Mouth Rinses

There are basically two categories of rinses: 1) Fluoride containing rinses and 2) antibacterial containing types. As stated elsewhere, we recommend rinsing last thing in the day with an OTC fluoride rinse such as Aim or Fluorigard (or any containing 0.05% sodium fluoride) for cavity prevention.

In the second category of rinses (antibacterial), we have both prescription strength ones containing Chlorhexidine and non-prescription Listerine. These not used to combat decay or harden teeth. They are used to combat gum infections. Chlorhexidine is a potent antibacterial rinse. Unfortunately, it has a side effect of staining teeth. For that reason, it can only be used for a limited length of time. Multiple tests have shown Listerine to be an effective antibacterial rinse, although not as powerful as Chlorhexidine.

To complicate things further, both Fluoride containing rinses and Listerine are now available with added ingredients. In this, they are copying toothpastes. With names like “Total Care”, etc they are marketed as being superior to the simpler formulations.

Again, we are dealing with only two basic types of rinses – one for decay and the other for gum disease. Whether the addition of calcium to either is of any benefit remains to be seen.

May 09 – I went to a local pharmacy today and checked on mouth rinses. You have to be a bit of a chemist to differentiate between the various ones. For example, I found the following:

Listerine “Total Care” contains no Listerine at all ! Its active ingredient is fluoride. I called the company to verify that this is so.

Act “Total Care” – It has only one active ingredient – fluoride. Therefore, I don’t see where it’s chemically any better than just plain “Act” (all its other ingredients are “Inactive”.) In addition, it contains only 0.02% Fluoride – half of what regular ACT contains.

AF = Alcohol Free (good idea – less apt to cause mouth dryness and other problems).

Oct 2010 – The FDA has just issued a warning to Listerine Total Care’s maker, J & J, to cease crediting

their mouth rinses with preventing periodontal disease. It goes on to say that sodium fluoride is the active

ingredient – an ingredient the FDA agrees is effective in preventing cavities, but unproven in preventing gum disease.

April 2010 – A study came out (JADA) about “Plax” which is another OTC antimicrobial (antibacterial) rinse . That study showed Plax to be as effective as Listerine in reducing bacteria. This is good news as Plax has a more agreeable taste.


Listerine’s active ingredients are: Eucalyptol, Menthol, Methyl Salicylate, & Thymol. Listerine also contains alcohol, however (up to 25 %!). Due to this, there are concerns with its long-term use and should only be used when advised to do so by a dentist or dental hygienist.

Now Listerine has come out with a version that contains no alcohol – Listerine Zero (makes you think of Coke Zero, doesn’t it?). The problem I see is that all the testing has been done with the original, alcohol containing, Listerine. How much of its efficacy is from alcohol?

Act, Fluorigard:

Act, Fluorigard, and other 0.05% fluoride containing rinses – there are lots of these, but again they are for cavity prevention and not gum disease even though they may say “anti-gingivitis” etc. And Act, unlike Listerine “Total” is Alcohol free (as are many other fluoride rinses).

Watch out – there are many products that contain 0.02% sodium fluoride – less than 1/2 the strength of the 0.05% that you should be using)

Biotene Rinse:

Biotene originally started as a saliva substituted (see Root & Gumline Cavities – Xerostomia). It is now being promoted as an anti-gingivitis/anti-bacterial type of rinse. Listerine (or Plax) will be more effective for people without dry mouth. If you do have a dry mouth problem, Biotene is an appropriate, non-fluoride containing rinse.

The only thing I can tell you is that all the studies on anti-bacterial types of rinses have been done on Peridex (Chlorthexidine) and Listerine (and now Plax). Biotene may or may not be a good, reliable anti-bacterial rinse. It is a known saliva substitute for people with dry mouth conditions.


There are a ton of mouth rinses out there (Listerine makes six different rinses now), but there are still only two basic types of OTC rinses – Antibacterial & Anticavity: Listerine & Plax are in the first group and Fluoride containing types in the second. Biotene could be considered in a class by itself as an effective saliva substitute.

Make sure to see “Toothpast” for more information on how misleading ads and product names can be.

JADA = Journal Of the American Dental Association


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