Rinsing with salt water beats out swishing with mouthwash

Author: John Przybys

A bottle can be found on just about every bathroom countertop or in just about every medicine cabinet in America. But is incorporating an over-the-counter mouthwash into your daily oral hygiene routine worth it?


Dr. Daniel L. Orr II, a professor and director of oral and maxillofacial surgery at the University of Nevada, Las Vegas School of Dental Medicine, says over-the-counter mouthwashes pose no health problems to those who use them sparingly.

But Orr also notes that some over-the-counter mouthwashes contain more than 20 percent alcohol. That alcohol — in addition to being a potential poisoning danger to kids who might stumble upon it and drink it — also is “an irritant” to the gums and mouth, Orr says.

“If you want to do a little experiment, you can just put any name brand (of mouthwash) into your mouth and just hold it there for a couple of minutes. It starts to burn and doesn’t feel good at all.”

Over-the-counter mouthwashes usually are taken by consumers in an attempt to kill odor-causing bacteria in the mouth. But, Orr says, “mouthwash doesn’t really clean your mouth. It doesn’t debride like a toothbrush and floss do. So if you brush and floss correctly, there really shouldn’t be much need for mouthwash at all.”

Also, Orr says, some studies indicate that “people who use it a lot — like taking it three times a day — have a slightly increased chance of oral cancer, other things being equal.”

In addition, Orr says, there are studies that indicate that “mouthwash use can actually raise your blood pressure a little bit. We’re talking maybe two or three points. That might not be a big deal, but why do it?”

The bottom line: Using an over-the-counter mouthwash to refresh one’s mouth “once a day probably is not a big deal,” and studies that point to adverse reactions tend to involve the more chronic use of mouthwash three or so times a day.

Note, too, that there are nonalcohol over-the-counter mouthwashes on the market, and that dentists often recommend specialized mouth rinses in treating specific dental problems. And while strong over-the-counter preparations may be iffy additions to an oral hygiene regimen, “rinsing is good,” Orr says.

“For instance, I’m an oral and maxillofacial surgeon, and when you take out a tooth, you can’t mechanically debride that socket very well,” he says. “So after I take out a tooth, I recommend rinsing, and what I recommend 90 percent of the time is warm salt water.”

So try rinsing with a teaspoon of salt dissolved in an 8-ounce glass of water, Orr says. “It kills bacteria and keeps (the mouth) clean.”

August, 2015|Oral Cancer News|

HPV DNA detected in mouthwash predicts oral cancer recurrence

Author: Kelly Johnson

The presence of HPV16 DNA is common at diagnosis of HPV-related oropharyngeal carcinoma (HPV-OPC) but rare after treatment. HPV-OPC has a favorable prognosis; however, 10% to 25% of patients experience disease progression, usually within 2 years of treatment.

Patients who have HPV 16 DNA in their saliva following treatment of their oropharyngeal cancer are more likely to have their cancer recur, and a prospective cohort study published in JAMA Oncology has shown that a simple mouth rinse can be used to detect it.


Gypsyamber D’Souza

Gypsyamber D’Souza, PhD, Johns Hopkins Bloomberg School of Public Health, and fellow researchers monitored 124 patients with newly diagnosed oropharyngeal cancer from 2009 through 2013. They collected oral rinse and gargle samples using 10 mL of mouthwash at the time of diagnosis as well as after treatment 9, 12, 18, and 24 months later.

HPV16 DNA was detected in 67 out of 124 of the participants testing positive. Of the 67 patients who had HPV16 DNA in their saliva at the time of diagnosis, five patients (7%) were found to still have traces of HPV16 in their oral rinses following treatment.

All five patients developed a local recurrence of oropharyngeal cancer, three of whom died from the disease.

“It’s a very small number so we have to be somewhat cautious,” said D’Souza, an associate professor in the Department of Epidemiology at the Bloomberg School and a member of the Sidney Kimmel Comprehensive Cancer Center, in a statement. However, “The fact that all of the patients with persistent HPV16 DNA in their rinses after treatment later had recurrence meant that this may have the potential to become an effective prognostic tool.”

