What's the best mouthwash for bad breath? - How about toothpaste, gum, mints & lozenges?

- A look at ingredients proven to be effective in treating halitosis and brands that contain them. / Chlorine dioxide, zinc chloride, chlorhexidine, cetylpyridinium, essential oils/antiseptic formulations

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Link to types of oral rinses.
Link to how to use mouthrinse.

What's the best kind of mouthwash to use for bad breath?

Rather than just relying on advertising claims, picking a mouthrinse for treating breath problems should be based on science. The product you select should be one that contains ingredients that have been clinically proven to be effective in treating halitosis.

Toward that goal, we've created this page. Its purpose is to:

The most effective products usually contain more than one active ingredient.

As you'll find out below, the best mouthrinses take a multifaceted approach. They contain a combination of ingredients so they are able to tackle the causes of breath odor on more than one front.

Generally speaking, their mechanisms of action involve the use of the following approaches:

1) Antibacterial agents.

Since it's anaerobic bacteria living in your mouth that create the smelly compounds that cause bad breath, mouthwashes that contain antibacterial compounds can help to reduce their numbers and therefore aid in reducing malodor.

Ingredients to look for - As you read through this page, take notice of rinses that contain the antibacterials chlorhexidine, cetylpyridinium chloride and/or triclosan.

2) Ingredients that affect VSC formation.

VSC's (volatile sulfur compounds) are the smelly molecules responsible for the stench of bad breath. So any compound that's effective in neutralizing them will help to improve the quality of your breath.

Ingredients to look for - Chlorine dioxide (sodium chlorite), zinc compounds.

Other kinds of products use these same methods of odor control.

Besides just mouthwashes, other types of products use these same mechanisms and ingredients too. They include: mints and lozenges, toothpaste and gum. (Use the links for more details about them.)


About the effectiveness of even the best mouthwashes.

A bottle of mouthwash.

Mouthwash alone usually isn't a cure for halitosis.

We think it's important to point out that even the best rinses for treating bad breath probably aren't as effective as you might expect or hope.

They do have a place and can play a role. But only when used in conjunction with thorough mouth and tongue cleaning. (This goes for the use of mints, lozenges, gum and toothpaste too.)

What you really need to do.

Curing halitosis has to do with reducing the numbers of bacteria that produce VSC's. And the most effective, efficient and cheapest way to do that is by mechanical removal (tongue cleaning and also brushing and flossing your teeth).

Then as an additional step, using a mouthrinse can further assist in killing remaining bacteria or neutralizing the smelly compounds that they have created.

So despite whatever advertising claims you see, don't expect any type of product (oral rinse, mints, lozenges, toothpaste and chewing gum) to be an effective cure just on its own. That simply isn't realistic.


Mouthwash ingredients proven to help control bad breath.

1) Antibacterial compounds -

a) Chlorhexidine gluconate.

Properties: Antibacterial

Chlorhexidine gluconate is a broad-spectrum antibacterial compound. It's commonly used in dentistry in the treatment of gum disease. As a treatment for halitosis, it creates its effect by killing bacteria that produce smelly VSC's.

The most commonly used form of this compound is a 0.12% oral rinse (Peridex®, Perioguard®), available by prescription only (like from your dentist).

Effectiveness.

In terms of effectiveness in treating bad breath, chlorhexidine is generally considered to be the gold standard of oral rinses.

  • Several studies have demonstrated that the use of a 0.2% chlorhexidine solution can produce a significant reduction in VSC levels for over 3 hours.

    The use of a 0.12% rinse (the most common formulation) tends to create a similar but more moderate effect, over the same time frame.

  • Its antimicrobial effects also help to create a reduction in breath odor over the long-term.

(Cortelli 2008, Lourith 2010) [page references]

Side effects.

Unfortunately, the use of chlorhexidine mouthwash creates some noticeable side effects and for that reason should only be used under the supervision of a dentist, especially when its long-term use is considered. Issues of concern are:

  • Temporary but noticeable staining of the user's tongue and teeth. A professional dental cleaning is typically needed to remove the discoloration from tooth surfaces.
  • It tends to alter the user's sense of taste. The compound itself also has a bad taste.
  • Extended use may result in tissue irritation.

(Fedorowicz 2008, Cortelli 2008)

Chlorhexidine products to look for:
  • Peridex®, Perioguard®, Paroex® - chlorhexidine gluconate
  • Perio-Aid® - chlorhexidine + cetylpyridinium chloride
  • Halita® - chlorhexidine + cetylpyridinium chloride + zinc lactate

[See "best to use" section below for comparisons about effectiveness.]

b) Cetylpyridinium chloride.

