Rethinking rinsing: an update on mouthwash for patients

Laura Bailey outlines why updated evidence on mouthwash can really make a difference to the guidance you give to patients.

Let’s look at the ‘spit, don’t rinse’ message. I remember when I came out of uni and I got given a leaflet that would sit pride of place in my surgery, and I’d go through it and just make sure I was doing everything right. And there’s a message in there that was construed in the wrong way as it was missing two words, which meant that there’s been a decade of clinicians and colleagues potentially telling patients the wrong message. It was updated in 2021 from ‘spit out after brushing and do not rinse, to maintain fluoride concentration’ to ‘spitting out after brushing rather than rinsing with water to avoid diluting the fluoride concentration’ (Delivering Better Oral Health, 2014, 2021).

So, you’re probably thinking, ‘that doesn’t change my messaging’, but I bet a lot of clinicians were also telling patients not to use a mouthwash straight after brushing, because you’re going to rinse away the fluoride.

For as long as I can remember, my advice had been simple: spit, don’t rinse. That means no rinsing with water and definitely not with mouthwash – avoid both. This recommendation comes from the Delivering Better Oral Health (DBOH) toolkit, which we consider the ultimate guide for dental health, and it’s the guidance I’ve always followed in practice.

New guidance

My mind was blown the day I learned that the fluoride levels of a toothpaste and mouthwash cannot be directly compared due to their different bioavailability.

If you use a mouthwash of 100ppm, you will end up with net net (Duckworth, 2009a).

However, if you use a 226ppm mouthwash, you actually increase the fluoride levels for your patients (Duckworth 2009b). This could be a huge benefit and opportunity for a number of patients that we have previously missed. You cannot compare fluoride levels in a toothpaste to that in a mouthwash.

So, let’s use this information and evidence to break down our treatment stages and how we could be more effective.

Importance of education

This chart looks at our stages of therapy and their cost and effectiveness of reducing disease sites. The second most effective is subgingival PMPR (professional mechanical plaque removal). But as we move along to step three, we can see how small the reduction is compared to the expense.

What this shows is actually step one, which is OHI (oral hygiene instruction), and the education phase has the biggest reduction in disease sites than any other step, including surgical.

We know this works, yet we spend the smallest amount of time here. Imagine if we utilise our evidence base to really get step one right – we could stabilise a lot more patients without the need for further interventions.

Head to Dentistry.co.uk to complete the Digital Oral Hygiene Roadshow 2025.

References

• Delivering Better Oral Health: an evidence-based toolkit for prevention. 3rd edition. London: Public Health England 2014. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention (accessed November 2025).
• Delivering Better Oral Health: an evidence-based toolkit for prevention. Version 4. London: Department of Health and Social Care 2021. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention (accessed November 2025).
• Duckworth RM et al. Effect of rinsing with mouthwashes after brushing with a fluoridated toothpaste on salivary fluoride concentration. Caries Research2009a; 43(5): 391-396.
• Duckworth RM et al. Effects of flossing and rinsing with a fluoridated mouthwash after brushing with a fluoridated toothpaste on salivary fluoride clearance. Caries Research2009b; 43(5): 387-390.
• Delivering phased care. London: British Society of Periodontology and Implant Dentistry 2021. Available at: https://www.bsperio.org.uk/assets/downloads/Delivering_phased_Care_Final_29th_April_2021_Final.pdf (accessed November 2025).

This article is sponsored by Listerine.