August, 2015|Oral Cancer News|

Could the everyday use of mouthwash be linked to oral cancer?

Author: Staff


“Experts warn using mouthwash more than twice a day can give you cancer,” the Daily Mirror reports.

The news comes from a European study that examined the oral health and dental hygiene of people diagnosed with cancers of the mouth, throat, vocal chords or oesophagus (collectively called “upper aerodigestive cancers”).

The researchers found that people with the poorest oral health (including wearing dentures and bleeding gums) had a more than doubled risk of these cancers compared with those with the best oral health.

Similarly, they found that those with the poorest dental care (including frequency of tooth brushing and visiting the dentist) had a more than double risk compared with those with the best dental care.

Importantly, these associations remained after adjustment for smoking and alcohol consumption – established risk factors for these cancers – and for other factors that may influence risk, such as socioeconomic status.

But despite the Mirror’s headline, the link between oral cancer and mouthwash is less clear. The association was only significant when looking at very frequent use (three times a day).

Very few people used mouthwash this frequently, which decreases the reliability of this risk estimate. There is certainly no credible evidence that mouthwash “can give you cancer”.

Even if there is a true link, it is unclear whether it is mouthwash itself (the alcohol content) or the reasons it is being used, such as poor oral hygiene, that are responsible for the association.

The results do suggest a link between poor dental hygiene and oral cancers, however, and reinforce the importance of maintaining good dental health.

Where did the story come from?

This was multicentre research conducted by numerous academic institutions across Europe and the US.

The study was supported by the European Community Fifth Framework Programme, the University of Athens Medical School, the Bureau of Epidemiologic Research Academy of Athens, Padova University, Compagnia di San Paolo, Associazione Italiana per la Ricerca sul Cancro (AIRC), the Piedmont Region, targeted financing from the Estonian government through the European Regional Development Fund in the frame of Centre of Excellence in Genomics, and the 7FP Project ECOGENE.

It was published in the peer-reviewed Journal of Clinical Oncology.

The quality of the UK’s media reporting on the study was mixed. BBC News rightly focused on the link between poor dental hygiene and oral cancer.

But the Daily Mirror incorrectly states in its headline that, “Experts warn using mouthwash more than twice a day can give you cancer”. In fact, the researchers specifically go out of the way in their conclusion to state that their data does not provide proof that excessive mouthwash increases cancer risk.

What kind of research was this?

This was a case-control study that included a group of people diagnosed with cancer of the mouth, throat, vocal chords or food pipe (oesophagus). They were then matched with a group of people without these cancers (the controls) and were interviewed about their oral health, dental care and lifestyle.

The researchers aimed to see whether oral health and dental care – in particular, the use of mouthwash – may be associated with these cancers. As a group, these cancers are sometimes called “upper aerodigestive cancers” as they involve the upper parts of the respiratory and digestive system.

These cancers are said to account for around 129,000 new cancer cases in the European Union, making them the fourth most common cancers for men and the tenth for women.

Alcohol and smoking are widely known to be risk factors for these cancers. Other research has also associated the cancers with lower fruit and vegetable consumption, and found that they are more common among lower socioeconomic status groups.

Additional research has also suggested that poorer dental and oral health may be associated with increased risk, independent of alcohol and smoking behaviour.

It is also speculated that frequent use of mouthwash could be a risk factor as a result of the ethanol (alcohol) it contains. However, there is limited evidence proving that there is an increased risk associated with mouthwash containing alcohol.

This study aimed to examine whether mouthwash and wider oral health and dental care are associated with the risk of upper aerodigestive cancers, importantly adjusting for the potential confounders of smoking and alcohol.

What did the research involve?

This study used information from the multicentre alcohol-related cancers and genetic susceptibility in Europe (ARCAGE) case-control study, which was conducted across 13 centres in nine European countries.

The study included 1,963 people newly diagnosed with cancers of the mouth, throat, vocal chords or oesophagus between 2002 and 2005 (cases). They were matched by age and sex to 1,993 people without cancer, who were randomly selected from people attending the same medical centres or hospitals as the cases for other health reasons.

