Fluoride-Free Mouthwashes Available Over-The-Counter in the US-An Overview

Fluoride-free mouthwashes (FFM) are commonly used by patients for a variety of cosmetic and/or therapeutic reasons. The purpose of this study was to investigate the composition and purposes of FFM available over-the-counter in the US.

This study used a convenience sample by purchasing all different FFM (not considering different flavours) from supermarkets, pharmacies, and variety stores in Indianapolis, Indiana, USA. The purpose and active ingredients were obtained from the bottle labels, and FFM were categorized as therapeutic and cosmetic. Only FFM with a 'drug facts' label as regulated by the US Food and Drug Administration were considered therapeutic.

Eighty-one different FFM were identified, of which 30 were therapeutic. The most common therapeutic purpose was antiplaque/antigingivitis (n = 25), followed by oral debriding/antiseptic/wound-cleanser/pain-reliever (n = 5). Cetylpyridinium chloride (0.05%-0.1%; n = 15) and essential oils (0.092% eucalyptol/0.042% menthol/0.060% methyl salicylate/0.064% thymol; n = 9) were the most used antiplaque/antigingivitis agents. The most common purpose of cosmetic products (n = 51) was whitening (n = 11), followed by bad breath management (n = 6), pre-brushing (n = 3), dry mouth (n = 3), anti-tartar (n = 2), anti-sensitivity (n = 1), and other (n = 25). The most used whitening agents were hydrogen peroxide and/or sodium hexametaphosphate (n = 7). Among all FFM, 27 contained alcohol (≤ 26.9%). Not considering breath freshening, many FFM (n = 35) do not appear to provide a clinically meaningful benefit.

FFM vary considerably in their composition and purpose, with many providing only cosmetic benefits. Among the therapeutic FFM, most provide antiplaque/antigingivitis benefits.

Dental professionals should consider the type of FFM used by their patients as part of their home-care instructions.