You should not rinse after brushing
Here in the US, the American Dental Association and other dental organizations, actually don’t say all that much on the topic of rinsing after brushing.
It is a shame that they haven’t really taken a firm stance on this matter as we believe it would be beneficial to the nation to do so.
If you want to achieve the best oral health standards, don’t rinse straight after brushing, that is our viewpoint.
A study in the UK found that 62% of respondents were rinsing our mouth out after having brushed their teeth.
You should not rinse after brushing your teeth and to learn to ‘Spit, not rinse’.
The primary reason that this advice is given is explained by Dr Nigel Carter – CEO of Oral Health Foundation.
“Rinsing our mouth with water is very bad for our teeth as it washes away the protective fluoride left behind by brushing.
Fluoride is the single-most important ingredient in toothpaste. It greatly helps oral health by strengthening the tooth enamel, making it more resistant to tooth decay. It also reduces the amount of acid that the bacteria on your teeth produce”
“By spitting toothpaste out then not rinsing with water it ensures that the fluoride found in the majority of toothpastes will remain on the teeth and continue to be effective.”
Why are so many of us doing it wrong?
Here in the USA, it can be argued we are not actually doing it wrong because there is no strong advice not to rinse.
However, it is fair to assume based on the words of Dr Carter and the NHS that the advice given in the UK, is based on solid research that confirms this is the best approach.
As a result, perhaps we should follow the UK’s example.
The reason so many of us are doing it wrong, going against the advice is simple, we haven’t been told not to rinse.
Advances in technology, science and clinical study have allowed medical professionals to better understand the effects of toothpaste and rinsing, now meaning that we know toothpaste is most effective if left on the teeth.
Pitts et al. summarise the effects of rinsing and explain that fluoride containing mouthrinses are effective at reducing the risk of decay, but advise that these should be used at a separate time to brushing to avoid the “wash-out effect”.
Fluoride as a primary ingredient within toothpaste is something that is agreed upon, due to the health benefits it brings to the teeth.
Bodies like the NHS at some point have to take a stance one way or another. The public look to these organizations for advice and professional insight. These decisions do not normally get taken likely, but ultimately they believe that the effects of not rinsing are potentially better for the public and the nation’s oral health than those arguments for rinsing.
Mouthwash before or after brushing
Rinsing can be with water, mouthwash or any other liquid.
More often than not people rinse with mouthwash after brushing.
Here is where things get a little more interesting and perhaps confusing.
Whilst the ADA makes no statement on rinsing, it does make comment on the use of mouthwash.
While not a replacement for daily brushing and flossing, use of mouthwash (also called mouthrinse) may be a helpful addition to the daily oral hygiene routine for some people. Like interdental cleaners, mouthwash offers the benefit of reaching areas not easily accessed by a toothbrush. The question of whether to rinse before or after brushing may depend on personal preference; however, to maximize benefit from the oral care products used, manufacturers may recommend a specific order for their use, depending on ingredients. For example, some dentifrice ingredients (like calcium hydroxide or aluminum hydroxide) can form a complex with fluoride ions and reduce a mouthwash’s effectiveness. Therefore, vigorous rinsing with water may be recommended after brushing and before rinsing if these ingredients are present.ADA Oral Health Topics
So, the ADA suggests it is up to you, but you are perhaps best to follow the instructions given by the mouthwash manufacturer.
Based on the evidence from the UK though, whilst there are potential benefits to the mouthrinse they may be at the expense of the toothpaste used.
We feel, unless medically necessary (advised by your dentist) mouthwash is best used at other times in the day, ideally when a toothbrush is not to hand. Maybe after lunch or a snack.
The arguments for and against
What are some of the key thoughts and reasoning that people give to deciding to rinse or not?
Reasons you should not rinse after brushing
- Fluoride wash-out
- Rinsing removes the fluoride containing toothpaste from the teeth.
- This means you get less benefit from your toothpaste.
- By not rinsing, the freshness of the toothpaste and feeling of cleanliness remain for longer as the water dulls that sensation.
- Waste of money
- Rinsing the mouthwash after brushing has no known benefit and could be seen as a waste of money.
Reasons you should rinse after brushing
- Get rid of the taste
- Rinsing after brushing can remove or quash the strong residual taste left behind from the toothpaste, which may be important if you don’t like the taste of toothpaste.