All participants were interviewed about a range of health and lifestyle measures:

  • sociodemographic characteristics (number of years of full-time education was used as the main indicator of socioeconomic status)
  • smoking history (lifetime smoking history was used to calculate “pack years”)
  • alcohol consumption (lifetime consumption of number of drinks per day was assessed for all categories of alcoholic drinks)
  • weekly consumption of fruits and vegetables (recorded by food frequency questionnaire)
  • employment history
  • body measurements
  • medical and dental history, including oral hygiene habits

Oral health was assessed using the following scoring system, where a maximum total score of 7 would indicate poorest oral health:

  • wearing of dentures (none = 0; partial denture in upper or lower jaw = 1; partial denture in both jaws = 2; complete denture in one jaw = 3; complete denture in both jaws = 4)
  • age at starting to wear dentures (no denture = 0; denture at age 55 years or older = 1; denture at age 35-54 years = 2; denture at age below 35 years = 3)
  • frequency of gum bleeding from brushing teeth (sometimes or never = 0; always or almost always = 1; 0 in subjects wearing complete dentures in both jaws)

Similarly, dental care was assessed as follows, where a maximum total score of 8 would indicate poorest dental care:

  • frequency of tooth cleaning (at least twice per day = 0; once per day = 1; 1-4 times per week = 2; less often or never = 3)
  • use of toothbrush, toothpaste or dental floss (two or three of these = 0; only one of these three = 1; none of these = 2)
  • frequency of visiting a dentist (at least once per year = 0; every 2-5 years = 1; less than every 5 years = 2; never = 3)

Participants were asked about their use of mouthwash in a separate question, but this was not included in these scores.

The researchers also took blood samples to look at whether people had four variations in genes that code for proteins involved in breaking down alcohol (ethanol).

The researchers previously found these variations to be associated with risk of upper aerodigestive cancers, with one particularly associated among heavy drinkers.

As many brands of mouthwash contain alcohol, the researchers wanted to test whether a person who had these variants influenced the potential link between mouthwash and upper aerodigestive cancers.

What were the basic results?

Participants were aged 60 years on average. Almost half of cases had mouth cancer (48%), followed by cancer of the lower throat or vocal chords as the next most common cancer (36%).

After adjustment for all other measured health and lifestyle factors, the risk of upper aerodigestive cancers increased with poorer dental care. People with the worst dental care (scores of 5-8) had the highest risk, more than double the cancer risk for people with the best dental care (a score of 0; odds ratio[OR] 2.36, 95% confidence interval [CI] 1.51 to 3.67).

Looking at oral health, people with the poorest oral health (score of 5, 6 or 7) had an increased risk compared with those with the best oral health (score of 0). People with the highest oral health score of 7 had a more than doubled risk compared with those with a score of 0 (OR 2.22, 95% CI 1.45 to 3.41). Those with moderate oral health – a score of 1-4 – were not at increased risk compared with those with the best oral health.

Reported use of mouthwash of more than three times per day was associated with tripled risk of upper aerodigestive cancers (OR 3.23, 95% CI 1.68 to 6.19). Importantly, the researchers say that although this effect was strong, only 1.8% of cases and 0.8% of controls reported such frequent use.

These relatively small numbers reduce confidence that these estimates of risk are correct. There was also no link between less frequent use of mouthwash (less than three times a day) and risk.

Looking at the four gene variants, certain variants associated with faster ethanol metabolism were associated with a decreased risk of these cancers, while a variant associated with slower ethanol metabolism was associated with increased risk.

One particular variant associated with faster ethanol metabolism was found to be less common in mouthwash users compared with “never users”.

How did the researchers interpret the results?

The researchers concluded that poor oral health and dental care seem to be independent risk factors for upper aerodigestive cancers, even after adjusting for potential confounders such as smoking and alcohol use.

They say that, “Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.”


