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Does Your Mouthwash Put You at Risk for Cancer

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Non-Carcinogenic Mouthwash

We believe that everything you put in or on your body should be as close to natural and harmless as possible. Avoiding foods and products that contain man-made chemicals and carcinogenic compounds is at the top of our list of priorities for a healthier life and for cancer prevention and treatment. That includes products that we eat, drink, apply to our skin and hair, and even those that we solely rinse with. Mouth rinses or mouthwashes are part of this list.

We ingest 5% to 7% of our toothpaste when we brush our teeth1, and the same happens potentially to a higher degree with mouthwashes. Even if you are very careful not to ingest much of it, the contact of the ingredients contained in most mouthwashes with your oral mucosa can still wreak havoc on your oral and overall health.

Let’s take a closer look at one of the most concerning ingredients present in a conventional store-bought mouthwash – alcohol.

Why do we want to avoid store-bought mouthwash?

The first and foremost reason is that most mouthwashes contain alcohol.

According to the literature, alcohol is used in mouthwashes principally as a solvent for other ingredients and as a preservative of the preparation2,3. At percentages of 10 to 12 percent, it also acts as an antiseptic and caustic agent2.

Most store-bought mouthwashes advertise the benefits of using alcohol because of its antibacterial properties. Unfortunately, alcohol is not selective in the type of bacteria that it kills, killing both potentially harmful oral bacteria and healthy bacteria, essential and necessary for oral health.

Alcohol, both consumed in alcoholic beverages or used as mouthwash/mouth rinse, poses considerable health risks2,3:

  • Increased risk of oral cancer
  • Affects mucosal permeability (it affects the permeability of the mouth lining)
  • Metabolic production of acetaldehyde

Acetaldehyde – A Known Carcinogen

Acetaldehyde is a primary metabolic product of ethanol (alcohol)2, which means that when you ingest alcohol, one of the main compounds that result from its breakdown is acetaldehyde. Acetaldehyde is considered a mutagenic compound2. A mutagen is a chemical or physical agent capable of inducing changes in DNA called mutations that can then lead to cancer4.

The World Health Organization’s International Agency for Research on Cancer (IARC) evaluates the cancer risk of different compounds. When assessing the carcinogenic risk of acetaldehyde the IARC concluded5:

  • There is inadequate evidence in humans for the carcinogenicity of acetaldehyde.
  • There is sufficient evidence in experimental animals for the carcinogenicity of acetaldehyde.


Where Is Alcohol Metabolized?

As pointed out in scientific studies, although the bulk of alcohol metabolism is carried out in the liver, evidence shows that alcohol is also metabolized in other tissues outside the liver6. It was shown that alcohol is metabolized in particular in the oral cavity and namely the gingiva (gums) and lingual (tongue) mucosa6. It was found that the differential expression of enzymes in the oral cavity could allow the accumulation of acetaldehyde in oral tissues and that this cytotoxic compound may be a contributing cause to oral injury related to alcohol6.

Acetaldehyde, Cancer and Excessive Oxidative Stress

In 2008 a group of researchers studied for the first time specific alcohol-induced changes to the oral epithelium (the tissue lining the surfaces of the mouth cavity) in patients with both oral cancer and dysplasia (abnormal cell growth)7. The results showed that acetaldehyde and end products of lipid peroxidation are formed in oral tissues of alcohol misusers with oral pre-cancer (leukoplakia) or oral cancer (squamous cell carcinoma)7. This study showed strong evidence of alcohol-induced cancer cell formation, supporting the harmful role of acetaldehyde and excessive oxidative stress in carcinogenesis7.

The Link Between Alcohol-Containing Mouthwash and the Development of Oral Cancer

Published in 2007, an extensive international case-control study involving 3210 patients with neck and head cancer and 2752 controls showed a significant link between the daily use of alcohol-containing mouthwash and the development of oral cancer8. In this study, self-reported daily mouthwash use was found to be a significant risk factor for the development of head and neck cancer, and this association was independent of other alcohol consumption and tobacco use8.

Considering only cancers of the oral cavity, pharynx and larynx, the results of the use of an alcoholic mouthwash twice daily were astonishing8:

  • Over nine times increased risk of acquiring cancer for current smokers.
  • Over five times increased risk of acquiring cancer for people who also drank alcohol.
  • Almost five times increased risk of acquiring cancer for those who never drank alcohol.

