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Mouthwashes – Part 2: Ingredients and ADA Approval

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Mouthwashes part 2: Ingredients and ADA Approval

Mouthwashes part ii – Ingredients and ADA approval


Be sure to read Mouthwashes Part I – So Many Mouthwashes!

There are 3 key mouthwash ingredients that determine the purpose and scope of each mouthwash:

  • Cetylpyridinium chloride (CPC) or Zinc Chloride – kills the bacteria that cause plaque and tartar.
  • Tetrasodium Pyrophosphate (TSPP) – removes the amount of calcium and magnesium in your saliva, preventing it from depositing on your teeth and forming plaque and tartar build up.
  • Sodium Fluoride – the key ingredient in anti-cavity rinses; it remineralizes weakened tooth structures, making them more resistant to bacteria and decay

There are side effects to use of some mouthwashes – such as mild staining from higher concentrations of CPC and TSPP.  When it comes to alcoholic vs alcohol free rinses, there are no studies that indicate one works better than the other.  Some people prefer the “after burn” that the alcohol rinses provide, giving them a more “clean” feel after they rinse.
These are the arguments I’ll make against alcoholic mouthwashes, for your information:

  • Some studies have shown that chronic use of mouth washes containing alcohol may lead to an increased risk of oral cancer. HOWEVER, other studies have shown that proof to be not conclusive.  We do know that chronic alcohol consumption is linked to oral cancer.
  • Saliva is a vital component of the mouth, providing lubrication, protection, and other important function of mastication. Additionally, your mouth contains a numerous types of bacteria – both good and bad – that provide important functions.  The alcohol reduces the saliva in the mouth and can kill the good bacteria in addition to the bad bacteria.
  • The burning sensation may prevent you from holding the mouthwash in your mouth for as long as indicated.
  • Alcohol-free mouthwashes can be used by people of all ages! If you have children in the house, having an alcoholic mouthwash they can get into is not a good idea.  Additionally, elderly patients who have dry mouth (usually from medication) should definitely avoid alcohol mouthwashes that further dry out their mouth.

That’s why it is always important to ask your dentist if he/she recommends a specific mouthwash for your distinct oral cavity, as your needs may be different than someone else in your family.

In our final discussion, Mouthwashes Part III, we’ll take a look at the different categories of mouthwashes and see some samples from each.  But first, let’s take a quick look at the American Dental Association (ADA) Seal of Acceptance and how a company is able to put that on their bottle.

The ADA website states:

A company earns the ADA Seal by submitting scientific evidence that demonstrates the safety and efficacy for its product. The ADA Council on Scientific Affairs carefully evaluates the evidence according to objective requirements. In the case of a mouthrinse, the Council may use any of the following requirements, depending on the product’s intended use:
A mouthrinse that claims to control gingivitis must substantiate that claim by demonstrating a statistically significant reduction in gingival inflammation. Mouthrinse that claims to control bad breath must substantiate that claim by showing that it works to reduce odors over a prolonged time frame. A mouthrinse that contains fluoride for reducing decay must either demonstrate effectiveness in clinical studies, or show that the formula is the same as a similar product that has been clinically proven. With any type of mouthrinse, a manufacturer must show that the product is safe and that it does not damage oral tissues or cause any internal problems.


This means the ADA, when evaluating a new product, looks for:

  • Objective clinical and/or laboratory studies that demonstrate safety and effectiveness
  • FDA-approved ingredients
  • Manufacturing standards that assure purity and uniformity
  • Packaging and advertising claims that are supported by science

An important note from their guidelines to remember is:  A mouthrinse… that the formula is the same as a similar product that has been clinically proven.
This means that generic brands, such as Target, Walmart, Meijer, etc., that have the ADA Seal on their products have shown that their formulas are similar to the brand name products formulas.


So which products out there do what?  Take a look at Mouthwashes Part III – Mouthwashes Categories and Which Is For You? to get a closer look!

And be sure to read Mouthwashes Part I – So Many Mouthwashes!


About Clayton

I graduated in 2012 from the University of Michigan Dental School, and in 2015 with my Master's in Oral & Maxillofacial Pathology. Our son was born in August 2016, and since then I've split my time between practicing at a community health center in Flint, MI and raising Caleb with my incredible wife!

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