- Ingesting ingredients
- Some people claim that ingesting toothpaste and its ingredients into the mouth and stomach may cause irritations and have long term health implications.
- Plaque and debris removal
- Rinsing can dislodge and remove any remaining bacteria and food particles that may have been missed when brushing.
The merit of each of these claims supporting either side of the argument could be discussed at length.
I wish not to go into these, other than mentioning, that the taste could be helped by opting for other flavored or less flavored options, whilst if there are concerns over the ingredients, understanding the ingredients in toothpaste and other possible ingredient free options are worthwhile.
As I mentioned earlier the opinions even amongst dental professionals in different countries differ.
Rinsing and the effects of such have been researched but many of these have concluded or recorded results that conflict or struggle to draw solid, conclusive and clinically significant results. Hence the difference in opinion between the UK and the USA.
A 2002 study by a team at the Clinic of Oral Pathology from Kaunas University of Medicine in Lithuania, looked at the effect of post-brushing rinsing behavior on dental caries (decay or cavities). The 3 year study concluded that post-brushing rinsing with water, under the conditions of this study, does not significantly affect the caries reducing effect of a fluoride toothpaste.
Goteborg University in Sweden’s department of Cariology study found that the amount of fluoride absorbed after brushing with a toothbrush is strongly related to the way in which the water is rinsed.
Ralph Duckworth and team looked at the impact of rinsing with a mouthwash after brushing with a fluoride toothpaste. He concluded that using a non fluoride based mouthwash after brushing might reduce the anticaries protection provided by the toothpaste alone, but the use of a mouthwash with at least 100mg of fluoride per litre should minimize this risk.
In a literature review by Monika Prasad, that looked at the effect of rinsing effects on plaque reduction and gingivitis, the results showed the use of certain mouthwashes when used in conjunction with toothbrushing, did provide additional benefit in plaque and gingivitis reduction.
Whilst a 2013 article in the International Dental Journal by Jonathan Creeth and team came to the conclusion that the amount of toothpaste and the time spent brushing has an impact on fluoride retention.
Berkeley University have commented on the topic and state non-fluoride mouth rinses will rinse away much of the fluoride from the toothpaste, so if you use one, do so before you brush or at a different time than brushing.
A possible alternative rinse could be that of a toothpaste ‘slurry’. A teaspoon amount of water, mixed with a toothpaste foam in your mouth. By rinsing this around the mouth and then spitting it out after a minute can leave a higher fluoride concentration.
Here are a few quotes from dental professionals supporting both sides of the argument.
The last step many of us take in our tooth brushing routine is to rinse out our mouths with a little water. That’s actually a bad idea. You’re just washing off the film from the toothpaste. – Dental Associates of Lancaster
Experts suggest that simply rinsing your mouth with water after eating should remove any leftover food particles that might cause issue. – Buttercup Dental
After brushing and flossing, rinsing with a mouthwash, not water, keeps you plaque-free, prevents gum disease and keeps your breath fresh – Greenspoint Dental
Rinsing comes first, brushing second, and flossing third – followed by a quick finishing rinse with a quality mouthwash. – Dynamic Dental
Some dentists advocate not rinsing your mouth after brushing so that the effects of the ‘remineralisation’ continue to work. Personally I am of the opinion that although the compounds in toothpaste work well when topically applied to your teeth, they are not so good for you systemically (in the rest of your body), so I always rinse my mouth after brushing. – Victoria Jones Dental
A good thorough brushing-flossing-rinsing does wonders – Matt Messina
One thing to consider though is that too few people are actually brushing for the dentist recommended 2 minutes.
The Academy of General Dentistry suggests the average person brushes for 45-70 seconds per day.
Such short brushing times mean the fluoride is having little or no time to actually begin working and protecting the teeth. By not rinsing, what fluoride is left has a better chance of working and protecting the teeth from cavities.
With such poor oral hygiene routine and public attention to their health, despite years of consistent advice and campaigning, dental practitioners are more worried about getting people to brush for the right time.
Taking into consideration my own research and the comments made by dental professionals, the advice given varies depending on which country you are in and your dentist’s or hygienist’s own opinions. There are justifiable arguments both for and against rinsing after brushing.
So, should you rinse after brushing your teeth?
Ultimately it is up to you. Not rinsing could allow you to benefit from the effects of toothpaste for longer.
But, it is advisable to speak to your dentist and get a personalized oral care plan based on your personal circumstances.