||It has been suggested that Oil pulling be merged into this article. (Discuss) Proposed since March 2014.|
Mouthwash, mouth rinse, oral rinse or mouth bath, is a liquid which is held in the mouth passively or swilled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.
Usually mouthwashes are an antiseptic solution intended to reduce the microbial load in the oral cavity, although other mouthwashes might be given for other reasons such as for their analgesic, anti-inflammatory or anti-fungal action.
The most common use of mouthwash is commercial antiseptics, which are used at home as part of an oral hygiene routine. Some manufacturers of mouthwash state that antiseptic and anti-plaque mouth rinse kill the bacterial plaque that causes cavities, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both brushing and flossing. The American Dental Association asserts that regular brushing and proper flossing are enough in most cases, although they approve many mouthwashes that do not contain ethanol (in addition to regular dental check-ups). For many patients, however, the mechanical methods could be tedious and time-consuming and additionally some local conditions may render them especially difficult. Chemotherapeutic agents, including mouthrinses, could have a key role as adjuncts to daily home care, preventing and controlling supragingival plaque, gingivitis and oral malodor. Another common use of mouthwash is prior to and after oral surgery procedures such as tooth extraction. The number of mouthwash variants in the U.S. has grown from 15 (1970) to 66 (1998) to 113 (2012).
- 1 Use
- 2 Typical formulation of commercial mouthwashes
- 3 Custom formulations ("magic mouthwash")
- 4 Specific mouthwash ingredients
- 4.1 Alcohol
- 4.2 Benzydamine (Difflam)
- 4.3 Betamethasone
- 4.4 Cetylpyridinium chloride
- 4.5 Chlorhexidine digluconate
- 4.6 Essential oils
- 4.7 Edible oils
- 4.8 Fluoride
- 4.9 Hydrogen peroxide
- 4.10 Phenol
- 4.11 Providone/iodine
- 4.12 Sanguinarine
- 4.13 Sodium bicarbonate (baking soda)
- 4.14 Sodium chloride (salt)
- 4.15 Sodium lauryl sulfate
- 4.16 Tetracycline
- 4.17 Tranexamic acid
- 4.18 Triclosan
- 5 Example brands of common commercial mouthwashes
- 6 History
- 7 Research
- 8 References
- 9 External links
Common use involves rinsing the mouth with about 20ml (2/3 fl oz) of mouthwash. The wash is typically swished or gargled for about half a minute and then spit out. Most companies suggest not drinking water immediately after using mouthwash. In some brands, the expectorate is stained, so that one can see the bacteria and debris. Mouthwash should not be used immediately after brushing the teeth so as not to wash away the beneficial fluoride residue left from the toothpaste. Similarly, the mouth should not be rinsed out with water after brushing. Patients were told to "spit don't rinse" after toothbrushing as part of an National Health Service campaign in the UK.
Gargling is where the head is tilted back, allowing the mouthwash to sit in the back of the mouth while exhaling, causing the liquid to bubble. Gargling is practiced in Japan for perceived prevention of viral infection. One commonly used way is with infusions or tea. In some cultures, gargling is usually done in private, typically in a bathroom at a sink so the liquid can be rinsed away.
Typical formulation of commercial mouthwashes
Each commercial brand of mouthwash has different ingredients. The active ingredients are usually alcohol, chlorhexidine gluconate, cetylpyridinium chloride hexetidine, benzoic acid (acts as a buffer), methyl salicylate, triclosan, benzalkonium chloride, methylparaben, hydrogen peroxide, domiphen bromide and sometimes fluoride, enzymes, and calcium. They can also include essential oil constituents that have some antibacterial properties, like phenol, thymol, eugenol, eucalyptol or menthol. Ingredients also include water, sweeteners such as sorbitol, sucralose, sodium saccharin, and xylitol (which doubles as a bacterial inhibitor).
Commercial mouthwashes usually contain a preservative such as sodium benzoate to preserve freshness once the container has been opened. Many newer brands are alcohol-free and contain odor-elimination agents such as oxidizers, as well as odor-preventing agents such as zinc ion to keep future bad breath from developing.
