Mouthwash is a misunderstood tool for looking after your oral hygiene.
Not everyone needs it, so you may even be wasting money if you buy it unnecessarily. And some of the manufacturer claims are over-hyped.
But mouthwash does have its uses — it can manage bad breath, ease pain and inflammation in the mouth and protect against tooth decay.
If you do need a mouthwash, below are my recommendations based on my experience as a dentist and research into the various products available.
Our recommendations
Best all-round: Listerine Total Care Zero Alcohol
Best budget: Crest Scope Enamel Protection
Best unflavoured: Oxyfresh Unflavoured
Best for bad breath: TheraBreath Fresh Breath Oral Rinse
Best for dry mouth: Biotene Dry Mouth Relief
10 useful things to know when choosing a mouthwash
- Mouthwash can be beneficial for those with specific dental issues, but it’s not essential for everyone.
- Mouthwash is not a substitute for brushing and flossing. Physical cleaning is more important.
- Use fluoride mouthwash in addition to fluoride toothpaste to reduce decay risk.
- Alcohol-free mouthwashes are recommended over those containing alcohol.
- Consult a dental professional if you have persistent bad breath.
- Avoid using mouthwash immediately after brushing.
- Always follow the usage instructions on the mouthwash label.
- Children under six should not use mouthwash due to the risk of swallowing.
- Mouthwash is normally considered safe for people who are pregnant, but this does depend on the ingredients list.
- Consider eco-friendly mouthwash options to minimize environmental impact.
Best all-round mouthwash
Listerine Total Care Zero Alcohol
Approx. $8 per bottle — Amazon.ca, London Drugs.
Listerine is one of the most widely known mouth care brands, and can be found around the world. It is widely available in stores and online, with a range of flavours and bottle sizes.
Why we chose it
Listerine’s large range can be somewhat overwhelming.
I recommend this option because it is one of their alcohol free options (many Listerine mouthwashes do contain alcohol), and has a milder mint taste. From personal testing I have found many Listerine options to be very strong.
Whilst there are many other listerine options I have picked this one specifically because it contains fluoride at 0.02%, which is at the higher end of the scale.
It has been approved by the Canadian Dental Association, too.
Recommended use is 20ml twice a day. Although they recommend using it after brushing, I would advise using it at a separate time of day.
It comes in bottle sizes of 500ml and 1L, and has a cost of about 9c per dose.
Pros
- Value for money
- Fresh taste
- No burning sensation
- Alcohol free
- Contains fluoride
Cons
- Not always recycled material bottles
Best budget mouthwash
Crest Scope Enamel Protection
Approx. $6 per bottle — Walmart.ca, Amazon.ca
More often than not, Crest it is the cheapest on the shelf. It contains 0.02% sodium fluoride. It also contains tetrasodium pyrophosphate and disodium pyrophosphate which help prevent calculus (tartar) build up.
Why we chose it
Recommended use is 10ml twice daily. The bottles come as 1L, which works out as a 50 day supply.
The cost per rinse works out at 6c — one of the best value options out there.
There are two flavours: cool peppermint and strong mint, depending on your preferences.
Pros
- Affordable option
- Contains fluoride
- Alcohol free
- No burning sensation
- Different bottle size options
- Choice of flavours
Cons
- Contains alcohol
- Lack of sustainability information
Best unflavoured mouthwash
Oxyfresh
Approx. $18 per bottle — Oxyfresh
There are a lack of unflavored mouthwash options available in Canada. Oxyfresh ships from the USA but is reasonably priced and ships to Canada.
As well as having no taste, there is no burning sensation as it is alcohol free.
Why we chose it
The benefits of this mouthwash include Oxygene, which contains chlorine dioxide to help counteract the VSCs that cause bad breath. This mouthwash is also recommended if you have bad breath.
Sadly there is no fluoride in this rinse, although other Oxyfresh mouthwashes are available that do contain it (specifically the Cavity Protection Mouthwash for Sensitive teeth) but which do have a minty flavour.
This mouthwash is alcohol free and SLS free, and is suitable for vegans.
It comes in a 16oz (473ml) nottle.
The recommended use is “a couple of capfuls” (approx 15ml) twice a day, and works out att 57c per rinse. It is not a cheap option, but it is one of the few unflavoured options available.
If for any reason you can’t order Oxyfresh, CloSYS is an alternative. It is available on Amazon.ca, but it is an import from the USA so it is very expensive.
Pros
- Alcohol free
- No burning sensation
- Different bottle size options
- Vegan recipe
- Recycled and recyclable bottles
Cons
- No fluoride
- More expensive option
Best for bad breath
TheraBreath Fresh Breath Oral Rinse
Approx. $11 per bottle — Amazon.ca, Walmart.ca.
