Mouthwash is one of those things that a lot of us use automatically. You brush. You floss (or mean to). You rinse. You get on with the rest of your day, assuming you’ve done a good job taking care of your teeth and gums.
You probably don’t wonder much about the mouthwash you use, but dental researchers have plenty of questions still about using rinse, studying how it helps, whether it helps, and so on. For there’s a difference between that clean feeling you have after rinsing and the overall health of your mouth, particularly your gums.
For although bad breath can be a sign of gum disease, minty fresh breath doesn’t tell you your mouth is disease-free. And healthy teeth need healthy tissues to support them.
Recently, a large umbrella review in the Journal of Clinical Periodontology took a closer look at the issue, analyzing a selection of systematic reviews in order “to evaluate and compare the long-term efficacy of commonly used, commercially available daily mouthwashes in plaque control and gingival inflammation.”
In short, what evidence do we have for daily mouthwash? Does it improve oral health? If so, do some kinds work better than others?
As the research team dug into the nine studies that made the cut, they focused on two key measures that dentists use every day: plaque index, which reflects bacterial buildup on the teeth, and gingival index, a clear sign of gum inflammation. (That inflammation is the hallmark of gum disease.)
What they found was telling.
Across the studies, essential oil-based mouthwashes consistently did better than placebo rinses. One of those studies found that they reduced plaque by about 32% and gingival inflammation by about 24% compared with placebo.
One especially large review they included analyzed 32 randomized controlled trials (the gold standard in biomedical research) involving more than 5100 participants. The analysis showed that when essential oil mouthwash was used in addition to brushing and flossing, there were statistically significant reductions in both plaque and gingivitis after 6 months vs. just brushing and flossing.
What’s more, in those trials, nearly 37% of those using essential oil rinse achieved at least 50% plaque-free sites. Almost 45% reached at least 50% healthy gum sites.
Compare that to the results for those who only brushed and flossed: Just 5.5% had the same degree of plaque improvement as those in the essential oil rinse group, while 14.4% hit the mark for healthy sites.
Interestingly, the results were more mixed when it came to other types of mouthwash. For instance, Cetylpyridinium chloride (CPC) also led to improvements in both measures across multiple reviews, but the results weren’t as consistent as those of essential oil rinses. There was little evidence that fluoride rinses helped improve gum health at all – though in fairness, fluoride research has historically focused more on dental outcomes than on periodontal health.
It’s not all that surprising, really, that essential oil-based mouthwashes performed as well as they did. Oils such as clove, peppermint, and cinnamon have long been valued for their antimicrobial and anti-inflammatory properties. Rather than relentlessly “killing germs,” such oils appear less disruptive to the overall microbial balance than some stronger antiseptic rinses – helping keep harmful bacteria at bay so helpful bacteria can flourish, while also soothing gum tissue and working in harmony with the body’s natural systems.
And this aligns with a key to biological dentistry: supporting natural processes biocompatibly rather than trying to overpower them.
It’s a point worth emphasizing: Mouthwashes don’t just affect plaque; they affect the oral microbiome itself. Certain strong antimicrobial rinses can disrupt the delicate balance of oral bacteria involved in the nitrate-nitrite-nitric oxide pathway – an essential system that plays a role in blood pressure regulation and heart health.
It’s one reason why stronger is not always better and why, long term, daily use deserves careful consideration. As with many things in mouth/body health, intention matters.
Want to take a deeper dive into essential oils and oral health? This article is a great place to start.