Minor and transient side effects of commercial mouthwashes are very common, such as taste disturbance, tooth staining, sensation of a dry mouth, etc. Alcohol-containing mouthwashes may make dry mouth and halitosis worse since it dries out the mouth. Soreness, ulceration and redness may sometimes occur (e.g. aphthous stomatitis, allergic contact stomatitis) if the person is allergic or sensitive to mouthwash ingredients such as preservatives, coloring, flavors and fragrances. Such effects might be reduced or eliminated by diluting the mouthwash with water, using a different mouthwash (e.g. salt water), or foregoing mouthwash entirely.
Custom formulations ("magic mouthwash")
A "magic mouthwash" (or "magic swizzle"), refers to a non-standardized mixture of ingredients prescribed for a specific purpose, e.g. oral surgery, or to treat the pain associated with mucositis caused by radiation therapy or chemotherapy. It is also prescribed for aphthous ulcers, other oral ulcers, and other mouth pain. Variations are common, and some are done with over-the-counter products. Magic mouthwashes are intended to combine ingredients to treat a variety of oral conditions. Magic mouthwashes are typically compounded in a pharmacy from a doctor's prescription.
Common ingredients include: Diphenhydramine (antihistamine), Glucocorticoids (anti-inflammatory), Lidocaine/Xylocaine (local anesthetic), Maalox (antacid), Nystatin (antifungal for oral candidiasis), Sucralfate (coating agent), Tetracycline or Erythromycin (antibiotics).
Despite a lack of evidence that magic mouthwashes are effective in decreasing the pain of oral lesions, many patients and prescribers continue to use them. There has been only one controlled study to evaluate the efficacy of magic mouthwash; it shows no difference in efficacy among the most common formulation and other agents such as chlorhexidine and a saline/baking soda solution. Current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief or shortening of healing time of oral mucositis from cancer therapies.
Because magic mouthwash has no standard formulation, its use involves concerns about patient safety. It is important that the prescriber and pharmacist are in specific agreement about exactly what is being prescribed, so as to minimize the potential for drug interaction and the possibility of drug allergy.
Specific mouthwash ingredients
Sometimes a significant amount of alcohol (up to 27% vol) is added, as a carrier for the flavor, to provide "bite". Because of the alcohol content, it is possible to fail a breathalyzer test after rinsing although breath alcohol levels return to normal after 10 minutes . In addition, alcohol is a drying agent, which encourages bacterial activity in the mouth, releasing more malodorous volatile sulfur compounds. Therefore, alcohol-containing mouthwash may temporarily worsen halitosis in those who already have it, or indeed be the sole cause of halitosis in other individuals.
There is now sufficient evidence to accept the proposition that developing oral cancer is increased or contributed to by the use of alcohol-containing mouthwashes. Whilst many of these products may have been shown to be effective in penetrating oral microbial biofilms in vitro and reducing oral bacterial load, it would be wise to restrict their use to short-term therapeutic situations if needed. Perhaps the use of mouthwashes that do not contain alcohol may be equally effective. Further, mouthrinses should be prescribed by dentists, like any other medication. There may well be a reason for the use of alcohol-containing mouthrinses, but only for a particular situation and for a limited and controlled period of time. As such, patients should be provided with written instructions for mouthwash use, and mouthwash use should be restricted to adults for short durations and specific, clearly defined reasons. It is the opinion of the authors that, in light of the evidence currently available of the association of alcohol-containing mouthwashes with the development of oral cancer, it would be inadvisable for oral healthcare professionals to recommend the long-term use of alcohol-containing mouthwashes.
The same researchers also state that the risk of acquiring oral cancer rises almost five times for users of alcohol-containing mouthwash who neither smoke nor drink (with a higher rate of increase for those who do). In addition, the authors highlight side effects from several mainstream mouthwashes that included dental erosion and accidental poisoning[clarification needed] of children. The review garnered media attention and conflicting opinions from other researchers. Yinka Ebo of Cancer Research UK disputed the findings, concluding that "there is still not enough evidence to suggest that using mouthwash that contains alcohol will increase the risk of mouth cancer". Studies conducted in 1985, 1995, 2003, and 2012 did not support an association between alcohol-containing mouth rinses and oral cancer. Andrew Penman, chief executive of The Cancer Council New South Wales, called for further research on the matter. In a March 2009 brief, the American Dental Association said "the available evidence does not support a connection between oral cancer and alcohol-containing mouthrinse". Many newer brands of mouthwash are alcohol free, not just in response to consumer concerns about oral cancer, but also to cater for religious groups who abstain from alcohol consumption.