I recommend this mouthwash as it has such positive feedback from thousands of customers. Whilst it isn’t a cheap, it’s worth a go as it comes with a money back guarantee.
Why we chose it
For those who really suffer with bad breath (halitosis) this is a good option because the sodium chlorite fights the cause of bad breath, whilst the minty flavour also gives a refreshing taste.
It is also alcohol free and SLS free.
It comes in 500ml bottles, and recommended use is to rinse with a capful and then gargle with a capful, and to do this twice daily. Unhelpfully the cap doesn’t give a measurement, but I measured it to be approx 35ml at home. This means a regular bottle would only give a 7 day supply.
Whilst this isn’t a cheap option, it is CDA-validated to support the claims made by the company.
Pros
- No burning sensation
- Alcohol free
- Different bottle size options
- Vegan recipe
- Powerful taste, feels refreshing
- Money back guarantee
Cons
- No fluoride
- More expensive option
- Lack of sustainability information
- Large doses for recommended usage
Best for dry mouth
Biotene Dry Mouth Relief
Approx. $14 per bottle — Walmart.ca, Amazon.ca.
I highly recommend Biotene Mouthwash for people who experience dry mouth symptoms.
Why we chose it
A dry mouth can be sore when eating, drinking, and cleaning your teeth. Sometimes a mouthwash can provide temporary relief.
This mouthwash is not necessary for most people. It’s aim is to rehydrate the mouth, and it does this by helping to retain water and moisture on the mouth surfaces (using ingredients called humectants).
The flavour isn’t all that pleasant, from our testing, but it does provide relief for people who do suffer from a dry mouth.
There is no fluoride in this mouthwash, but it is alcohol free and pH neutral.
The bottles come in 500ml options only, and recommended dose is 15ml, up to 5 times daily, depending on how dry your mouth feels. It works out about 42c per rinse.
Pros
- Dry mouth relief
- Alcohol free
- Helps with things such as mouth ulcers as well as dry mouth
Cons
- No fluoride
- More expensive option
- Lack of sustainability information
- Large doses for recommended usage
Buyer’s guide: most people don’t need a mouthwash
Mouthwash is not necessary for most people.
Physical cleaning is most important. Brushing twice a day for two minutes with a fluoride toothpaste and cleaning in between your teeth is enough to achieve good oral health.
However, mouthwashes can be beneficial in addition to this if there are reasons why physical cleaning is not good enough, or if additional doses of certain ingredients are needed.
The advice of professional organisations around the world varies.
The Canadian Dental Association advises: “As part of your morning oral health routine, swish with an oral rinse (also known as mouthwash or a mouth rinse) once a day. This will help keep odour-causing bacteria at bay.”
The American Dental Association says: “While not a replacement for daily brushing and flossing, use of mouthrinse (also called mouthwash) may be a helpful addition to the daily oral hygiene routine for some people.”
The UK National Health Service advises: “Using a mouthwash that contains fluoride can help prevent tooth decay, but don’t use mouthwash (even a fluoride one) straight after brushing your teeth or it’ll wash away the concentrated fluoride in the toothpaste left on your teeth.”
These people do benefit from mouthwash:
- Adults at high risk of tooth decay – to get an additional dose of fluoride
- Children over the age of six at high risk of tooth decay – to get an additional dose of fluoride
- People with sore mouths due to infection, ulcers or surgery should use mouthwash – specific ingredients can help prevent infection of open wounds and ulcers, reduce inflammation, and help manage soreness in the mouth.
- People who struggle using a toothbrush should use a mouthwash – for example people who struggle to physically clean their teeth with brushing due to disabilities. The fluoride can protect against tooth decay whilst anti-plaque ingredients can help manage the inevitable build up which can’t be removed by brushing.
- People with gum disease should use a mouthwash to help manage plaque levels.
- People with sensitive teeth – by using mouthwashes containing desensitising ingredients to help manage sensitivity.
- People with bad breath – to help mask the smell and to help manage the causes.
Choose a mouthwash with fluoride and without alcohol
Alcohol is added to mouthwash as a preservative. It has little effect on most people, other than a mild burning sensation.
But some people find the alcohol content can actually dry the mouth out and make bad breath worse. There is some conflicting evidence about whether or not alcohol in mouthwash can increase cancer risk.
Overall, there is nothing to suggest that alcohol containing mouthwashes are more effective than alcohol-free mouthwashes, so it’s best to avoid it if you can.
We do recommend opting for a mouthwash with fluoride, unless you are using it for another specific purpose such as pain relief. The additional fluoride can help to prevent tooth decay.
Don’t use it more than twice a day unless told to by your dentist
Most mouthwashes will give you the most benefit if they are used twice a day. You are unlikely to get any extra benefits from using it more often.
