Mouthwash question

[JoeR1234]

Hi,
I have a situation where I'm trying to ensure a sterilized mouth prior to flossing and brushing. I have significant mucosa erosion in the vestibule due to what I believe is from a silicone chin implant that I intend on having removed. I made an appt with a Periodontist in early August to have gums etc. evaluated and plant to have the implant removed in January.

My question is related to opinions on mouthwash before flossing and brushing to sterilize and if it should be alcohol based. I've been using Listerine in this capacity for a couple years but recently thought that maybe the alcohol can contribute to the tissue erosion. I used Crest clinical with hydrogen peroxide and had a bad reaction where I actually had pieces of tissue in my mouth as if it had burned the inside of my mouth. Would like to get the opinion of some of the great contributors here as to whether an antiseptic based mouthwash would even sterilize the mouth prior to brushing - is it even worth it for that purpose with the potential tradeoff being negative affects on the soft tissue?

Thanks!

 

[MattKW]

Most mouthwashes have removed alcohol because of a tenuous association to mouth cancer. Some of the "burning" mouthwashes (yes, I'm looking at you, Listerine!) have caused my patients to shed skin. It appears as white strings; not harmful but it makes you wonder. Those sort of mouthwashes also only have limited working time, despitre their marketing. The best mouthwashes contain chlorhexidine gluconate. But you have to brush and floss first to clean off the plaque so it will stick to clean tooth surfaces for best effect. If you don't like the taste, studies have shown that even diluted with water 50:50 it is still very effective.

 

[JoeR1234]

Most mouthwashes have removed alcohol because of a tenuous association to mouth cancer. Some of the "burning" mouthwashes (yes, I'm looking at you, Listerine!) have caused my patients to shed skin. It appears as white strings; not harmful but it makes you wonder. Those sort of mouthwashes also only have limited working time, despitre their marketing. The best mouthwashes contain chlorhexidine gluconate. But you have to brush and floss first to clean off the plaque so it will stick to clean tooth surfaces for best effect. If you don't like the taste, studies have shown that even diluted with water 50:50 it is still very effective.

Thanks Matt - you're very helpful. What do you recommend to sterilize the mouth before flossing/brushing relative to concerns about microcuts/possible infection due to particular circumstances (I'm the chin/cheek implant guy from the other thread). I just stopped the alcohol mouthwash pre-rinse and my current routine is to first do a quick swish with no alcohol listerine, floss - brush and final rinse with no alcohol 1x per day ACT 1 anticavity flouride mouthwash. This combo still feels intense and seems to dry the mouth ......I just read that a warm water & salt mouthwash has effective anti-bacterial properties - do you think this would be a better option than the Listerine I'm using as a pre-rinse? Or, is doing anything pre floss/brush an exercise in futility in terms of trying to prevent potential infection from flossing/brushing? (of course I know I'm over the top here - I'm having these implants removed in March of next year and won't be concerned after that point. I'm just trying to avoid infection before than because I would have to get them removed immediately and I'm unable to because of allowable time off from work & sole custody of a special needs child).
Thanks again - really appreciate your help.

 

[Busybee]

Why do you need to sterlise your mouth with chemicals? Saliva does that already. If you want to promote healing, saliva is better than listerine. What you eat and drink will make the difference. The only mouthwash I've found helpful (for short term use only) is peroxyl. By that I mean one or two days. It should only be for acute conditions or for people who have long term health problems where the body doesn't create healthy saliva.

 

[MattKW]

Thanks Matt - you're very helpful. What do you recommend to sterilize the mouth before flossing/brushing relative to concerns about microcuts/possible infection due to particular circumstances (I'm the chin/cheek implant guy from the other thread). I just stopped the alcohol mouthwash pre-rinse and my current routine is to first do a quick swish with no alcohol listerine, floss - brush and final rinse with no alcohol 1x per day ACT 1 anticavity flouride mouthwash. This combo still feels intense and seems to dry the mouth ......I just read that a warm water & salt mouthwash has effective anti-bacterial properties - do you think this would be a better option than the Listerine I'm using as a pre-rinse? ...

No harm in salty water, and can use as much as you like. Not as effective as chlorhexidine (CHX) mouthwash for length of time or range of bacteria. The beauty of CHX is that if you use it after brushing, it stays working for up to 12 hours (good substantivity).

 

[honestdoc]

You cannot sterilize the mouth. It has natural bacteria called oral flora. Once the flora forms biofilm/plaque around your teeth, you must remove it by brushing & flossing if you want to keep your teeth.