In painful oral conditions such as aphthous stomatitis, analgesic mouthrinses (e.g. benzydamine mouthwash, or "Difflam") are sometimes used to ease pain, commonly used before meals to reduce discomfort while eating.
Betamethasone is sometimes used as an anti-inflammatory, corticosteroid mouthwash. It may be used for severe inflammatory conditions of the oral mucosa such as the severe forms of aphthous stomatitis.:209
Cetylpyridinium chloride containing mouthwash (e.g. 0.05%) is used in some specialized mouthwashes for halitosis. Cetylpyridinium chloride mouthwash has less anti-plaque effect than chlorhexidine and may cause staining of teeth, or sometimes an oral burning sensation or ulceration.
Chlorhexidine digluconate is a chemical antispetic and is used in a 0.12-0.2% solution as a mouthwash. It has significant anti-plaque action, but also some anti-fungal action. It is especially effective against Gram-negative rods. It is sometimes used as an adjunct to prevent dental caries and to treat periodontal disease, although it does not penetrate into periodontal pockets well. Chlorhexidine mouthwash alone is unable to prevent plaque, so it is not a substitute for regular toothbrushing and flossing. In the short term, if toothbrushing is impossible due to pain, as may occur in primary herpetic gingivostomatitis, chlorhexidine is used as temporary substitute for other oral hygiene measures. It is not suited for use in acute necrotizing ulcerative gingivitis however. Rinsing with chlorhexidine mouthwash before a tooth extraction reduces the risk of dry socket, a painful condition where the blood clot is lost from an extraction socket and bone is exposed to the oral cavity. Other uses of chlorhexidine mouthwash include prevention of oral candidiasis in immunocompromised persons, treatment of denture-related stomatitis, and many other uses.
Chlorhexidine has good substantivity (the ability of a mouthwash to bind to hard and soft tissues in the mouth). However, chlorhexidine binds to tannins, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth. Chlorhexidine is rarely associated with other issues like overgrowth of enterobacteria in persons with leukemia, desquamation and irritation of oral mucosa, salivary gland pain and swelling, and hypersensitivity reactions including anaphylaxis.
In traditional Ayurvedic medicine, the use of oil mouthwashes is called "Kavala" ("oil swishing") or "Gandusha", and this practice has more recently been re-marketed by the complimentary and alternative medicine industry as "oil pulling". Its promoters claim it works by "pulling out" "toxins", which are known as ama in Ayurvedic medicine, and thereby reducing inflammation. Ayurvedic literature suggests oil pulling is capable of improving oral and systemic health, including a benefit in conditions such as headaches, migraines, diabetes mellitus, asthma, and acne, as well as whitening teeth.
Oil pulling has received little study and there is little evidence to support claims made by the technique's advocates. When compared with chlorhexidine in one small study, it was found to be less effective at reducing oral bacterial load, otherwise the health claims of oil pulling have failed scientific verification or have not been investigated. There is a report of lipid pneumonia caused by accidental inhalation of the oil during oil pulling.
The mouth is rinsed with approximately one tablespoon of oil for 10–20 minutes then spat out. Sesame oil, coconut oil and ghee are traditionally used, but newer oils such as sunflower oil are also used.
Fluoride mouthwashes are sometimes used in individuals who are at high risk of dental decay. They usually contain about 225 parts per million fluoride. The fluoride strengthens teeth against decay.
Hydrogen peroxide can be used as an oxidizing mouthwash (e.g. Peroxyl, 1.5%). It kills anearobic bacteria, and also has a mechanical cleansing action when it froths as it comes into contact with debris in mouth. It is often used in the short term to treat acute necrotising ulcerative gingivitis. Side effects with prolonged use might occur, including hypertrophy of the lingual papillae.
