Listerine explains the often overlooked benefits that daily mouthwash can provide and the evidence behind them.
Effective plaque control remains the cornerstone of both gingivitis management and the prevention of periodontitis. While mechanical plaque removal through toothbrushing and interdental cleaning is fundamental, evidence shows that mechanical methods alone are often insufficient to achieve and sustain gingival health across populations (Chapple et al, 2015).
This has renewed interest in the role of adjunctive chemical plaque control, particularly daily use of mouthwash, as part of a preventive, evidence-based oral hygiene regimen. Despite this, misconceptions persist around mouthwash use, especially in relation to fluoride retention and the long-standing ‘spit, don’t rinse’ message.
Clarifying these issues is essential to ensure clinical advice aligns with contemporary evidence and with the principles set out in the British Society of Periodontology and Implant Dentistry (BSP) implementation of the European Federation of Periodontology (EFP) S3-level clinical practice guideline.
Mechanical plaque control alone is often insufficient
The EFP S3-level clinical practice guideline emphasises that supragingival biofilm control and gingival inflammation management are the foundation of periodontal therapy, particularly within step one of care (Sanz et al, 2020). This step prioritises patient education, behavioural change and daily plaque control to stabilise disease and reduce long-term risk.
However, systematic reviews demonstrate that even with instruction, many patients struggle to maintain plaque levels below the threshold required to prevent gingival inflammation. Serrano et al (2015) and Figuero et al (2019) demonstrate that adjunctive anti-plaque chemical agents, including mouthrinses, provide statistically significant reductions in plaque accumulation, gingival inflammation and bleeding compared with mechanical plaque control alone. These benefits are observed in long-term, home-use randomised controlled trials of at least six months’ duration.
Mouthwash within S3-guided preventive care
The BSP’s adaptation of the EFP S3 guideline reinforces the importance of risk-driven prevention and stabilisation, particularly through sustained control of supragingival biofilm (West et al, 2021). Chemical plaque control is recognised as a useful adjunct for patients who are unable to achieve optimal plaque control through mechanical means alone, or who present with elevated risk factors.
Within this framework, daily mouthwash use supports the objectives of step one therapy by reducing gingival inflammation, improving bleeding outcomes and supporting long-term periodontal stability. Importantly, this approach aligns with the guidelines’ emphasis on cost-effective prevention, patient engagement and maintenance of health over time, rather than repeated cycles of reactive intervention.
Reframing the ‘spit, don’t rinse’ message
One of the most persistent misconceptions surrounding mouthwash use relates to fluoride dilution following toothbrushing. The Delivering Better Oral Health toolkit updated its wording in 2021 to clarify that the recommendation is to ‘spit out after brushing and avoid rinsing with water’, rather than avoiding all forms of rinsing. This distinction is clinically significant.
Evidence from Duckworth et al (2009a, 2009b) demonstrates that fluoride bioavailability from toothpaste and mouthwash cannot be directly compared. Rinsing with a fluoride mouthwash containing 100ppm fluoride following toothbrushing does not reduce salivary fluoride levels compared with toothpaste alone. Furthermore, use of a higher concentration fluoride mouthwash, such as 226ppm, can increase salivary fluoride retention beyond that achieved with toothpaste alone. These findings challenge the assumption that post-brushing mouthwash use inevitably compromises fluoride exposure.
Clinical implications for daily practice
Taken together, the evidence supports a more nuanced approach to mouthwash recommendations. Daily use of an evidence-based mouthwash can complement mechanical plaque control, support gingival health and align with S3-level guidance on prevention and stabilisation.
Clear, evidence-informed communication is essential to ensure patients understand that avoiding rinsing with water does not equate to avoiding mouthwash, and that appropriate formulations can offer clinical benefit.
As prevention continues to move to the forefront of periodontal care, integrating mouthwash appropriately within daily oral hygiene routines represents a practical, evidence-based opportunity to improve outcomes.
For access to the evidence, visit the Listerine Oral Hygiene Roadshow today.
References
- Chapple ILC et al (2015) Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol 42(Suppl 16): S71-S76
- Duckworth RM et al (2009a) Effects of flossing and rinsing with a fluoridated mouthwash after brushing with a fluoridated toothpaste on salivary fluoride clearance. Caries Res 43: 387-390
- Duckworth RM et al (2009b) Effect of mouthwashes and toothpastes on salivary fluoride retention. Caries Res 43: 391-396
- Figuero E et al (2019) Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: a systematic review and network meta-analyses. J Clin Periodontol 46: 723-739
- Office for Health Improvement and Disparities. Delivering Better Oral Health: an evidence-based toolkit for prevention. Updated 2021
- Sanz M et al (2020) Treatment of stage I–III periodontitis: the EFP S3 level clinical practice guideline. J Clin Periodontol 47(Suppl 22): 4-60
- Serrano J et al (2015) Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: a systematic review and meta-analysis. J Clin Periodontol 42(Suppl 16): S106-S138
- West NX et al (2021) BSP implementation of the EFP S3-level clinical practice guideline in UK clinical practice. J Dent 106: 103562
This article is sponsored by Listerine.