I prescribe CHX for short term use only. Like Dr. MattKW mentioned, it continues to work and according to various periodontal sources up to 10 days after 2 weeks of use. Long term use of CHX can lead to potential teeth discoloration.

I don't like mouth rinses for everyday use. I had a discussion with a periodontal instructor in dental school over 20 years ago. Rinses cause mouth irritation. The mouth wants to protect itself by making abnormal (hyperkeratinized, precancerous) tissue. This takes weeks/months of constant irritation. Depending on risk factors such as tobacco, recreational alcohol use, and/or unresolved irritation, about 3% of precancerous lesions can potentially lead to Squamous Cell Carcinoma which is the most common cancer in the mouth. Like Dr. MattKW mentioned, companies are removing alcohol and adding proprietary ingredients. We don't have enough information about irritation potentials with these. Here in the US, there were numerous cases of severe mouth trauma from Peroxide use.

Another reason I don't like daily rinses is people think they don't have to brush and floss now that they have this "magic" rinse.

 

[JoeR1234]

You cannot sterilize the mouth. It has natural bacteria called oral flora. Once the flora forms biofilm/plaque around your teeth, you must remove it by brushing & flossing if you want to keep your teeth.

I prescribe CHX for short term use only. Like Dr. MattKW mentioned, it continues to work and according to various periodontal sources up to 10 days after 2 weeks of use. Long term use of CHX can lead to potential teeth discoloration.

I don't like mouth rinses for everyday use. I had a discussion with a periodontal instructor in dental school over 20 years ago. Rinses cause mouth irritation. The mouth wants to protect itself by making abnormal (hyperkeratinized, precancerous) tissue. This takes weeks/months of constant irritation. Depending on risk factors such as tobacco, recreational alcohol use, and/or unresolved irritation, about 3% of precancerous lesions can potentially lead to Squamous Cell Carcinoma which is the most common cancer in the mouth. Like Dr. MattKW mentioned, companies are removing alcohol and adding proprietary ingredients. We don't have enough information about irritation potentials with these. Here in the US, there were numerous cases of severe mouth trauma from Peroxide use.

Another reason I don't like daily rinses is people think they don't have to brush and floss now that they have this "magic" rinse.

I really appreciate your responses - thanks. My main concern is staph opposed to the plaque causing bacteria (not that I don't worry about plaque ....I have always religiously brushed and flossed so my teeth are in great condition). My concern is that I had a staph infection last year and have facial (cheek&chin) implants which are being removed next March....a worst case would be if they get infected prior which is what I'm trying to prevent). My thinking was to the effect of "If I cut myself while flossing the staph has an entry in my bloodstream so I need to "kill" the bacteria prior to brushing & flossing. After being educated here I think my error was thinking that I can "kill" the bacteria. It seems from the answers here that the bacteria would only be temporarily killed (if even that) while a gum cut from flossing might take days to heal and the bacteria continually regenerate. Not to mention - as mentioned in this thread for all I know the mouthwash might be weakening the mucosa making me more susceptible to bacterial entry. Depending on if you guys disagree, I think going forward it makes sense to do a salt water rinse first, brush & floss and finish with my standard ACT flouride rinse. (I did obtain Clorhexedine though I'm not sure it will be worth using for my purposes (no perio disease,etc) due to the staining and temporary use recommendations which would put my back in the same place. Plus, as Matt mentions the directions are to use after brushing & flossing where my concerns are what could happen while brushing & flushing (and as mentioned this is where my understanding of bacteria might be way off)
Thanks a lot guys - you do the board a great service!

 

[honestdoc]

Staph bacteria generally resides outside the mouth like your skin. In a normal oral flora, it is generally Strep along with 700 other species which about 50% have not been cultivated according to a source. It is difficult to assess risk of infection to your implants. The general protocol for joint implants is usually antibiotic premedication before dental procedures up to 2 years after implants placed. Unfortunately, there are growing cases of antibacterial resistance due to overexposure. According to another source, there have been no evidence of artificial joint infection due to bacterial species from the oral flora.

 

[JoeR1234]

Staph bacteria generally resides outside the mouth like your skin. In a normal oral flora, it is generally Strep along with 700 other species which about 50% have not been cultivated according to a source. It is difficult to assess risk of infection to your implants. The general protocol for joint implants is usually antibiotic premedication before dental procedures up to 2 years after implants placed. Unfortunately, there are growing cases of antibacterial resistance due to overexposure. According to another source, there have been no evidence of artificial joint infection due to bacterial species from the oral flora.

Thank you for the information - I feel like myself and some of the other "free info recipients" on here should be writing checks to you guys. Thanks again