A 2005 study found that gargling three times a day with simple water or with a providone/iodine solution (although with less effectiveness) was effective in preventing upper respiratory infection and decreasing the severity of symptoms if contracted. A later study found that the same procedure did not prevent influenza-like illnesses. Other sources attribute the benefit to a simple placebo effect.
Sanguinarine-containing mouthwashes are marketed as anti-plaque and anti-malodor. It is a toxic alkaloid herbal extract, obtained from plants such as Sanguinaria canadensis (Bloodroot), Argemone mexicana (Mexican Prickly Poppy) and others. However, its use is strongly associated with development of leukoplakia (a white patch in the mouth), usually in the buccal sulcus. This type of leukoplakia has been termed "sanguinaria-associated keratosis" and more than 80% of people with leukoplakia in the vestibule of the mouth have used this substance. Upon stopping contact with the causative substance, the lesions may persist for years. Although this type of leukoplakia may show dysplasia, the potential for malignant transformation is unknown. Ironically, elements within the complimentary and alternative medicine industry promote the use of sanguinaria as a therapy for cancer.
Sodium bicarbonate (baking soda)
Sodium bicarbonate is sometimes combined with salt to make a simple homemade mouthwash, indicated for any of the reasons that a salt water mouthwash might be used. Pre-mixed mouthwashes of 1% sodium bicarbonate and 1.5% sodium chloride in aqueous solution are marketed, although pharmacists will easily be able to produce such a formulation from the base ingredients when required. Sodium bicarbonate mouthwash is sometimes used to remove viscous saliva and to aid visualization of the oral tissues during examination of the mouth.:4
Sodium chloride (salt)
Hot salt water mouth baths (or hot salt water mouth washes, sometimes abbreviated to "HSWMW") are also routinely used after oral surgery, to keep food debris out of healing wounds and to prevent infection. Some oral surgeons consider salt water mouthwashes the mainstay of wound cleanliness after surgery. In dental extractions, hot salt water mouthbaths should start about 24 hours after a dental extraction. The term mouth bath implies that the liquid is passively held in the mouth rather than vigorously swilled around, which could dislodge a blood clot. Once the blood clot has stabilized, the mouth wash can be used more vigorously. These mouthwashes tend to be advised about 6 times per day, especially after meals to remove food from the socket.
Salt water mouth wash is made by dissolving 0.5–1 teaspoon of table salt into a cup of water, which is as hot as possible without causing discomfort in the mouth. Saline has a mechanical cleansing action and an antiseptic action as it is a hypertonic solution in relation to bacteria, which undergo lysis. The heat of the solution produces a therapeutic increase in blood flow (hyperemia) to the surgical site, promoting healing. Hot salt water mouthwashes also encourage the draining of pus from dental abscesses. Conversely, if heat is applied on the side of the face (e.g., hot water bottle) rather than inside the mouth, it may cause a dental abscess to drain extra-orally, which is later associated with an area of fibrosis on the face (see cutaneous sinus of dental origin). Gargling with salt water is said to reduce the symptoms of a sore throat.
Sodium lauryl sulfate
Sodium lauryl sulfate (SLS) is notorious for causing aphthous stomatitis (mouth ulcers) in susceptible individuals. It is present in a great many oral hygiene products including many mouthwashes. Some may suggest that it is probably advisable to use mouthwash at least an hour after brushing with toothpaste when the toothpaste contains SLS, since the anionic compounds in the SLS toothpaste can deactivate cationic agents present in the mouthrinse. However, many of the popular mouthwashes also contain SLS as an ingredient (e.g., Listerine Total Care).