Although the authors didn’t know the specific mouthwash being used or its alcohol content, in the countries studied, the alcohol levels contained in the most common and commercialized mouthwashes are above 20%8. According to the authors, it is possible that the increased risk of cancer observed in people who do not drink alcoholic beverages may indicate that the alcohol content of commonly available mouthwashes could be a causal agent for head and neck cancers8.

It is now considered in the scientific community that “there is now sufficient evidence to accept the proposition that developing oral cancer is increased or contributed to by the use of alcohol-containing mouthwashes2.”

Alcohol is metabolized into acetaldehyde, a carcinogenic compound, and can contribute to the development of oral cancer. Do you really want to swish your mouth with a potentially cancer-causing liquid?

Beyond Cancer Risk

Beyond increased cancer risk, high concentrations of alcohol in mouthwashes may have other detrimental effects on oral health. For example, a study found a direct relationship between the alcohol content of mouthwash and the amount of oral pain felt by subjects9. “The amount of pain was found to increase with time of rinsing, and to slowly decrease after cessation of rinsing9.”

Negative effects reported from the use of alcohol-containing mouthwashes include2,9:

  • epithelial detachment (changes in the cells of the oral mucosa)
  • keratosis (oral lesions caused by the growth of keratin on the mucous membranes of the mouth)
  • mucosal ulceration (mouth ulcers)
  • gingivitis (inflammation of the gums, characterized by redness and swelling)
  • petechiae (small purple, red or brown spots on the mucous membranes of the mouth, caused by hemorrhage of the capillaries – bleeding under the skin)

 

And there is more…

If all these risks and potential negative effects are not enough, the use of alcohol-containing mouthwash also has a drying effect on the mouth. Chronic alcohol ingestion was found to enhance tumor necrosis factor-alpha expression and to lead to apoptosis (cell death) in salivary gland acinar cells10. Acinar cells have a key role in secreting saliva and studies have shown a significant decrease in salivary secretion after alcohol intake11. When evaluating the effects of ethanol (alcohol) on human saliva “chronic alcohol ingestion is associated with significant changes in parotid saliva secretion and its composition, which may perpetuate and compound ethanol-induced injury to the upper gastrointestinal tract11.”

Furthermore, dry mouth and dry mouth syndrome often associated with regular use of alcohol can increase the risk of plaque, mouth sores, gum disease, oral yeast infection, cracked lips and split skin in the corners of the mouth.

This is compelling evidence in favor of alcohol-free mouthwashes. And the truth is, they can be so easy to make, and equally effective!

Here is our alcohol-free mouthwash recipe.

Natural Refreshing Mouthwash

  • Distilled water
  • Essential oil (peppermint, spearmint, wintergreen, cinnamon)

Yes, that is it.

You can make your mouthwash in advance, or just use a couple of drops in a glass of water, and gargle in your mouth for 30–60 seconds before rinsing.

Products using water as an ingredient will have a reduced shelf-life, so you may want to use a small container. We prefer using a small spray bottle. Fill the bottle almost to the top with distilled water and then add some drops of your favorite mouth-refreshing essential oil. Usually, peppermint, spearmint or even wintergreen essential oils are good options.

  • Peppermint essential oil has a stimulant effect and may help improve mood. Research shows that peppermint essential oil has, among others, anti-inflammatory, antibacterial, antiviral, immunomodulatory, antitumor, neuroprotective, anti fatigue and antioxidant effects12.
  • Spearmint essential oil has a more calming effect and may help reduce anxiety and stress. Bioactive compounds in spearmint essential oil exhibit antimicrobial, antioxidant, insecticidal, antitumor, anti-inflammatory and antidiabetic activities13.
  • Cinnamon essential oil adds a nice and very palatable taste to your toothpaste. Furthermore, cinnamon essential oil has anti-inflammatory, antioxidative, antimicrobial antibacterial, and antifungal, among other beneficial properties14. These properties make it a preferential essential oil to use in mouth rinses, toothpastes, or root canal irrigation14. A study published in 2020 on the effects of cinnamon in dentistry concluded that “Cinnamon essential oil, cinnamon extracts, and the main components show significant antimicrobial activities against oral pathogens and could be beneficial in caries and periodontal disease prevention, endodontics, and candidiasis treatment14.”
  • Wintergreen essential oil is not such a known or used option however, it has amazing benefits. Besides helping to naturally freshen your breath, it may protect gums and teeth from infection and pain. Studies on the biological activity of wintergreen have shown anti-inflammatory, antioxidant, and antimicrobial (antibacterial and antifungal) activities, which can benefit oral health15.

Stop putting carcinogens in your mouth and try our DIY mouthwash today!