This multicentre study conducted across nine European countries has many strengths, including its large sample size. Most importantly, it adjusted for smoking and alcohol consumption, which are well-established risk factors for these cancers and could otherwise influence the association between oral health and dental hygiene and these cancers.

The researchers also adjusted for other potential risk factors, such as socioeconomic status and how much fruit and vegetables people ate.

However, there are some potential limitations. Although the researchers have made every effort to adjust for these confounders, as the researchers themselves acknowledge, the questions asked about these lifestyle factors may not fully capture a person’s smoking habits, alcohol use and diet, so there is still the possibility that they have some effect.

Also, the questions asked around oral health and dental hygiene may not have given a full representation of the person’s mouth care. These self-reported measures were not checked against dental records.

The study asked people to rate their current oral health and dental hygiene, and in the people with cancer this was after their diagnosis. This may not reflect their lifelong oral health or care before their diagnosis. An independent assessment provided by a dentist, or examination of dental records, may have been more reliable.

Nevertheless, the study does support an independent link between oral health and dental hygiene and aerodigestive cancers. The link seems biologically plausible and further study could also assess why these links might exist. Previous studies have suggested similar links, and ideally a systematic review would be able to look at this new study alongside the other available evidence. Such a review may provide new insights into potential risk factors.

Despite reports to the contrary, the link between mouthwash and cancer is less clear. Although using mouthwash more than three times a day was more common among cases than controls, very few people used mouthwash this frequently – only 1.8% of cases and 0.8% of controls. Risk calculations involving such small numbers of people are less reliable than those including larger samples.

The possible link between mouthwash and mouth and throat cancers needs to be clarified. If there is a link, it is currently unclear whether it could be related to the alcohol contained in mouthwash, or whether the link is caused by poor oral health and not a direct effect of mouthwash at all. It could be that poor oral health or dental hygiene increases the risk, and people with poorer health are also more likely to use mouthwash.

However, in the meantime, if you are concerned, there are plenty of alcohol-free mouthwash brands available. Your local pharmacist should be able to advise you.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


April, 2014|Oral Cancer News|

‘Dentist should have spotted my cancer’

Author: staff

An NHS dentist who advised a patient to treat what turned out to be a life-threatening oral cancer with mouthwash is being sued for tens of thousands of pounds in damages.

Paula Drabble, 58, went to Pinfold Dental Practice, in Hattersley, Hyde, in June 2008 with concerns about a white lesion on her gum.

She was told by her dentist, Ian Hughes, it was nothing serious, a court heard.

Mrs Drabble of Mottram Moor, Mottram, Hyde, had five further appointments with Mr Hughes and was advised to ‘manage’ her complaint with mouthwash. She was eventually referred to hospital in April 2009, and ‘seriously invasive cancer’ diagnosed.

She had surgery, including removal of affected bone, followed by radiotherapy and chemotherapy.

She has now made a good recovery and has begun a High Court fight for damages, claiming Mr Hughes was negligent to have not spotted the cancer and referred her to hospital earlier. Timothy Briden, for Mrs Drabble, told the court his client had developed the patch on her gum some years earlier. The lesion was found to be benign by medics at the University Dental Hospital in Manchester and she was discharged in 2004 with a letter being sent to Mr Hughes, warning him to ‘re-refer if you notice or indeed Mrs Drabble notices any changes’.

Marcus Dignum, for Mr Hughes, denied that his client was at fault in failing to spot the cancer. He said: “Plainly the court will have every sympathy with Mrs Drabble in respect of her ordeal, as does Mr Hughes, but the allegations made against him are extremely serious from both a personal and professional standpoint. They are vigorously denied.

“In June 2008 the presence of the cancer would not have been detectable with the human eye, as its presence would have been at a cellular level only.”

January, 2013|Oral Cancer News|

The danger in smokeless tobacco products

Source: (Uganda, Africa)
Author: Racheal Ninsiima

Tobacco use is the single most preventable cause of death among adults and is a significant factor for several mouth, throat, lung and heart diseases.

