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How to Choose the Correct Mouthwash: A Dentist's Guide

Maintaining good oral hygiene is crucial for overall health. Brushing and flossing are essential for removing plaque and food particles, but using mouthwash can provide additional benefits. Mouthwash can help kill bacteria that cause bad breath, prevent cavities, and reduce the risk of periodontal disease. However, with so many different types of mouthwash available in the market, it can be challenging to choose the right one. In this guide, we will provide tips on how to choose the correct mouthwash to maintain optimal oral health. Periodontal Disease: The Link Between Oral Health and Systemic Conditions Periodontal disease is a type of infection that affects the teeth, and it is characterized by symptoms such as swollen and bleeding gums, an increased gap between teeth, and gum recession. If left untreated, it can even lead to tooth loss. The bacterial infection that causes periodontal disease triggers a mild inflammatory response in the body, contributing to the development of systemic diseases. Furthermore, without early treatment, the bacteria toxins can enter the bloodstream through everyday activities like eating or brushing teeth, leading to temporary bacteremia. This can stimulate the formation of blood clots in the blood vessels, which increases the risk of cardiovascular diseases such as heart attacks and strokes that are associated with arterial hardening. Image Source：iStock What Should an Ideal Mouthwash Contain? An ideal mouthwash should have the following properties: Antiseptic: It should effectively kill or inhibit the growth of bacteria and other microorganisms that can cause plaque, gingivitis, and bad breath. Disinfectant: It should be able to neutralize or destroy harmful pathogens and prevent cross-contamination. Correct concentration for gingivitis: The mouthwash should contain the right concentration of active ingredients to effectively combat gingivitis without causing unnecessary side effects. Pleasant taste: The mouthwash should have an appealing flavor to encourage consistent use and promote good oral hygiene habits. Safe for daily use: The mouthwash should be gentle enough for daily use without causing irritation, dryness, or other adverse effects. Patients often inquire about maintaining their dental hygiene after completing treatment. Along with teaching proper brushing and flossing techniques, I advise them on suitable mouthwash products to augment oral protection. The market provides numerous options for mouthwash, with different formulations emphasizing gum health, cavity prevention, fresh breath, and even ones specifically formulated for children and pregnant women. In Taiwan, the Food and Drug Administration categorizes mouthwash into two types: "medicated mouthwash" and "general mouthwash." Classification Ingredients Main Functions Medicated Mouthwash Chlorhexidine Gluconate (concentration ranging from 0.1% to 0.2%) Cetylpyridinium Chloride (concentration ranging from 0.045% to 0.1%) Antibacterial and disinfectant properties General Mouthwash Chlorhexidine Gluconate (concentration < 0.1%) Cetylpyridinium Chloride (concentration < 0.045%) Sodium Fluoride Essential oils Alcohol Antibacterial and disinfectant properties Cavity prevention Oral freshness Medicated mouthwashes have higher concentrations of antibacterial ingredients compared to general mouthwashes. However, prolonged use may cause tooth staining, so it's best to follow instructions from healthcare professionals. After rinsing with mouthwash, avoid rinsing with water and wait for 30 minutes before eating or drinking to maximize its effectiveness. If you have oral wounds or dry mouth, choose alcohol-free mouthwash to avoid irritating the oral mucosa and tongue. For periodontal disease, mouthwashes with Chlorhexidine Gluconate can combat plaque and inhibit periodontal disease when used twice a day for 30 seconds to one minute. What is Chlorhexidine and How Does it Work? Chlorhexidine is a widely used antiseptic and disinfectant in the field of dentistry. It is a bisbiguanide compound that was first developed in the 1940s and has been used as a general disinfectant ever since. In the 1970s, its antiplaque activity was discovered, leading to its introduction as a mouthwash. Mechanism of Action The mechanism of action of chlorhexidine involves its rapid attraction to negatively charged bacterial cell surfaces, which contain phosphates and sulfate groups. This cationic property allows it to bond strongly to these negatively charged sites within the biofilm, including bacteria and extracellular polysaccharides. This binding disrupts the bacterial cell wall, allowing chlorhexidine to penetrate and damage the cytoplasmic membrane, ultimately leading to the death of the bacterial cell. Pharmacological Effects Chlorhexidine has potent antimicrobial and antifungal properties, which make it effective against a wide range of oral pathogens, including Streptococcus mutans, a major contributor to dental caries. It is also effective against both gram-positive and gram-negative bacteria, as well as some fungi and viruses. Side Effects of Chlorhexidine Although chlorhexidine is generally considered safe and effective, it can cause some side effects, especially when used at higher concentrations or for extended periods. Some of the most common side effects include: Extrinsic tooth staining: Prolonged use of chlorhexidine mouthwash can lead to the staining of teeth, which is the most common reason for patients discontinuing its use. Altered taste sensation: Some users may experience a change in taste or a numb feeling in their mouth and tongue after using chlorhexidine mouthwash. Oral irritation and xerostomia: Some people may develop oral irritation, burning sensation, or dry mouth after using the mouthwash. Allergic reactions: Though rare, some users may experience allergic reactions to chlorhexidine, such as swelling of the parotid gland, oral paraesthesia, or glossodynia. Clinical Uses of Chlorhexidine Chlorhexidine has several clinical applications in dentistry, including: Gingivitis treatment: When used as an adjunct to mechanical plaque control, chlorhexidine mouthwash can help reduce gingivitis and improve overall oral health. Prophylactic use and post-oral surgery: Chlorhexidine mouthwash is commonly prescribed following periodontal and implant surgeries, as well as in situations where mechanical plaque control is difficult or impossible due to postoperative pain or discomfort. Periodontal disease management: Chlorhexidine mouthwash can be used as an adjunct to subgingival instrumentation in patients with periodontitis, helping to control inflammation and improve overall periodontal health. Can Mouthwash Replace Brushing? The short answer is no. While chlorhexidine mouthwash can be an effective adjunct to mechanical plaque control, it should not be considered a replacement for regular brushing and flossing. Proper mechanical cleaning of teeth, such as brushing and using interdental cleaning aids, is essential for removing plaque and maintaining good oral hygiene. Chlorhexidine mouthwash can help in reducing the bacterial load and inflammation, but it cannot remove plaque and food debris as effectively as mechanical methods. Conclusion In summary, chlorhexidine mouthwash is a valuable tool in promoting good oral hygiene and combating gingivitis when used as an adjunct to regular mechanical oral hygiene procedures. It is essential to choose a mouthwash with the correct concentration of chlorhexidine for your specific needs and to be aware of its mechanism of action, clinical uses, and potential side effects. While mouthwash can provide additional benefits in maintaining good oral health, it should not be considered a replacement for regular brushing and flossing. By incorporating an appropriate chlorhexidine mouthwash into your daily oral care routine, you can help maintain a healthy mouth and prevent common dental issues like gingivitis and plaque buildup. References： Chlorhexidine mouthrinse as an adjunctive treatment for gingival health Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects

