An update on mouthwashes: advice for dental practitioners

Due to their antimicrobial constituents, mouthwashes are well-known to be clinically effective for reducing plaque biofilms containing bacteria and reducing gingival inflammation. However, with a variety of products now available (often containing more than one active ingredient), it is important to consider which chemical constituents are most suitable for different types of oral disease and how mouthwashes should be best used. This article thus updates professionals on techniques for use and which agent to select, using current professional guidelines and the highest level of evidence available. As examples, clinicians need to be aware of adjunctive approaches for mouthwash use and 'spit don't rinse with water' instructions. However, there is currently insufficient evidence on mouthwashes and the oral microbiome (including systemic health) to support microbiome testing to guide a choice. After consulting the literature, this article reiterates that adjunctive fluoride mouthwashes, alongside effective toothbrushing and interdental cleaning, are effective for preventing dental caries. Adjunctive chlorhexidine, essential oils and/or cetylpyridinium chloride mouthwashes may also be effective for managing plaque-induced periodontal diseases at early stages. Some possible risks to mouthwash use are highlighted, including allergies, tooth staining and oral microbiome dysbiosis. Until more evidence is available, clinicians should ensure that benefits outweigh risks and refer to current mouthwash guidelines to support personalised preventive care advice.