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Mouthwash:

Mouthwash, mouth rinse, oral rinse or mouth bath, is a liquid which is held in the mouth
passively or swilled around the mouth by contraction of the perioral muscles and/or
movement of the head, and may be gargled, where the head is tilted back and the liquid
bubbled at the back of the mouth. A solution, often containing antiseptic, astringent, and
breath-sweetening agents, is used for cleansing the mouth and teeth, and for gargling.
Characteristics of an ideal Mouthwash:
It should be an effective antimicrobial agent and should have a pleasant odor.
It helps reduce plaque and other harmful bacteria buildup, especially between the
narrow crevices between the teeth.
It also temporarily combats bad breath.
Natural mouthwashes are as effective as commercial ones but without the synthetic
ingredients.
Certain mouthwash is as good as flossing.
Rinsing twice a day with the antiseptic mouth rinse was as effective as flossing for
reducing plaque and gingivitis between the teeth.
Mouthwash or mouth rinse is a product used for oral hygiene
Antiseptic and anti-plaque mouth rinse claims to kill the germs that cause plaque,
gingivitis, and bad breath.
Anti-cavity mouth rinse uses fluoride to protect against tooth decay.
Non corrosive on mucous membranes & oral tissue and low toxicity would be some
considerations as well as having an acceptable taste + sugar free.
Uses of mouthwash:
A mouthwash is used after brushing and flossing. This liquid is swished in the mouth and
then spit out. Mouthwashes are used for a variety of reasons:
Cleaning the mouth and teeth
Freshening the breath
Help prevent or control tooth decay
Reduce plaque (a thin film of bacteria that forms on teeth)

Prevent or reduce gingivitis (an early stage of gum disease)


Reduce the speed that tartar (hardened plaque) forms on the teeth
To produce a combination of these effects.
Most oral rinses contain fluoride which helps prevent tooth decay.
Many mouthwashes have antibacterial and antiseptic properties.
Some mouth rinses have ingredients which help to reduce tooth sensitivity.
Usually mouthwashes are an antiseptic solution intended to reduce the microbial load in the
oral cavity, although other mouthwashes might be given for other reasons such as for
their analgesic, anti-inflammatory or anti-fungal action.
Route of Administration
Oromucosal use. (This product is not intended to be swallowed)
Indications
Palliation of generalized oral mucositis.
Contraindications
Hypersensitivity to any component of the product or to local anesthetics of the
amide type. Oral diphenhydramine is contraindicated in newborns or premature
infants and breast-feeding women. Hydrocortisone is contraindicated in systemic
fungal infections.
Adverse Reactions:

CNS: Drowsiness, dizziness, headache.


Dermatologic: Rash, photosensitivity.
EENT: Burning sensation, unpleasant taste.
GI: Abdominal pain or discomfort, constipation, dry mouth, diarrhea, nausea,

vomiting.
Hypersensitivity: Hypersensitivity reactions, including anaphylaxis.

Classification of mouthwash:
The U.S. Food and Drug administration has classified mouthwashes into different types:
Classification
Cosmetic

Description
These are over-the-counter products which are used after
brushing to remove oral waste. The effect of cosmetic
mouthwashes last from 10 minutes to a maximum period of
three hours. These mouthwashes are mainly fluoride based.
These mouthwashes help to reduce oral bacteria, prevent bad
breath and give a fresh, clean feeling in the mouth. Cosmetic
mouthwashes cannot reduce the risk of tooth decay.

Therapeutic
These mouthwashes contain ingredients that fight against oral
diseases, swelling and bleeding of gums. Therapeutic
mouthwashes are classified into antiplaque/ant gingivitis and
anticavity fluoride rinses.

Combination
These mouthwashes combine all the benefits offered by
cosmetic and therapeutic mouthwashes. They are ideal to
provide complete care.

Based on ingredients, mouthwashes are classified as:


Classification

Description

Fluoride mouthwashes

This type of mouthwash contains sodium


fluoride, a chemical that helps in fighting
against tooth decay. Avoid overuse of
fluoride mouthwashes.

Antiseptic Mouthwashes

This

type

of

mouthwash

contains

chlorhexidine gluconate which obstruct the


growth of bacteria. It is suitable for people
suffering from mouth infections and bad
breath. Excessive usage can cause tooth
staining. These mouthwashes are also used
before and after surgery to fight against oral
bacteria and infections.

Natural Mouthwashes

These mouthwashes are home-made. They

contain salt and warm water. This is a


suitable option for an individual suffering
from mouth infections and injury or has
undergone tooth extraction.

Magical Mouthwashes

This category contains antibiotics, local


anaesthetic, glucocorticoids, nystatin and
Maalox. It is prescribed by dentists for
people

suffering

from

mouth

ulcers,

engorged mouth or cancer.

To re-iterate: the types of mouthwash available include:


Classification

Description

Fluoride mouthwashes

Contain sodium fluoride which helps to


strengthen the teeth as well as adding extra
protection against tooth decay. However,
fluoride is present in toothpaste and tap
water and is more than adequate for our
needs.