It is also a major contributor to morbidity. Globally, the World Health Organisation (WHO) estimates that tobacco causes about 71% of lung cancer, 42% of chronic respiratory diseases, 20% of global tuberculosis incidence and nearly 10% of cardiovascular diseases. But the issue of smokeless products that contain tobacco has for long been ignored.

According to Dr Sheila Ndyanabangi, the tobacco control focal point person at the ministry of Health, schoolchildren are also consuming the products. This is because sometimes the ingredients are written in foreign languages which may not be understood by the consumers.

What is smokeless tobacco?
There are two basic forms of smokeless tobacco: snuff and chewing tobacco. An article ‘smokeless tobacco and how to quit’ on the website, says snuff is finely ground tobacco packaged in cans and is sold either dry or moist. The nicotine in the snuff is absorbed through the tissues of the mouth as it is placed between the cheek and gum.

Snuff is designed to be both “Smoke-free” and “spit-free” and is marketed as a discreet way to use tobacco. Chewed tobacco comes along as long strands of tobacco leaves that are chewed by the user who thereafter spits out the brown liquid (saliva mixed with tobacco).

Types of smokeless tobacco
Mouth fresheners:
The commonest is Kuber. It is a highly addictive tobacco drug disguised as a mouth freshener and packed in sachets similar to tea leaves. Kuber may be added to tea or simply licked. According to Dr Ndyanabangi, Kuber, rich in nicotine, is widely consumed by secondary school students and taxi drivers.

Results of a research conducted by the Uganda Youth Development Link (UYDEL) in 2011 revealed that Kuber also contains drugs like cocaine and marijuana which may lead to hormonal change, impaired brain development, mental health disorders and heart problems.
Kuber is often chewed with mairungi leaves, sucked or taken with hot water as a beverage resulting in a drowsy feeling. Kuber is sold in shops and supermarkets.

Many people value chocolate as a delicacy. However, tobacco is one of the sweeteners added to some brands of chocolate, especially dark chocolate. Among the ingredients are: cocoa, sugar, cocoa butter, tobacco, soya lecithin, milk and gluten.

Menthol products:
Dr Ndyanabangi says people ought to be careful with menthol products such as toothpaste, mouthwash and gum; they may also contain tobacco. In some, menthol is used as a sweetener to make them useable and disguise the smell of tobacco. Other products include nicotine lollipops, wafers and water. Currently in the US, tablets are being investigated for any form of tobacco.

Nevertheless, the fact still stands; smokeless tobacco is as lethal as cigars. Dr Prossy Mugyenyi, the manager at the Centre for Tobacco Control in Africa (CTCA), says the tobacco in these smokeless products acts as a receptor and the person keeps demanding more and more.

“Just like a person becomes addicted to smoking and becomes a chain smoker, so do these smokeless products make one addictive to the tar and nicotine in them,” Mugyenyi says.

No safe tobacco
According to Dr Jackson Orem, head of the Uganda Cancer Institute, there is no safe form of tobacco and at least 28 chemicals in smokeless tobacco have been found to cause cancer. Smokeless tobacco products raise the incidence of cancer, especially oral cancers like mouth, tongue and throat.

In addition, Mugyenyi says excessive exposure of one’s body to tobacco increases the risk of heart disease, stroke, teeth loss, gum disease and aneurysm (abnormal widening of a portion of an artery due to weakness in the wall of the blood vessel). However, despite the prevalent risk, Uganda does not have a comprehensive tobacco control law. The WHO Framework Convention on Tobacco Control (FTCT) to which Uganda has been signatory since 2003 is not enforced.

“There is a lot of illicit trade in the tobacco industry and the fines of Shs 20,000 to Shs 30,000 stipulated in the statutory instrument of 2004 to ban smoking in public places are not punitive enough and neither are they being enforced,” Ndyanabangi says.

Using mouthwash can increase cancer risk for smokers

Author: Eilish O’Regan, health correspondent

Smokers have been warned to stay away from mouthwash – as it might increase their risk of developing mouth cancer. The combination of smoking and drinking alcohol has been established as increasing the risk of the disease.