References

  1. Ciancio SG. Baking soda dentifrices and oral health. J Am Dent Assoc. 2017 Nov;148(11S):S1-S3. doi: 10.1016/j.adaj.2017.09.009. PMID: 29056183. 
  2. McCullough MJ, Farah CS. The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Aust Dent J. 2008 Dec;53(4):302-5. doi: 10.1111/j.1834-7819.2008.00070.x. PMID: 19133944. 
  3. Carretero Peláez MA, Esparza Gómez GC, Figuero Ruiz E, Cerero Lapiedra R. Alcohol-containing mouthwashes and oral cancer. Critical analysis of literature. Med Oral. 2004 Mar-Apr;9(2):120-3, 116-20. English, Spanish. PMID: 14990877. 
  4. National Human Genome Research Institute. Mutagen Definition. Updated: May 21, 2024.
  5. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Re-evaluation of Some Organic Chemicals, Hydrazine and Hydrogen Peroxide. Lyon (FR): International Agency for Research on Cancer; 1999. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 71.) Acetaldehyde. 
  6. Dong YJ, Peng TK, Yin SJ. Expression and activities of class IV alcohol dehydrogenase and class III aldehyde dehydrogenase in human mouth. Alcohol. 1996 May-Jun;13(3):257-62. doi: 10.1016/0741-8329(95)02052-7. PMID: 8734840. 
  7. Warnakulasuriya S, Parkkila S, Nagao T, Preedy VR, Pasanen M, Koivisto H, Niemelä O. Demonstration of ethanol-induced protein adducts in oral leukoplakia (pre-cancer) and cancer. J Oral Pathol Med. 2008 Mar;37(3):157-65. doi: 10.1111/j.1600-0714.2007.00605.x. PMID: 18251940. 
  8. Guha N, Boffetta P, Wünsch Filho V, Eluf Neto J, Shangina O, Zaridze D, Curado MP, Koifman S, Matos E, Menezes A, Szeszenia-Dabrowska N, Fernandez L, Mates D, Daudt AW, Lissowska J, Dikshit R, Brennan P. Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: results of two multicentric case-control studies. Am J Epidemiol. 2007 Nov 15;166(10):1159-73. doi: 10.1093/aje/kwm193. Epub 2007 Aug 30. PMID: 17761691. 
  9. Bolanowski SJ, Gescheider GA, Sutton SV. Relationship between oral pain and ethanol concentration in mouthrinses. J Periodontal Res. 1995 May;30(3):192-7. doi: 10.1111/j.1600-0765.1995.tb01273.x. PMID: 7473002. 
  10. Slomiany BL, Piotrowski J, Slomiany A. Chronic alcohol ingestion enhances tumor necrosis factor-alpha expression and salivary gland apoptosis. Alcohol Clin Exp Res. 1997 Nov;21(8):1530-3. PMID: 9394127. 
  11. Dutta SK, Orestes M, Vengulekur S, Kwo P. Ethanol and human saliva: effect of chronic alcoholism on flow rate, composition, and epidermal growth factor. Am J Gastroenterol. 1992 Mar;87(3):350-4. PMID: 1371639. 
  12. Zhao H, Ren S, Yang H, Tang S, Guo C, Liu M, Tao Q, Ming T, Xu H. Peppermint essential oil: its phytochemistry, biological activity, pharmacological effect and application. Biomed Pharmacother. 2022 Oct;154:113559. doi: 10.1016/j.biopha.2022.113559. Epub 2022 Aug 19. PMID: 35994817.
  13. Zhang LL, Chen Y, Li ZJ, Li X, Fan G. Bioactive properties of the aromatic molecules of spearmint (Mentha spicata L.) essential oil: a review. Food Funct. 2022 Mar 21;13(6):3110-3132. doi: 10.1039/d1fo04080d. PMID: 35212344. 
  14. Yanakiev S. Effects of Cinnamon (Cinnamomum spp.) in Dentistry: A Review. Molecules. 2020 Sep 12;25(18):4184. doi: 10.3390/molecules25184184. PMID: 32932678; PMCID: PMC7571082. 
  15. Michel P, Olszewska MA. Phytochemistry and Biological Profile of Gaultheria procumbens L. and Wintergreen Essential Oil: From Traditional Application to Molecular Mechanisms and Therapeutic Targets. Int J Mol Sci. 2024 Jan 1;25(1):565. doi: 10.3390/ijms25010565. PMID: 38203735; PMCID: PMC10778675. 

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