If you are using mouthwash for a specific condition, or after oral surgery, your dentist might recommend it differently – such as three or four times per day. This is for a short amount of time – normally a week or two. Follow the advice given by your dental care professional.
Here’s why you should use mouthwash at a separate time to brushing
The basic message is don’t use mouthwash straight after brushing. Rinsing after brushing removes the toothpaste you have just used.
Using mouthwash at a different time to brushing leaves the toothpaste contacting the teeth to allow the fluoride to have maximum benefit.
Using mouthwash before brushing has few benefits
Using mouthwash directly before brushing has very few benefits – it is, essentially, a waste of money. This is because the act of brushing the teeth will remove any ingredients left by the mouthwash.
Using mouthwash after brushing creates a fluoride wash-out
Research has shown that using a non fluoride or low fluoride mouthwash after brushing reduces the anticaries benefit of toothpaste. This is a wash-out effect.
To prevent this wash out, wait at least half an hour after brushing before using mouthwash.
However, there are a limited number of studies showing that mouthwash with a high enough fluoride content might not have a negative effect if used straight after brushing. A mouthwash containing a minimum of 100ppm fluoride “should not interfere with the toothpaste’s anticaries protection”.
Ingredients in mouthwash and toothpaste can react with each other
The other reason to leave it at least 30 minutes after brushing to use a mouthwash is because some ingredients in mouthwash can interact with some toothpastes. This makes the mouthwash less effective.
Some toothpaste ingredients (like calcium hydroxide or aluminium hydroxide) can form a complex with fluoride ions, which will reduce the effectiveness of a mouth rinse.
Two studies looked at two specific ingredients: Chlorhexidine and CPC. Both remove less plaque if used in a mouthwash directly after using a toothpaste containing SLS, as a result of ionic interactions.
Even though some higher fluoride mouthwashes will not have a wash out effect if used straight after brushing, if these mouthwashes also contain chlorhexidine or CPC then they will not be as effective due to chemical reactions.
This is why it is best to use mouthwash at a different time of day.
Don’t rinse with water after brushing either
Rinsing your mouth with water after brushing your teeth rinses off the toothpaste you have used.
Before modern toothpaste was invented, gritty pastes made from ingredients such as eggshells and urine were used to cleanse the teeth. This is why it was common to rinse after brushing.
However modern toothpaste doesn’t contain these harmful or unhygienic ingredients. It is totally safe to leave on your teeth. In fact, it has many beneficial ingredients. Avoid rinsing to avoid washing these off before they can have maximum benefit.
People who rinse with water after brushing have more tooth decay than people who don’t.
5 interesting things about mouthwash from scientific studies
Clinical trials have extensively tested various products and ingredients under different scenarios. Here’s what the research says:
1. Mouthwash prevents tooth decay
Using a fluoride mouthwash reduces the risk of tooth decay (Marinho et al).
This is when it is used in addition to brushing with a fluoride containing toothpaste. It is estimated that correct use of mouthwash decreases decay risk by 26% more than toothpaste alone (however dentist applied fluoride gel has even better outcomes).
2. Mouthwash reduces levels of plaque
Some ingredients are able to act directly on dental plaque. This complex film on the teeth is made up of bacteria, their waste products, and food debris from the mouth.
3. Mouthwashes improve gum health
The fact that mouthwashes reduce plaque levels seems to also cause an improvement in gum health.
A 2015 publication by A Jose and team found “Chlorhexidine mouthrinse with or without alcohol as an adjunct to brushing with regular fluoride toothpaste significantly reduces bleeding scores, plaque and gingival inflammation compared to brushing alone.”
This better gum health is also found with other ingredients, with a Brazilian study finding that CPC and zinc lactate containing mouthwashes providing “significantly greater reductions in Plaque, Plaque Interproximal, Gingival, Gingival Severity, and Gingival interproximal index after 4 and 6 weeks of product use”.
4. Mouthwashes can help manage bad breath
Mouthwash can mask bad breath temporarily. The strong mint flavours cover up the smell of bad breath.
Some mouthwashes contain ingredients to soak up VSCs, the chemicals that cause bad breath for some people. These types of mouthwashes are one method to help manage bad breath.
Research supports the use of a number of different mouthwashes containing different combinations of ingredients, with them all being more effective than not using a mouthwash.
Bad breath often has an underlying cause such as gum disease or tooth decay. Medical conditions like reflux can also cause bad breath, so it is important to talk to a medical or dental professional if this is an ongoing issue.
5. Essential oil mouthwash may be beneficial
There is some evidence to support the use of essential oil containing mouthwashes as being beneficial for oral health. One study showed essential oil mouthwash is more effective than floss at removing plaque from between the teeth.