Tetracycline is an antibiotic which may sometimes be used as a mouthwash in adults (it causes red staining of teeth in children). It is sometimes use for herpetiforme ulceration (an uncommon type of aphthous stomatitis), but prolonged use may lead to oral candidiasis as the fungal population of the mouth overgrows in the absence of enough competing bacteria.:209
4.8% tranexamic acid solution is sometimes used as an antifibrinolytic mouthwash to prevent bleeding during and after oral surgery in persons with coagulopathies (clotting disorders) or who are taking anticoagulants (blood thinners such as warfarin).:473
Triclosan is a non-ionic chlorinate bisphenol antiseptic. When used in mouthwash (e.g. 0.03%), there is moderate substantivity, broad spectrum anti-bacterial action, some anti-fungal action and significant anti-plaque effect, especially when combined with copolymer or zinc citrate. Triclosan does not cause staining of the teeth. The safety of triclosan has been questioned.
Example brands of common commercial mouthwashes
The first known references to mouth rinsing is in Ayurveda and Chinese medicine, about 2700 BC, for treatment of gingivitis. Later, in the Greek and Roman periods, mouth rinsing following mechanical cleansing became common among the upper classes, and Hippocrates recommended a mixture of salt, alum, and vinegar. The Jewish Talmud, dating back about 1,800 years, suggests a cure for gum ailments containing "dough water" and olive oil.
Before Europeans came to the Americas, Native North American and Mesoamerican cultures used mouthwashes, often made from plants such as Coptis trifolia. Indeed Aztec dentistry was more advanced than European dentistry of the age. Peoples of the Americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as teething and mouth ulcers.
Anton van Leeuwenhoek, the famous 17th century microscopist, discovered living organisms (living, because they were motile) in deposits on the teeth (what we now call dental plaque). He also found organisms in water from the canal next to his home in Delft. He experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. Next he tried rinsing the mouth of himself and somebody else with a mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. He concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms.
That remained the state of affairs until the late 1960s when Harald Loe (at the time a professor at the Royal Dental College in Aarhus, Denmark) demonstrated that a chlorhexidine compound could prevent the build-up of dental plaque. The reason for chlorhexidine effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours.
Since then commercial interest in mouthwashes has been intense and several newer products claim effectiveness in reducing the build-up in dental plaque and the associated severity of gingivitis, in addition to fighting bad breath. Many of these solutions aim to control the Volatile Sulfur Compound (VSC)-creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste.
Research in the field of microbiotas shows that only a limited set of microbes cause tooth decay, with most of the bacteria in the human mouth being harmless. Focused attention on cavity-causing bacteria such as Streptococcus mutans has led research into new mouthwash treatments that prevent these bacteria from initially growing. While current mouthwash treatments must be used with a degree of frequency to prevent this bacteria from regrowing, future treatments could provide a viable long term solution.
- Matthews, R W (12 July 2003). "Hot salt water mouth baths". British Dental Journal 195 (1): 3–3. doi:10.1038/sj.bdj.4810318.
- Gunsolley, JC (2006). "A meta-analysis of six-month studies of antiplaque and antigingivitis agents". Journal of the American Dental Association 137 (12): 1649–57. doi:10.14219/jada.archive.2006.0110. PMID 17138709.
- Tal, H; Rosenberg, M (1990). "Estimation of dental plaque levels and gingival inflammation using a simple oral rinse technique". Journal of periodontology 61 (6): 339–42. doi:10.1902/jop.19184.108.40.2069. PMID 2366142.
- "Listerine no replacement for flossing?". NBC News. 7 January 2005. Retrieved 14 October 2013.
- "Should I use Mouthwash: "When to Use Mouthwash"".
- "The effect of mouthrinses against oral microorganisms".
- Aichner, T. and Coletti, P. 2013. Customers' online shopping preferences in mass customization. Journal of Direct, Data and Digital Marketing Practice, 15(1): 20-35.
- Kozlovsky, A; Goldberg, S; Natour, I; Rogatky-Gat, A; Gelernter, I; Rosenberg, M (1996). "Efficacy of a 2-phase oil: Water mouthrinse in controlling oral malodor, gingivitis, and plaque". Journal of periodontology 67 (6): 577–82. doi:10.1902/jop.19220.127.116.117. PMID 8794967.
- Rosenberg, M; Gelernter, I; Barki, M; Bar-Ness, R (1992). "Day-long reduction of oral malodor by a two-phase oil: water mouthrinse as compared to chlorhexidine and placebo rinses". Journal of periodontology 63 (1): 39–43. doi:10.1902/jop.1918.104.22.168. PMID 1552460.