Can orthodontic treatment be performed on teeth with periodontal disease? Which is more suitable, Invisalign or traditional brackets?

Typically, people associate orthodontic treatment with young individuals who have healthy teeth. However, the reality is that a significant proportion of individuals requiring orthodontic treatment also suffer from varying degrees of periodontal disease. So, the question arises: Can teeth with periodontal disease undergo orthodontic treatment? If so, which option, traditional brackets or Invisalign, is more suitable? Let's delve further into the relationship between periodontal disease and orthodontic treatment. Understanding Periodontal Disease Periodontal disease is a chronic inflammatory condition caused by bacteria in the oral cavity, which affects the gums and supporting structures such as the alveolar bone. It starts with gingivitis, a mild gum disease characterized by redness, swelling, and easy bleeding of the gums. If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease where the surrounding bone is also affected and damaged. This bone loss can lead to tooth mobility and even tooth loss due to lack of support. Can Orthodontic Treatment and Periodontal Disease Coexist? Historically, the presence of periodontal disease has been considered a contraindication for orthodontic treatment, as moving teeth within inflamed periodontal tissues could exacerbate the inflammation and lead to further bone loss. However, recent studies have shown that orthodontic treatment can be safely performed before or during a well-controlled periodontal condition. Several research reports indicate that orthodontic treatment can improve periodontal health and address malocclusion issues. Additionally, it can reposition teeth that have shifted due to bone loss, contributing to periodontal control. Therefore, orthodontic treatment is viable when periodontal disease is well controlled. Invisalign and Traditional brackets: Which is More Suitable for Patients with Periodontal Disease? Regarding the treatment of patients with periodontal disease, recent research suggests that Invisalign may offer advantages over traditional brackets. Invisalign and Periodontal Health Invisalign's clear aligners can be removed, making it convenient for patients to maintain good oral hygiene during treatment. Many studies have found that patients using Invisalign show better results in terms of plaque index, probing pocket depth, and gingival index compared to those undergoing traditional brackets. Moreover, Invisalign carries a lower risk of periodontal bacterial growth and inflammation, further promoting periodontal health. These advantages make Invisalign an attractive option for patients with periodontal disease. Traditional brackets and Periodontal Health Traditional orthodontic brackets and archwires can make it difficult for patients to maintain oral hygiene. Research shows that patients with traditional brackets often have a higher plaque index and are more prone to gingival inflammation, which could exacerbate periodontal disease. However, it's important to note that maintaining good oral hygiene is still possible with traditional brackets, and many patients do not experience significant periodontal issues during treatment. Additionally, the use of low-profile brackets and improved oral hygiene aids can help minimize these risks. Long-Term Outcomes of Orthodontic Treatment in Patients with Periodontal Disease Multiple research studies have demonstrated that wearing Invisalign aligners may result in less gingival recession compared to traditional brackets. These findings suggest that Invisalign treatment may help reduce the risk of gingival recession. However, it's essential to recognize that each patient's case is unique, and treatment outcomes may vary. The occurrence of gingival recession is influenced by multiple factors, including individual oral hygiene habits, tooth position, and the specific treatment plan. Therefore, it is still recommended for patients to consult and assess with their dentist before undergoing orthodontic treatment, ensuring the most suitable treatment plan is chosen, and maintaining good oral hygiene practices to protect gingival health to the fullest extent. Case report The image shows a 70-year-old elderly woman in her seventies who has gradually improved the spacing between her upper and lower teeth through nearly ten months of Invisalign treatment. She is currently still undergoing treatment. In addition to the improvement in overjet, it can be observed from the photo that the patient's gum recession did not deteriorate, and the initial mild root exposure has not worsened. This case demonstrates the significant advantages of Invisalign treatment in preserving tooth structure and periodontal tissue. Even in the age group of seventy and above, the success of this patient highlights the potential of Invisalign treatment across different age groups. Results In the past, periodontal disease has been considered a contraindication for orthodontic treatment. However, recent research indicates that patients with periodontal disease can still safely undergo orthodontic treatment. Invisalign, with its removable and easy-to-clean features, may be a more suitable option for patients with periodontal disease. However, treatment choices should be based on the specific circumstances of the patient, including their periodontal health status, treatment needs, and personal preferences. For patients with periodontal disease, it is recommended to seek advice and evaluation from dental professionals before proceeding with orthodontic treatment. References： Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis Periodontal health status in patients treated with the Invisalign® system and fixed orthodontic appliances: A 3 months clinical and microbiological evaluation Effect of periodontal–orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: A systematic review with meta‐analysis