteria is bad bacteria and mouthwash can eliminate the bacteria responsible for producing nitric oxide that helps in protecting your cardiovascular system.

3. It can eliminate good bacteria

When you wipe out all of the bacteria in your mouth, you wipe out your first line of protection against invading bacteria. For this reason, using mouthwash can increase your risk of getting infections like H Pylori and C-difficile. Antibacterial mouthwash can increase your risk of gut inflammation that can lead to increased intestinal permeability and contribute to food intolerances, food allergies, and even some gut-related autoimmune diseases.

Whether you choose to use a mouthwash or not, you should know that mouthwash of any kind is not recommended for children younger than 6 years of age. The swallowing reflexes of children this young may not be well developed and that can result in them swallowing large amounts of mouthwash which can trigger nausea, vomiting, and intoxication (due to the alcohol content in some mouthwashes).

When shopping for a mouthwash, consider what the most important benefits of mouthwash are for you. Look for alcohol-free options so that you don’t have to worry about the risks associated with an alcohol-based mouthwash. Be sure to look for an ADA approved mouthwash and check to make sure it addresses the issues you’re looking to treat. If you find yourself unsure, don’t hesitate to ask your dentist for help!