- "Oral health promotion messages: "Spit don't rinse"".
- John Toedt, Darrell Koza, Kathleen Van Cleef-Toedt (2005), Chemical composition of everyday products (illustrated ed.), Greenwood Publishing Group, pp. 48–49, ISBN 9780313325793
- Ribeiro, L; Hashizume, L; Maltz, M (2007). "The effect of different formulations of chlorhexidine in reducing levels of mutans streptococci in the oral cavity: A systematic review of the literature". Journal of Dentistry 35 (5): 359–70. doi:10.1016/j.jdent.2007.01.007. PMID 17391828.
- "Products That Contain Triclosan". drbenkim.com.
- Levy, SM (2003). "An update on fluorides and fluorosis". Journal (Canadian Dental Association) 69 (5): 286–91. PMID 12734021.
- Stoeken, Judith E.; Paraskevas, Spiros; Van Der Weijden, Godefridus A. (2007). "The Long-Term Effect of a Mouthrinse Containing Essential Oils on Dental Plaque and Gingivitis: A Systematic Review". Journal of Periodontology 78 (7): 1218–28. doi:10.1902/jop.2007.060269. PMID 17608576.
- Giertsen, E.; Emberland, H.; Scheie, A. Aa. (1999). "Effects of Mouth Rinses with Xylitol and Fluoride on Dental Plaque and Saliva". Caries Research 33 (1): 23–31. doi:10.1159/000016492. PMID 9831777.
- Doreen Oneschuk, Neil Hagen, Neil MacDonald (2012). Palliative Medicine: A case-based manual (3rd ed.). Oxford University Press. p. 126. ISBN 9780191628733.
- Tom, Wah-Chih (2007-07-03). "Magic Mouthwash" (PDF). Pharmacist's Letter/Prescriber's Letter 23 (230703): 1–5. Retrieved 2009-12-09.
- Otterholt, Randall. "Magic Mouthwash". Retrieved 2009-12-05.
- "Magic Mouthwash". Pharmacist's Letter. Therapeutic Research Center. Retrieved 2009-12-05.
- "Lidocaine Jelly". empr.com. Prescribing Reference, Inc. Retrieved 14 October 2013.
Note: Formerly known under the brand name Xylocaine.
- Lachenmeier, Dirk W; Keck-Wilhelm, Andrea; Sauermann, Anne; Mildau, Gerd (2008). "Safety Assessment of Alcohol-Containing Mouthwashes and Oral Rinses". SOFW Journal 134 (10): 70–8.
- Pader, M. (October 1994). "Oral rinses". Cosmetics & Toiletries 109 (10): 59–68. ISSN 0361-4387.[unreliable medical source?]
- Cole, P; Rodu, B; Mathisen, A (2003). "Alcohol-containing mouthwash and oropharyngeal cancer: A review of the epidemiology". Journal of the American Dental Association 134 (8): 1079–87. doi:10.14219/jada.archive.2003.0322. PMID 12956348.
- Carretero Peláez, MA; Esparza Gómez, GC; Figuero Ruiz, E; Cerero Lapiedra, R (2004). "Alcohol-containing mouthwashes and oral cancer. Critical analysis of literature". Medicina oral 9 (2): 120–3, 116–20. PMID 14990877.
- Lachenmeier, Dirk W (2008). "Safety evaluation of topical applications of ethanol on the skin and inside the oral cavity". Journal of Occupational Medicine and Toxicology 3 (1): 26. doi:10.1186/1745-6673-3-26. PMC 2596158. PMID 19014531.
- McCullough, MJ; Farah, CS (2008). "The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes". Australian Dental Journal 53 (4): 302–5. doi:10.1111/j.1834-7819.2008.00070.x. PMID 19133944.
- Farah, C; McIntosh, L; McCullough, M (2009). "Mouthwashes". Australian Prescriber, 32:162-4. Available at australianprescriber.com
- Weaver, Clair (11 January 2009). "Mouthwash linked to cancer". Daily Telegraph (News Ltd). Retrieved 11 January 2009.