Now researchers have warned that may apply even to the alcohol contained in mouthwash. They pointed out that, while the link between the use of mouthwash containing alcohol and the cancer is not firmly established, it is best avoided or limited in use by smokers. The risk was examined by researchers led by dentist Dr John Reidy and colleagues in the Royal College of Surgeons and St James’s Hospital in Dublin.

Around 400 new cases of oral cancer are diagnosed each year in Ireland with two people a week dying from the disease. Symptoms include red and white patches on the lining of the mouth or tongue, a mouth ulcer that does not heal or a swelling that lasts for more than three weeks.

The most effective way of preventing mouth cancer is to quit smoking and limit consumption of alcohol, say experts. The researchers said they were concerned about the effects the alcohol in the mouthwash had and it was therefore “prudent” to restrict its use by smokers who are considered “high-risk” for mouth cancer. Around three-quarters of mouth cancers arise due to a patient both smoking and drinking, according to the study in the Journal of the Irish Dental Association.

August, 2011|Oral Cancer News|

Oral Cancer Prevention international lawsuit against Johnson & Johnson claims actions expected to cause over 7,300 oral cancers

Author: press release

A lawsuit filed by Oral Cancer Prevention International (OCPI) against Johnson & Johnson in Federal Court in Trenton New Jersey claims that J&J’s actions to protect the reputation of its Listerine mouthwash, which has been linked to oral cancer, can be expected to result in over 7,300 cases of otherwise preventable oral cancer across the US and over 1,120 such cancers in New York State alone. Some of the key markets impacted include: California, Colorado, Florida, Illinois, Michigan, New Jersey, Ohio, Pennsylvania, Tennessee, Texas, and Washington.

“Oral cancer kills as many Americans as melanoma and twice as many as cervical cancer,” says Mark Rutenberg, CEO of OCPI. “It is also rising sharply among women, young people and non-smokers. Because there has previously not been an easy way to test routine oral spots for precancerous cells, the disease is generally not detected until it is an already invasive cancer with a high mortality rate that has changed little in the last 50 years.”

The lawsuit, which seeks compensatory and punitive damages, claims that J&J blocked an agreement between OCPI and a then J&J subsidiary to sell its test for oral precancer. The lawsuit claims that J&J was concerned that such sales could draw attention in the $1B US Listerine market to recent studies suggesting that the mouthwash may be linked to oral cancer. J&J was particularly concerned about a 2008 study in the Australian Dental Journal — which concluded that mouthwashes with high alcohol content could cause oral cancer — because Listerine sales in Australia subsequently dropped by 50 percent. Listerine has the highest alcohol content of any over-the-counter-mouthwash.

As a result of its regard for the reputation of Listerine, J&J prevented a then subsidiary, OraPharma Inc., from executing on its exclusive sales agreement with OCPI to educate US dentists on how to prevent oral cancer using its painless test for still-harmless precancerous oral cells. Virtually all oral cancers begin as a very small, painless, white or red oral spot that look identical to the common oral spots that appear in about 10 percent of adults at any time. OCPI’s “Brush Test,” known as OralCDx, is somewhat like an “oral Pap smear” in that it uses a specialized painless biopsy brush and computerized analysis of the specimen to quickly and accurately determine if a harmless appearing oral spot may contain precancerous cells.

OralCDx was the subject of the largest clinical trial ever conducted in dentistry and a historic three-year nationwide public service billboard, transit, and magazine advertising campaign sponsored by the American Dental Association, which advised Americans “It’s a tiny spot now. Don’t let it become Oral Cancer. Ask your Dentist about a Brush Test.”

OraPharma’s sales and education program to US dentists was intended to follow-up on this historic ADA program by educating dentists on how to find oral spots and perform the OralCDx test.

“Due to its concerns about the reputation of Listerine, J&J restricted OraPharma to selling OralCDx to the 4 percent of New York dentists who do not recommend a mouthwash to their patients,” continues Rutenberg. “Based on the number of oral cancers already prevented by the over 500,000 OralCDx tests performed to date, we believe that J&J’s actions to prevent more dentists from being educated on OralCDx will result in over 1,200 otherwise preventable oral cancer cases in New York and over 7,300 across the US.”

