Mouthrinses and dental caries

Mouthrinsing for the prevention of dental caries in children and adolescents was established as a mass prophylactic method in the 1960s and has shown average efficacy of caries reduction between 20-50%. Commonly, weekly or twice monthly rinsing procedures using neutral 0.2% NaF solutions have been used in schools or institutions in areas with low fluoride concentrations in the drinking water. Today, when dental caries has declined substantially in the western countries, and relatively few individuals are suffering from caries, the efficiency of large scale mouthrinsing is questioned and more individual approaches of caries prevention strategies are needed. For this reason individual caries risk assessments are necessary, utilising diagnostic tools with the aim of explaining the main causes of the caries disease. Therefore in high risk patients, daily mouthrinses using 0.05% NaF can be recommended combined with other selective preventive measures such as sugar restriction, improved oral hygiene, antibacterial treatments, and so forth. Mouthrinsing solutions have therefore been combined with antiplaque agents like chlorhexidine and other agents which can improve the caries preventive effect not only in high caries risk patients, including those with dry mouth problems and root caries. Other agents than sodium fluoride have been used, such as stannous and amine fluoride with proven clinical effects. However, although a series of new formulas of mouthrinses containing fluoride combined with different antiplaque agents have shown promising antibacterial and antiplaque efficacy, their long-term clinical effects are sparsely documented. Acute and chronic side effects from established and recommended mouthrinsing routines are extremely rare but ethanol containing products should not be recommended to children for long-term use or to individuals with alcohol problems. Patients with dry mouth problems should avoid mouthrinses containing high concentration of detergent components which reduce the substantivity of the agent and worsen the dry mouth effect. For the future, patients, dentists and public health officials will welcome new and safe, controlled and self-administrated mouthrinsing procedures with not only high efficacy, but also high effectivity and efficiency.