Is Mouthwash Healthy? Dentists Reveal Benefits, Hidden Risks

Mouthwash can do more than just stop bad breath. It can deliver an extra dose of fluoride, whiten teeth and kill bacteria in the mouth. Some products promise to help prevent plaque and gum disease.

The germ-killing action makes mouthwash especially popular, but there’s concern it may also have unintended health consequences for the body, like higher blood pressure.

So should you use mouthwash and which type is healthiest?

Here’s what the experts say:

Do you really need a mouthwash?

No, mouthwash is not necessary for good oral health, say Dr. Tricia Quartey, a dentist in New York and consumer advisor spokesperson for the American Dental Association; and Dr. David Okano, a periodontist and assistant professor at the University of Utah School of Dentistry.

Mouthwash is also not a replacement for brushing and flossing, both emphasize.

“Can it help? Maybe a little bit. Can it be detrimental? Yes,” Okano tells TODAY.com.

One advantage is that mouthwash can reach places a toothbrush might not, so rinsing with a product that contains fluoride can be beneficial, Quartey notes.

Antiseptic mouthwash can fight plaque — the sticky film of bacteria on teeth — but only above the gum line, Okano notes.

It can fight the early stages of gingivitis, or gum inflammation, but not the later stages of periodontal disease, which involve bone loss caused by plaque below the gum line, he adds.

“These mouth rinses can’t make claims against the plaque or the germs that occur in the (gum) pockets,” Okano says.

Is it good to use mouthwash every day?

Mouthwash may be a “helpful addition” to the daily oral hygiene routine for some people, the American Dental Association notes.

But some experts caution against daily mouthwash use — unless a dentist recommends it — because of its effect on the oral microbiome, the community of microbes in the mouth.

“I don’t think it’s a wise idea to use any mouthwash just every day when you’re healthy,” microbiologist Jessica Mark Welch, Ph.D., tells TODAY.com. She studies the oral microbiome at the ADA Forsyth Institute in Cambridge, Massachusetts.

“I wouldn’t use any mouthwash at all. Your saliva is designed to maintain the healthy community in your mouth, the healthy bacteria in your mouth.”

The mouth contains the largest microbial community in humans besides the gut and is “crucial to health,” research has found.

And just like in the gut, there are good bacteria that are beneficial.

They evolved to live in our mouths and have important functions, Mark Welch says. One of them is helping the body to transform nitrate in the diet into nitric oxide, which is involved in dilating blood vessels and keeping blood pressure in check.

Are there negatives to mouthwash?

The big worry is about disrupting the mouth’s ecosystem.

Antiseptic mouthwash kills most bacteria, as advertised, including the good microbes in the mouth.

There is “unequivocal evidence” that disrupting the oral microbiome by using antiseptic mouthwash will suppress nitric oxide production and negatively impact blood pressure, researchers caution.

It’s a concern for Okano since nitric oxide is important for general health, he says.

Dr. Kami Hoss, a California dentist, compared it to taking an antibiotic for the mouth every day in his book, “If Your Mouth Could Talk,” and previously told TODAY.com that using antiseptic mouthwash is one of the biggest mistakes he sees patients make.

Dr. Jeremy London, a Georgia heart surgeon, says he avoids most mouthwash because he’s worried about the negative impact on his blood pressure.

It’s a valid concern, Mark Welch says.

“The evidence is pretty good right now that using antiseptic mouthwash every day in healthy people will tend to increase your risk for heart disease and other metabolic diseases, probably because you’re eliminating, or at least reducing, the ability to function of the good bacteria in your mouth,” she notes.

Her concern covers other types of mouthwash as well.

“I don’t think there’s good evidence for the usefulness of any kind of mouthwash in a healthy person to use every day,” she says.

Okano agrees. “I don’t think you really want to use any mouth rinse of any type for an extended period of time,” he says.

Another concern is that some mouthwashes are 25% alcohol, so they can dry out the mouth.

Mouthwash types

Besides cosmetic mouthwash, which temporarily controls bad breath, other over-the-counter types can have additional functions:

Fluoride mouthwash

It contains fluoride, a mineral that prevents or reverses tooth decay, according to the National Institutes of Health.

The fluoride in mouthwash is less concentrated than the fluoride in toothpaste, so it’s more beneficial when a person uses fluoride toothpaste, Okano says.

Antiseptic mouthwash

It’s designed to kill bacteria with ingredients such as essential oils or chlorhexidine.

Doctors sometimes recommend a prescription-strength chlorhexidine mouth rinse for patients with periodontal disease, but it’s used for two to six weeks, not indefinitely, Okano says.

Whitening mouthwash

It contains peroxides, which whiten teeth but can also be a little irritating, he notes.

“I have seen whitening mouthwashes work for sure,” Quartey adds.

Alkaline mouthwash

Alkalizing ingredients such as baking soda can help make the mouth less acidic.

Acid is what causes teeth to break down, so “alkaline is good,” Quartey says. “It would help to neutralize that acidity.”

Dry mouth mouthwash

This lubricating oral rinse can help patients who have conditions that decrease the amount of saliva in their mouth, Quartey says.

Okano is not a big advocate of these products, noting there can be more effective strategies, like chewing gum to stimulate saliva flow.

Sensitive teeth mouthwash

It contains ingredients that reduce the nerve transmission from the tooth to the brain, dampening the sharp pain people can feel when they eat something cold, hot, sweet or acidic.

What is the best mouthwash to use?

It depends on a patient’s needs, Quartey and Okano say.

Both recommend looking for a product with American Dental Association Seal of Acceptance, which means it’s safe and effective.

Quartey is a fan of mouthwash with fluoride because the liquid washes over all tooth surfaces.

“What I see most of my patients need would be an anti-cavity fluoride mouthwash,” she says.

Hoss recommends using an alkaline mouthwash because it can “help keep the pH of the mouth balanced to promote a healthy oral microbiome,” he writes in his book.

Mark Welch advises skipping mouthwash altogether. “The best thing to do is brush and floss and then let your mouth take care of itself,” she says. Use a tongue scraper once or twice a day since bacteria on the tongue can cause bad breath, she adds.

Mouthwash before or after brushing?

This can depend on personal preference, though a mouthwash manufacturer may advise a specific order for its product, the ADA notes.

Okano recommends using a mouthwash either before brushing or waiting at least 30 minutes after brushing to avoid washing away the fluoride from the toothpaste.