ADA Moves to Increase Mouthwash Awareness

David Lorich of Buffalo, N.Y., cares about his teeth. Some might even call it a passion.

Since the 40-year-old's braces were removed in high school, he has maintained a three-toothbrushings-per-day ritual. When it became clear that flossing could help his dental health, he took that up too.

Little surprise, then, that he ended up marrying a dental hygienist.

"It works out well," Lorich says. "She doesn't like kissing me if I have dirty teeth."

But Lorich also does something for his dental health that has not yet specifically found its way into the American Dental Association's guidelines. That is, he rinses with an antibacterial mouthwash once a day.

"You only have to rinse for 30 seconds," he says. "The brushing takes longer than the rinsing."

And though this step has still not attained the same respect accorded to brushing and flossing, recent moves by the ADA to boost awareness of antibacterial mouthwashes suggest that perhaps more Americans should be following Lorich's lead.

Brush, Floss ... and Rinse?

First, all you've heard from your dentist is brush your teeth every morning and night. More recently, of course, the message from the ADA has changed to brush and floss.

Cliff Whall, director of the ADA Seal of Acceptance program, agrees that adding "rinse" to the mantra would probably be a good move for most everyone as well, as antimicrobial mouthwashes have been shown in clinical studies to prevent the gum disease gingivitis, an inflammation of the gums caused by the accumulation of plaque along the gum line.

Whall says dozens of antimicrobial rinses, like Listerine and the prescription mouthwash Peridex (also known by the generic name chlorhexidine), have carried the ADA Seal of Acceptance for two decades now for this very reason. Many rinses containing the tooth-strengthening chemical fluoride have also garnered this seal.

"The council came to the conclusion that putting more information out would be beneficial, as the message just hasn't gotten out there as much as it has with fluoride toothpaste."

Maria Lopez Howell, consumer adviser for the ADA and a dentist in private practice near San Antonio, Texas, says the additional information has huge potential benefits for the public.

"Patients are always asking about whether they should be doing anything else to improve their dental health," she says. "To have that in our bag of tools that we use to help people is really great."

As yet, however, Whall says formal recommendations have not made room for the formal "recommended" status, even as growing evidence has supported the role of antibacterial mouthwash in oral health.

For example, a December 2002 article in the American Journal of Dentistry suggested that in combination with brushing, rinsing with an antimicrobial mouth rinse is actually more effective than flossing when it comes to preventing gingivitis.

Follow-up studies published in the Journal of the American Dental association in 2003 and 2004 further solidify the effectiveness of adding antimicrobial mouth rinses to the medicine cabinet.

But, Whall notes, "Just because these studies are published doesn't mean it meets all the criteria for recommendation."

Good Dental Habits Still Lacking

Overt recommendation or not, the lackluster dental care practiced by many Americans suggests they may do well to reach for the mouthwash bottle at least once a day.

According to a 2003 survey conducted by the ADA, only slightly more than three out of four American adults brush twice a day or after each meal. And even though about half of people say they use dental floss, dentists report that many of them floss incorrectly or inadequately.

"I think the ADA knows this," says Sebastian Ciancio, chairman of the department of periodontics at the University of Buffalo. "In order to improve the health of the public, we should start reminding the public about the products that we know have a positive effect -- those with the Seal of Approval -- and start recommending them."

He says this is particularly important since at any given time, more than 50 percent of the public has gingivitis. And many with gingivitis may not even know they have it.

Antimicrobial mouth rises may also help kill off the plaque-causing bacteria that brushing and flossing miss.

"The bacteria that we have on our teeth comprises only 25 percent of the bacteria that lives in our mouths," Ciancio says, noting that bacteria can reside on unbrushed areas such as the tongue, cheeks and tonsils. "That's an area where people don't brush, and that's an area where mouthwashes will get."

Still, Howell says, rinsing with antimicrobial mouthwash should be viewed strictly as a complement to brushing and flossing -- never as a substitute.

"This is not something that is going to replace brushing and flossing," she says.

Searching for the Seal

Those hoping to boost their dental health can find the ADA Seal of Approval on other products in their local pharmacies too. To date, two antimicrobial toothpaste lines carry the ADA Seal of Approval: Colgate Total and Crest Pro Health. Both these products contain ingredients that have been shown to kill the bacteria that cause gingivitis.

Whall says the host of new antimicrobial products deserving of the seal could spark tooth-healthy trends amongst the general public.

"I think it is a trend," he says. "If we can add to the products to help dental health, we're happy about that."

But Whall adds that people should still adhere to current ADA recommendations, which along with a balanced diet and regular dentist visits, include the time-honored routines of brushing and flossing.

"Everyone should still be brushing and flossing effectively every day," he says. "This is still probably the best thing they can do."

For a list of products bearing the ADA seal and descriptions of the various types of oral hygiene products available, visit