Cosmetic mouthwashes

Be

careful

about

consuming

excessive amounts of fluoride.


Do not offer the same protection as other

types and are used more as a means of


disguising bad breath (halitosis). They help
to keep your teeth clean but do not reduce
Antiseptic mouthwashes

the risk of tooth decay.


This contains chlorhexidine gluconate - a
chemical which stops the growth of bacteria
and is suitable for people with a mouth
infection. They are also useful for people
with bad breath (halitosis).

They are

effective in that they can prevent the buildup of plaque to a certain degree but they
should be used in conjunction with a
toothbrush and dental floss. Avoid overuse
of these as the high levels of chlorhexidine
can cause discolouration of the teeth over a
long period of time. But if you do
experience this then your dentist or dental
Natural mouthwashes

hygienist will be able to easily treat it.


They are alcohol-free (and contain no
fluoride) and work in much the same way as
conventional mouthwashes. Some people
find that a home-made mouthwash, such as
those made from a pinch of salt and warm
water,

are

useful

following

tooth

extraction. They can also treat a mouth


Total care mouthwashes

infection or injury.
Contain anti-bacterial ingredients which
help to reduce the build-up of plaque and
prevent gum disease.

Ingredients used in mouthwash:


Mouthwashes are generally composed of diluents, antibacterial agents, soaps, flavourings,
and colorants. The primary ingredient in most mouthwashes is water, a diluent, making up
over 50% of the entire formula. The water is specially treated to remove various particles and
ions which might impact flavour. Water treated as such is called deionized water.

Ingredients
Thickening agents

Humectants

Solvents

Detergents
(Surfactants)

Flavouring Agents

Sweeteners

Colouring Agents
Preservatives

Function
prevent the toothpaste from drying
out by binding water
control the viscosity and contribute
to give the toothpaste a creamy
consistency
Emulsifying effect by preventing the
solid and the liquid substances from
separating and give the possibility to
make oil in water emulsions.

Example
Glycerol
Sorbitol
Polyethylene glycol

to prevent loss of water

Glycerine
Sorbitol

Gum( natural)

used in mouth rinses as a solvent Alcohol


and taste enhancer
Water
oil-based ingredients to be dissolved Sodium
Lauryl
into a water-based solution
Sulphate (SLS)
exerts cleansing (oil-dissolving) and
Sodium
Lauryl
antibacterial effects
Toothpaste/mouthwash can contact
Sarcosinate
Cocamidopopybetaine
the teeth more easily.
Steareth-30.
Necessary to cover the horrid taste Spearmint
Peppermint
of most detergents, especially SLS.
Eucalyptus
menthol
Improve the taste of Mouthwashes Sodium saccharin
and give them a mild and sweet Sorbitol
taste.
Glycerin
Xylitol
to give them an attractive Titanium dioxide
appearance
F D & C Colors
Prevent

the

growth

of

organisms in mouthwashes.

micro- Sodium benzoate


Methylparaben
Ethylparaben

Therapeutic Agents:
Therapeutic class
Anti-caris Agents

(PEG)
Propylene glycol
Cellulose Gum
Xanthan

Agents
Fluoride:

Fluoride is considered to be the most effective cariesinhibiting agent, and almost all toothpastes today contain
fluoride in one form or the other. The most common form is
sodium fluoride (NaF), but mono-fluoro-phosphate (MFP)
and stannous fluoride (SnF) are also used.
Xylitol:
Xylitol is a sugar alcohol that cannot be fermented by oral
microorganisms. It is considered to be a cariostatic agent
since it can inhibit the carbohydrate metabolism in different
oral micro-organisms.
Calcium/Phosphate:
Calcium and phosphate supplementation in a mouthwash will
increase the concentration of these ions in the oral cavity. This
has been reported to improve remineralisation and increase
fluoride uptake
Sodium Bicarbonate:
Several studies have shown that bicarbonate is one of the
salivary components that potentially modifies the formation
of caries. It increases the pH in saliva, and in this way creates
Anti-Plaque Agents

a hostile environment for the growth of acid uric bacteria.


Sodium Lauryl Sulphate (SLS):
It has been shown that the enzymes glucosyl transferase and
fructosyl transferase are incorporated in an active form into
the pellicle; and by synthesizing glycan in situ from sucrose,
can provide a surface for colonization by Streptococcus
mutants. These enzymes can be inhibited by SLS. Such
inhibition can clearly retard the regrowth of plaque.
Triclosan:
Triclosan is a synthetic non-ionic chlorinated phenolic agent
with antiseptic qualities. Triclosan has a broad-spectrum
efficacy on Gram-positive and most Gram-negative bacteria.
It is also effective against mycobacterium and strictly
anaerobic bacteria, and against the spores and fungi of the
Candida species.