- Ebo, Yinka (14 January 2009). "Does mouthwash cause cancer?". Cancer Research UK. Retrieved 20 June 2009.
- Mashberg, A; Barsa, P; Grossman, ML (1985). "A study of the relationship between mouthwash use and oral and pharyngeal cancer". Journal of the American Dental Association 110 (5): 731–4. doi:10.14219/jada.archive.1985.0422. PMID 3859544.
- Elmore, J; Horwitz, R (1995). "Oral cancer and mouthwash use: Evaluation of the epidemiologic evidence". Otolaryngology - Head and Neck Surgery 113 (3): 253–61. doi:10.1016/S0194-5998(95)70114-1. PMID 7675486.
- Cole, P; Rodu, B; Mathisen, A (2003). "Alcohol-containing mouthwash and oropharyngeal cancer: A review of the epidemiology". Journal of the American Dental Association 134 (8): 1079–87. doi:10.14219/jada.archive.2003.0322. PMID 12956348.
- Gandini S, Negri E, Boffetta P, La Vecchia C, Boyle P (2012). "Mouthwash and oral cancer risk quantitative meta-analysis of epidemiologic studies". Ann Agric Environ Med. 19 (2): 173–80. PMID 22742785.
- Weaver, Clair (11 January 2009). "Mouthwash linked to cancer". The Daily Telegraph. Retrieved 12 January 2009.
- Science brief on alcohol-containing mouthrinses and oral cancer (PDF), American Dental Association, March 2009, archived from the original (PDF) on 19 March 2012
- Cawson RA, Odell EW, Porter S. (2002). Cawson's Essentials of Oral Pathology and Oral Medicine (7th ed.). Edinburgh: Churchill Livingstone. ISBN 0443071063.
- Fedorowicz Z, Aljufairi H, Nasser M, Outhouse TL, Pedrazzi V. Mouthrinses for the treatment of halitosis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006701. doi:10.1002/14651858.CD006701.pub2
- Scully C (2013). Oral and maxillofacial medicine : the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone. pp. 39, 41. ISBN 9780702049484.
- "Mouthwashes, gargles, and dentifrices". British National Formulary March 2014. BMJ Group and the Royal Pharmaceutical Society of Great Britain 2014.
- Daly, B; Sharif, MO; Newton, T; Jones, K; Worthington, HV (Dec 12, 2012). "Local interventions for the management of alveolar osteitis (dry socket).". The Cochrane database of systematic reviews 12: CD006968. doi:10.1002/14651858.cd006968.pub2. PMID 23235637.
- Singh A, Purohit B (April 2011). "Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health". J Ayurveda Integr Med 2 (2): 64–8. doi:10.4103/0975-9476.82525. PMC 3131773. PMID 21760690.
- Julie Beck (19 March 2014). "Swishing With Oil for Oral Health: Not Recommended". The Atlantic.
- Singh, A; Purohit, B (Apr 2011). "Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health.". Journal of Ayurveda and integrative medicine 2 (2): 64–8. doi:10.4103/0975-9476.82525. PMC 3131773. PMID 21760690.
- Grush, Loren (24 March 2014). "What is oil pulling? Examining the ancient detoxifying ritual". Fox News Channel. Retrieved 24 March 2014.
- Bethonie Butler (20 March 2014). "Everyone is talking about ‘oil pulling.’ But does this health practice actually work?". The Washington Post (Washington State, U.S.A.).
- Asokan S, Emmadi P, Chamundeswari R. "Effect of oil pulling on plaque induced gingivitis: A randomized, controlled, triple-blind study." Indian J Dent Res 2009;20:47-51
- "A second look at oil pulling as dental home care therapy".
- Kim JY, Jung JW, Choi JC, Shin JW, Park IW, Choi BW (Feb 2014). "Recurrent lipoid pneumonia associated with oil pulling". Int J Tuberc Lung Dis. 18 (2): 251–2. doi:10.5588/ijtld.13.0852. PMID 24429325.
- "Oil Pulling Your Leg".
- "Does ‘Oil-Pulling’ Actually Have Health Benefits?".