August, 2011|Oral Cancer News|

Alcohol based mouthwash and oral cancer – too much confusion

Author: Francis Mawanda

If you are like me, you probably always and almost faithfully, include a bottle of mouthwash on your grocery list especially after watching and/or listening to the numerous commercials in the media which claim that you will not only get long lasting fresh breath, but also freedom from the germs that cause plaque and gingivitis. However, many proprietary mouthwashes including my favorite brand contain Alcohol (ethanol) which also gives them the characteristic burn we have to endure, albeit for a few seconds each day, but safe in the knowledge that the product is hard at work killing all the germs that give us bad breath and may cause plaque and gingivitis. But the question I continually ask myself is whether regular or long term use of these products is safe especially after reading the numerous research reports and newspaper articles suggesting a possible link between long term use of alcohol based mouthwashes and oral cancer.

Several research studies have reported finding an association between long term mouthwash use and oral cancer (1, 2, 3). For example, in a study conducted by Wynder and colleagues (1), they found a significant association between mouthwash use and oral cancer. A bigger multi-site study by Guha and colleagues (3) comparing participants who reported having used mouthwash to those who reported never having used mouthwash found that individuals who reported using mouthwash more than twice a day were nearly six times more likely to develop oral squamous cell carcinoma compared to those who reported never having used mouthwash. However, in both these studies, no distinction was made on whether participants used alcohol or non-alcohol based mouthwashes which raises several epidemiological concerns such as specificity, since not all mouthwashes contain the same chemical ingredients

However, several studies have been conducted in which a distinction was made between alcohol containing and non alcohol containing mouthwash use (4, 5, 6). Unfortunately, these studies have produced mixed results. While some studies reported finding a positive association between alcohol containing mouthwash use and oral cancer (4), other studies found no association at all (5, 6). For example, although a 1983 study conducted in the states of California, Atlanta, and New Jersey by Winn and colleagues (4) found an increased risk of oral cancer among users of alcohol containing mouthwash compared to both non-users and users of non-alcohol based mouthwash, a similar study conducted in Puerto Rico found no significant association between the use of alcohol based mouthwash and oral cancer.

To add to the confusion is the fact that reviews of the subject by epidemiologists and other experts have also produced mixed results. While some researchers in their reviews concluded that the results of these studies provide sufficient evidence to demonstrate a link between long term use of alcohol based mouthwash and oral cancer (7, 8), other researchers concluded that the evidence is not sufficient to make the conclusion that there is an association between alcohol based mouthwash use and oral cancer (9,10).

Furthermore, while systematic reviews or meta-analyses can give us a better picture of the association between use of alcohol based mouthwashes and oral cancer because they can generate a pooled risk estimate by aggregating all the findings on the subject, there has only been one meta-analysis on this subject which was conducted by epidemiologists in Europe (10) and concluded that there is no excess risk for oral cancer from use of alcohol or non-alcohol based mouthwash.

From all this confusion, it’s clear that a randomized control trial (RCT) is needed to determine with a higher degree of certainty whether there is a true association between long term use of alcohol based mouthwashes and oral cancer. However a RCT is not feasible in this case simply because it would be unethical to expose individuals to a product that may cause cancer however weak the association maybe. Possible alternatives include quasi-experimental studies, prospective cohort studies or repeated case-control studies which may provide sufficient evidence through consistency. However, results from these alternatives will still face criticism since they do not offer unbiased estimates.

Therefore, until concrete evidence is available, the decisions on whether to use mouthwash or not and whether to use alcohol based or non-alcohol based mouthwashes remains a matter of personal preference and of course cost for some of us.

