Mouthwash: Therapeutic vs Cosmetic and Who Actually Benefits

The mouthwash shelf is crowded with products promising fresh breath, stronger enamel, healthier gums and whiter teeth. Some do more than others, and some do mainly one thing: make your mouth taste nice for a while. This guide explains the difference between therapeutic and cosmetic mouthwashes, who may benefit, what to watch for with children, and how mouthwash fits with brushing and flossing. It is based on guidance from the American Dental Association (ADA).

Mouthwash is an add-on, not a replacement

The ADA is clear that mouthwash (also called mouthrinse) is not a replacement for daily brushing and flossing. It may be a helpful addition to some people’s routine. If you are short on time, brushing twice a day and cleaning between your teeth once a day come first. See our guide on how to floss and clean between your teeth.

What mouthwash can do

Like floss, interdental brushes and water flossers, mouthwash can reach between teeth, into areas a toothbrush cannot. According to the ADA, depending on the product, mouthwash can help:

• Prevent or control tooth decay
• Reduce plaque, the thin film of bacteria that forms on teeth
• Prevent or reduce gingivitis, an early stage of gum disease
• Slow how quickly tartar (hardened plaque) forms
• Freshen breath

Not every mouthwash does all of these things. The label and the type of product matter.

The two main types

Therapeutic mouthwashes

The ADA explains that therapeutic mouthwashes contain active ingredients that kill bacteria and can help reduce plaque, gingivitis, cavities and bad breath. Those that contain fluoride help prevent or reduce tooth decay. Some therapeutic rinses require a prescription. Many are sold over the counter.

Cosmetic mouthwashes

Cosmetic mouthwashes may temporarily control or reduce bad breath and leave a pleasant taste. The ADA says they do not reduce your risk of cavities or gum disease.

	Therapeutic	Cosmetic
Active ingredients	Yes, such as antibacterial agents or fluoride	No therapeutic active ingredient
Bad breath	Can help	Temporary masking
Plaque and gingivitis	Some products help	No
Cavities	Fluoride rinses help	No
Where to get it	Over the counter or by prescription	Over the counter

How to choose

The ADA recommends talking to your dentist about whether you need a mouthwash and what kind, based on your dental health. For an over-the-counter product, look for the ADA Seal of Acceptance, which means the product has been tested and shown to be safe and effective.

Match the product to the goal

• Cavity-prone? Ask your dentist whether a fluoride rinse makes sense alongside fluoride toothpaste. Our guide to fluoride treatments covers in-office options.
• Gum concerns? Ask about an antibacterial therapeutic rinse, and see our guide to gum disease signs.
• Bad breath? A cosmetic rinse only masks odor for a while. If bad breath keeps coming back, look for the cause. Our guide to bad breath causes can help.

Read the label

The ADA advises checking the label and following its precautions, instructions and age recommendations. Labels tell you the active ingredient, how long to swish, and whether to avoid eating or drinking afterward.

Alcohol in mouthwash

Some rinses contain alcohol. That matters in a few situations:

• Mouth sores. For canker sores, MedlinePlus advises against mouthwashes that contain alcohol because they can irritate the area more.
• Burning mouth. NIDCR lists mouthwash containing alcohol among the things to avoid if you have burning mouth syndrome.
• Children. The ADA warns that swallowing large amounts can cause intoxication because of the alcohol in some rinses.

If alcohol bothers you, ask your dentist or pharmacist about alcohol-free alternatives with the ADA Seal.

Mouthwash and children

The ADA says mouthwash is not recommended for children younger than 6. They may accidentally swallow large amounts, which can cause nausea, vomiting and intoxication from the alcohol in some rinses. For older children, follow the age guidance on the label and supervise use. Store mouthwash out of reach of young children.

Using mouthwash well

• Follow the label for the amount and how long to swish.
• Spit it out. Do not swallow it.
• Use it as part of a routine that already includes brushing twice a day and cleaning between teeth daily.
• If a prescription rinse was recommended, use it exactly as your dentist directed.

Common misconceptions

“Fresh breath means a clean mouth”

Not necessarily. The ADA notes that cosmetic mouthwashes can leave a pleasant taste and temporarily reduce bad breath without lowering the risk of cavities or gum disease. A minty mouth can still have plaque between the teeth.

“Rinsing can replace flossing”

The ADA says mouthwash is not a replacement for daily brushing and flossing. Floss and interdental tools physically remove plaque and food from between teeth. A rinse is an extra step.

“All mouthwashes do the same thing”

Therapeutic and cosmetic rinses are different categories, and therapeutic rinses differ by active ingredient. Fluoride rinses target decay. Antibacterial rinses target plaque and gingivitis. Read the label to see what a product is designed to do.

“More is better”

Use the amount and timing on the label or the instructions from your dentist. The ADA’s guidance is to follow the label’s precautions, instructions and age recommendations.

A simple daily routine

1. Brush twice a day for two minutes with a fluoride toothpaste.
2. Clean between your teeth once a day with floss or another interdental tool.
3. If your dentist recommends it, add a mouthwash that matches your goal, ideally one with the ADA Seal.
4. Keep regular dental checkups so problems are found early.

When to talk to your dentist

Mouthwash can hide symptoms that deserve attention. Bring up any of these at your next visit, or sooner if they bother you:

• Bad breath that returns quickly after rinsing
• Gums that bleed when you brush or floss
• Sores, burning or pain in the mouth
• A dry mouth that makes rinsing feel necessary all day

A rinse can make a symptom feel better for a while without fixing what is causing it, so these signs are worth a professional look. If you need a dentist, you can search for one near you.

Frequently asked questions

Do I need to use mouthwash?

Not necessarily. The ADA describes mouthwash as a possible helpful addition for some people, not a replacement for brushing and flossing. Ask your dentist whether it would help you.

What is the difference between therapeutic and cosmetic mouthwash?

Therapeutic rinses have active ingredients that can reduce plaque, gingivitis, cavities or bad breath. Cosmetic rinses temporarily freshen breath and taste but do not lower your risk of cavities or gum disease, according to the ADA.

Can kids use mouthwash?

The ADA says mouthwash is not recommended for children under 6 because they may swallow it. For older children, follow the label’s age recommendations.

What does the ADA Seal mean on a mouthwash?

The ADA says the Seal means the product has been tested and shown to be safe and effective.

Is mouthwash with alcohol bad?

It can irritate canker sores and is on NIDCR’s list of things to avoid for burning mouth syndrome. If it bothers you, ask about alcohol-free options.

Sources

• ADA MouthHealthy: Mouthwash
• ADA MouthHealthy: Flossing
• MedlinePlus: Canker sore
• NIDCR: Burning Mouth Syndrome

By the Dentist Review Editorial Team.

This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

Featured image: “Perio-Aid Intensive Care, Hillegersberg, Rotterdam (2021) 06” by Donald Trung Quoc Don, via Wikimedia Commons, licensed CC BY-SA 4.0. Resized and compressed for the web.