- Satomura, Kazunari; Tetsuhisa Kitamura, MS, Takashi Kawamura, MD, Takuro Shimbo, MD, Motoi Watanabe, MS, Mitsuhiro Kamei, MD, Yoshihisa Takano, MD, Akiko Tamakoshi, MD, Great Cold Investigators-I (November 2005). "Prevention of upper respiratory tract infections by gargling: a randomized trial". American Journal of Preventive Medicine 29 (4): 302–307. doi:10.1016/j.amepre.2005.06.013. ISSN 0749-3797. PMID 16242593. Retrieved 7 February 2013.
- To gargle or not to gargle? Japan Times, 15 December 2009
- Leukoplakia, (pdf format) hosted by the American Academy of Oral and Maxillofacial Pathology. Page accessed on 19 December 2006.
- Neville BW , Damm DD, Allen CM, Bouquot JE. (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 337–345. ISBN 0721690033.
- Wray D, Stenhouse D, Lee D, Clark AJE (2003). Textbook of General and Oral Surgery. Edinburgh [etc.]: Churchill Livingstone. pp. 199, 210, 222. ISBN 0443070830.
- Clive Edwards; Paul Stillman (2006). Minor Illness or Major Disease?: The Clinical Pharmacist in the Community (4th ed.). London [u.a.]: Pharmaceutical Press. p. 223. ISBN 9780853696278.
- O'Conner, Anahad (27 September 2010). "The Claim: Gargling with Salt Water Can Ease Cold Symptoms". The New York Times. Retrieved 12 January 2014.
- Rosenberg, Mel (2002). "The Science of Bad Breath". Scientific American 286 (4): 72–9. doi:10.1038/scientificamerican0402-72. PMID 11905111.
- Greenberg MS, Glick M (2003). Burket's oral medicine diagnosis & treatment (10th ed.). Hamilton, Ont.: BC Decker. ISBN 1550091867.
- "New studies show dangers of Triclosan in Toothpastes and Mouthwash". New York Orthodontists.
- Fischman, Stuart L. (1997). "The history of oral hygiene products: How far have we come in 6000 years?". Periodontology 2000 15 (1): 7–14. doi:10.1111/j.1600-0757.1997.tb00099.x. PMID 9643227.
- Shifman, A; Orenbuch, S; Rosenberg, M (2002). "Bad breath—a major disability according to the Talmud". The Israel Medical Association journal 4 (10): 843–5. PMID 12389360.
- Keoke, Emory Dean; Porterfield, Kay Marie (2002). Encyclopedia of American Indian contributions to the world 15,000 years of inventions and innovations. New York, NY: Facts on File. p. 180. ISBN 978-1-4381-0990-9.
- Lax, Alistair (27 October 2005). Toxin: The cunning of bacterial poisons. Oxford University Press. ISBN 978-0-19-157850-2. Retrieved 26 November 2013.
- Budtz-Jörgensen, E; Löe, H (1972). "Chlorhexidine as a denture disinfectant in the treatment of denture stomatitis". Scandinavian journal of dental research 80 (6): 457–64. doi:10.1111/j.1600-0722.1972.tb00314.x. PMID 4575037.
- Bosy, A; Kulkarni, GV; Rosenberg, M; McCulloch, CA (1994). "Relationship of oral malodor to periodontitis: Evidence of independence in discrete subpopulations". Journal of periodontology 65 (1): 37–46. doi:10.1902/jop.1922.214.171.124. PMID 8133414.
- Loesche, Walter J.; Kazor, Christopher (2002). "Microbiology and treatment of halitosis". Periodontology 2000 28 (1): 256–79. doi:10.1034/j.1600-0757.2002.280111.x. PMID 12013345.
- "Hacking the Microbiome for Fun and Profit: Can Killing Just One Mouth Bacterium Stop Cavities? | 80beats | Discover Magazine". Blogs.discovermagazine.com. Retrieved 31 October 2012.
- Article on Bad-Breath Prevention Products – from MSNBC
- Mayo Clinic Q&A on Magic Mouthwash for chemotherapy sores
- Gargle at the Centre for Cancer Education, University of Newcastle upon Tyne