1. Weaver A, Fleming SM, Smith DB. Mouthwash and oral cancer: carcinogen or coincidence? Journal of Oral Surgery 1979;37:250-3.
2. Wynder E L, Kabat G, Rosenberg S, Levenstein M.Oral cancer and mouthwash use. J National Cancer Institute 1983; 70: 255-260.
3. Guha N, Boffetta P, Wunsch Filho V et al. Oral health and risk of squamous cell carcinoma of the head and neck and oesophagus: results of two multicentric case-control studies. American Journal of Epidemiology 2007; 166: 1159-1173.
4. Winn D M, Blot W J, McLaughlin J K et al. Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer. Cancer Research 1991; 51: 3044-3047.
5. Winn D M, Diehl S R, Brown L M et al. Mouthwash in the etiology of oral cancer in Puerto Rico. Cancer Causes Control 2001; 12: 419-429.
6. Marshberg A, Barsa P, Grossman M L. A study of the relationship between mouthwash use and oral and pharyngeal cancer. Journal of the American Dental Association 1985; 110: 731-734.
7. McCullough M J, Farah C S. The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Aust Dent J 2008; 53: 302-305
8. Werner C .W. & Seymour, R. A., Are alcohol containing mouthwashes safe? British Dental Journal 2009; 207: E19
9. La Vecchia C. Mouthwash and oral cancer risk: an update. Oral Oncology 2009; 45: 198-200.
10. Lewis M A O, Murray S. Safety of alcohol-containing mouthwashes. A review of the evidence. Dent Health (London) 2006; 45: 2-4.

April, 2010|Oral Cancer News|

Doctors using mouthwash to detect head, neck cancer

Author: Jean Enersen

For a patient with head and neck cancer, the cure rate is only 30 percent. That’s because the disease is often detected in the late stages. Now catching the cancer earlier may be as simple as gargling with mouthwash.

Edie Acosta’s niece and nephew gave her the courage to fight neck cancer.

“They cut from here, all the way down here,” she said.

On her neck, the scar marks where a stage four tumor was removed.

“It seemed bigger and bigger ’til it got to the size of a fist, a man’s fist,” she said. “And I couldn’t even move my neck. You feel like a little bird whose wings got cut and you can’t fly anymore. I just, I thought I was really gonna die.”

For patients like Edie, late stage diagnosis makes treating neck cancer more difficult. Now, researchers have developed a quick, inexpensive mouthwash to detect these cancers earlier.

The patient rinses with the saline mouthwash. After they spit it out, doctors add antibodies. In about 48 hours, if there’s cancer detected in the saliva, the molecules show up in color.

“We’ve found that these molecules show up differently in the oral rinses from patients that have cancer compared to patients that don’t have cancer,” said Dr. Elizabeth Franzmann, otolaryngologist, Sylvester Cancer Center at the University of Miami.

In a study that included 102 head and neck cancer patients and 69 patients with benign disease, the oral rinse detected the cancer nearly 90 percent of the time.

For Edie, 30 years of smoking has taken a toll. She hopes this new test helps others catch the cancer before it’s too late.

“I think that would be a miracle,” she said.

If head and neck cancer is caught early, doctors say it has and 80 percent cure rate. Researchers are now working on a version of the mouthwash for home use.

December, 2009|Oral Cancer News|

Mouthwash multiplies risk of cancer up to nine times

Author: Adam Creswell

Mouthwashes containing alcohol should be used only for short periods because they may increase the risk of oral cancer by up to nine times. Dental researchers warned yesterday that among people using such mouthwashes, the risk of oral cancer was increased nine times if they smoked, and five times if they drank alcohol.

For non-drinkers using alcohol-based mouthwashes, the risk of oral cancer is just under five times higher, the experts warn in the latest edition of the National Prescribing Service journal Australian Prescriber.

Brands of mouthwash with more than 20 per cent alcohol could have other harmful effects, including the gum disease gingivitis, flat red spots called petechiae and detachment of the cells lining the mouth, they said.

“Although many popular mouthwashes may help to control dental plaque and gingivitis, they should only be used for a short time and only as an adjunct to other oral hygiene measures such as brushing and flossing,” they wrote. “Long-term use of ethanol-containing mouthwashes should be discouraged, given recent evidence of a possible link with oral cancer.”

The paper expands on concerns aired by university researchers early this year.

December, 2009|Oral Cancer News|