Over Use of Mouth wash disturbs the oral ecology

It has become fasionable to use different kinds of mouthwashes in many of the urban patients. It is often used by some dental practitioners, Oto Rhino Larynologists and family doctors as a general panacea in shot gun therapy of all oral conditions. All the dental students and the specialists are directed to read the following and make your own conclusions

1. Andrew J. McBain,¹ Robert G. Bartolo,² et al in this article Effects of a Chlorhexidine Gluconate-Containing Mouthwash on the Vitality and Antimicrobial Susceptibility of In Vitro Oral Bacterial Ecosystems: Appl Environ Microbiol. 2003 August; 69(8): 4770–4776.

clearly mentions that there is a definite shift in the oral microflora which may not be beneficial to the person using this mouthwash.

2. Anderson KM, Stoner GD, et al in their article Immunohistochemical assessment of Viadent-associated leukoplakia. Oral Oncol. 2005 Feb;41(2):200-7.

Studies show an association between sanguinarine, the active ingredient in Viadent oral health care products, and oral premalignant lesions. The study was undertaken to quantitatively compare the staining profiles of sanguinarine-associated leukoplakia to normal and dysplastic specimens. Archived oral mucosal specimens were stained for tumor markers p16, p53, cyclin D1, Ki-67, and Bcl-x and analyzed through Simple PCI image analysis software. Quantitative analyses showed trends towards intermediate staining in Viadent-related specimens. Luckily the viadent based products have been discontinued in India.

3. Winn DM, Blot WJ, et al Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer. Cancer Res. 1991 Jun 1;51(11):3044-7. National Cancer Institute, Bethesda, Maryland 20892.

Interviews with 866 patients with cancer of the oral cavity and pharynx and 1249 controls of similar age and sex from the general population in four areas of the United States revealed increased risks associated with the regular use of mouthwash. Risks of oral cancer were elevated by 40% among male and 60% among female mouthwash users, after adjusting for tobacco and alcohol consumption. Risks among both sexes generally increased in proportion to duration and frequency of mouthwash use. These findings, together with other studies, provide further incentive for clarifying the association between mouthwash use and oral cancer.

4. Tschoppe P, Wolgin M, et al Etiologic factors of hyposalivation and consequences for oral health.

Quintessence Int. 2010 Apr;41(4):321-33. University School for Dental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Hyposalivation is represented by a reduced salivary flow rate and can be caused by etiologic factors such as systemic diseases and intake of various medications The aim of this review was to compile data about the qualitative and quantitative changes of salivary components during hyposalivation, and to summarize their consequences for oral health. A Medline/PubMed/Scopus search was conducted to identify and summarize articles published in English and German that reported on etiology of hyposalivation and changes in the salivary composition due to hyposalivation of different origins. T Apart from the reduction of the salivary flow rate, the quality of saliva is strongly altered because of systemic diseases, medications, and radiotherapy, including increased viscosity and pH shift to more acidic values and changes in salivary protein compositions. Furthermore, hyposalivation may be accompanied by pronounced shifts in specific microbial components, in particular toward a highly acidogenic microflora. Moreover, therapy of hyposalivation is often restricted to palliative treatment (ie, saliva substitutes or gels). To prevent tooth tissue demineralization, clinicians should consider saliva substitutes that are supersaturated with calcium and phosphates and contain fluoride.

Professor Bailoor's comment

The oral findings in hypo salivation are a. Increase in size of major salivary glands due to reflex hyperplasia b. Shiny glistening oral mucosa c. Minor bleeding spots due to sharp teeth and micro trauma d. Random pigmented spots in the healing areas of oral mucosa . The patient must be asked to discontinue any mouth wash use and stick to the grandma suggested salt warm water gargle with a pinch of neem oil. As per personal clinical observations by Durgesh Bailoor Consultant in Oral Medicine such cases are increasing in frequency due to over use and self administration of various mouth washes available in the market The astute student is directed to read this link http://www.ncbi.nlm.nih.gov/pubmed/12555958 this is an ADA reference Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment J Am Dent Assoc. 2003 Jan;134(1):61-9; quiz 118-9. A literature review by McCullough and Farah from 2008 published in the Dental Journal of Australia concluded that there is "sufficient evidence" that "alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer".The authors also state that the risk of acquiring cancer rises almost five times in alcohol-containing mouthwash users who neither smoke nor drink (with a higher rate of increase in those who do) Oral Medicine Radiology Students from Karnavati School of Dentistry and other Schools are requested read the above references and to comment on this blog