Metal-ions:
The most widely used metal-ions in dental preparations are
zinc (Zn2+) and stannous (Sn2+). These metals have the
ability to limit bacterial growth, inhibit plaque 10 formation,
inhibit the glycolytic sequence in oral anaerobic bacteria, and
to restrict the ability of plaque bacteria to convert urea to
ammonia.
Stannous- ions:
Stannous-ions are added to dentifrices and mouthwashes in
the form of stannous fluoride or stannous pyrophosphate.
Stannous fluoride was frequently used as a vehicle for
fluoride in dental preparations.
Amyloglucosidase and Glucose oxidase:
These are enzymes that are claimed to reduce plaque,
gingivitis and dental caries. Their mechanism of action is by
activating

the

antibacterial

lactoperoxidase-thiocyanate

system in saliva.
Essential oils:
Essentials oils of Thymol, menthol, eucalyptol and methyl
salicylate are thought to have anti-bacterial activity by
altering the bacterial cell wall.
Chlorhexidine:
Chlorhexidine formulations are considered to be the gold
standard antiplaque mouth rinses due to their prolonged
broad spectrum antimicrobial activity and plaque inhibitory
potential. Chlorhexidine is effective against both Grampositive and Gram-negative bacteria.

Anti-Calculus Agents

Pyrophosphate:
Pyrophosphate has recently been introduced in dentifrices to
inhibit the formation of supragingival dental calculus.
Pyrophosphate is added as tetra sodium pyrophosphate, tetra
potassium pyrophosphate or disodium pyrophosphate.
Zinc:

Zinc has anti-calculus effect due to its anti-plaque properties,


but in addition it is thought to influence calculus formation by
Anti-dentine
Hypersensitivity
Agents

inhibiting crystal growth.


Potassium salts:
Potassium ions are thought to act by blocking action potential
generation in interdental nerves. It is claimed that potassium
salts in dental preparations increase the concentration of
potassium ions around the pulpal nerves, and thereby
depolarizes the nerve. This can inhibit a nerve response from
different stimuli.
Sodium Bicarbonate
It is claimed that dentifrices containing high concentrations of
sodium bicarbonate are more effective in removing intrinsic

Anti-halitosis Agents

tooth stain than those not containing sodium bicarbonate.


Zinc:
Bad breath or halitosis originates mainly from the oral cavity.
The unpleasant smell is due to the retention of anaerobic,
Gram-negative

bacteria.

These

bacteria

use

sulphur

containing amino acids as substrates in their production of


volatile sulphur-containing compounds (VSC). VSC have a
distinctly unpleasant odor even in low concentrations. Zinc
inhibits the production of VSC in the oral cavity by
interacting with sulphur in the amino acids or their
metabolism.

Preparation and Formulation of Mouthwash

Formulation

Ingredient

Quantity

Justification

Methyl Salicylate

0.6g

Flavouring agent, Astringent

Eugenol

0.44g

Flavouring

agent,

Mild

antibacterial agent
Menthol

1g

Flavouring agent

Hexachlorophene

0.6g

Antibacterial agent

Sodium benzoate

1g

Preservative

SLS

0.75g

Surfactant/ Foaming agent

Poloxomer 407/ tween 20

3g

Emulsifying agent

Water

Upto 100ml

Sorbitol

(5-10)%

Sweetening agent , thickener

Manitol/Glycerin/Sucrose
Solution

Procedure

At 1st 300ml water is taken and Na benzoate is dissolved in water.

The menthol is triturated with mortar and pestle to make fine powder and then transfer
into the previous solution and shake to make it disappear in water.

Then methyl salicylate, Eugenol are taken in the solution and shake for few minutes.

(5-10)% Sorbitol added with the mixture to make solution homogenous.

After that in a different beaker, 100 ml water and poloxomer 407 is poured into the
water and keep it (15-30) mins without shake to get the clear solution.

When clear solution is prepared, it is poured into the previous solution and shakes for
10 mins.

After that SLS added into the solution and shake for 5 min.

Add water to make the volume 1000ml.

Trial Formulation:
Trial Formulation: 01
Ingredients

Quantity
cup

Justification
Vehicle

2 tsp

Thickening agent. Anti-caries

Distilled Water
Baking Soda

and abrasive, whiten teeth.

2 drops

Flavouring agent.

2 drops

Prevent

Tea tree essential oil


Peppermint essential oil

tooth

decay,

bacteria and germs, feeling


fresh.

Procedure
1. a container use a small mason jar
2.

cup filtered or distilled water (find the best water purification systems here)

3. 2 tsp. baking soda


4. 2 drops tea tree essential oil (find 100% pure essential oils here)
5.
Precaution

2 drops peppermint essential oil

kills

Baking soda will settle to the bottom of the jar when not in use, so be sure to shake
mouthwash before each use. Swish about 2-3 teaspoons of this homemade formula in mouth
for a minute or two. As with any mouthwash, try to avoid swallowing this while gargling.

Trial Formulation (Saltwater Mouthwash): 02


Ingredients

Quantity

Justification

16-ounce

Vehicle

1tsp

Thickening agent. Anti-caries

Distilled Water

Baking Soda

and abrasive, whiten teeth.

Procedure
1. Mix all the ingredients properly.
Use:
Rinse, gargle, and spit after meals, before bed, and anytime mouth feel dry or sore.