Properties: Antibacterial

Cetylpyridinium chloride is an antibacterial compound that can help to reduce breath odors by way of helping to control the number of VSC-producing anaerobic bacteria found in a person's mouth.

Effectiveness in mouthwash.

Studies suggest that the antibacterial affect of cetylpyridinium chloride isn't as robust as chlorhexidine's.

  • Its effect on VSC levels was found to last for only 3 hours, as compared to 12 hours for chlorhexidine.

However, simply rinsing with it more frequently throughout the day could help to overcome this deficiency.

Research suggests that when combined with other compounds (especially with zinc alone, or in combination with chlorhexidine too) a synergistic (more effective) action is created. (You'll see below that many mouthwash formulations make use of this fact.)

(Fedorowicz 2008, Cortelli 2008)

Something you didn't know.

Because this compound is safe for use in products for cats and dogs, it is overwhelmingly the most-used agent for breath odor control. (Lourith 2010)

Cetylpyridinium products to look for:
  • Crest Pro-Health®, Scope®, Cepacol®, Colgate Plax®, Act Advanced Care®, KForce Balance® - cetylpyridinium chloride
  • Breath Rx® - cetylpyridinium chloride + zinc + essential oils
  • Perio-Aid® - chlorhexidine + cetylpyridinium chloride
  • Halita® - chlorhexidine + cetylpyridinium chloride + zinc lactate

[See "best to use" section below for comparisons about effectiveness.]

c) Essential oil preparations.

Properties: Antibacterial

Essential oil mouthrinses are typically water/alcohol solutions of menthol, eucalyptol, thymol and/or methyl salicylate.

These products have a history of being used in the treatment of gum disease. When used for that purpose or the treatment of halitosis, the basis of their effect is due to their antibacterial properties.

The most common form of this kind of preparation is the "antiseptic" mouthwash (e.g. Listerine® or one of its many generic equivalents).

Effectiveness as a mouthwash.

Studies suggest that:

  • The initial effect (first 60 minutes) of using this type of preparation is simply re-odorization, meaning that the essential oils act as masking agents that just cover over the person's breath odor.
  • At post treatment times of 2 to 3 hours, the anti-odor activity of these products is more likely due to their antibacterial action.
  • Long term use of an essential oil rinse can help to maintain reduced levels of VSC producing bacteria, both in dental plaque and in the coating that builds up on the tongue.

(Cortelli 2008)

Criticisms.

This type of mouthwash may not make the best choice for treating bad breath:

  • Antiseptic preparations typically contain a high level of alcohol (around 25% ethanol). Since alcohol acts as a desiccant, it creates a drying effect on oral tissues which may ultimately contribute to a person's breath problems. (Read here for more details about how dry mouth conditions contribute to oral malodor.)
  • It's possible for ethanol to be metabolized into smelly compounds, thus increasing breath malodor. (Lourith 2010)
Essential oils products to look for:
  • Listerine® - essential oils
  • Generic "antiseptic" mouthwashes (of which there are many) - essential oils
  • Breath Rx® - cetylpyridinium chloride + zinc + essential oils

[See "best to use" section below for comparisons about effectiveness.]

d) Triclosan.

Properties: Antibacterial

Triclosan is an antimicrobial compound that reduces VSC formation by way of reducing the levels of bacteria that create them. Besides just mouthwash, it's also found in other oral care products such as toothpaste (Crest Total®).

Criticisms.

Concerns have been raised about the safety of using products formulated with triclosan. Use this link for further discussion.

Triclosan products to look for:
  • Breeze® - triclosan, zinc

2) Compounds that affect VSC formation. -

a) Chlorine dioxide (or sodium chlorite).

Properties: Affects Volatile Sulfur Compound Formation

Chlorine dioxide (ClO2) is an oxidizing agent that's been shown to degrade sulfur-based amino acids. Since these are the building blocks of the volatile sulfur compounds that cause bad breath, when fewer of them are available, fewer smelly VSC's will be formed.

It also has antimicrobial properties and therefore can help to reduce the number of bad-breath causing bacteria.

Effectiveness.
  • The one-time use of a mouthrinse containing 1.0% sodium chlorite was found to be effective in reducing VSC levels for 8 hours and beyond. (Frascella 2000)

Probably more important, combination mouthwashes (such as chlorine dioxide + zinc) are likely more effective than the use of either component alone. (Fedorowicz 2008)

Chlorine dioxide products to look for:

There seems to be no shortage of brands of these types of rinses, or advertising hype to go along with them. Some mouthwashes are formulated with sodium chlorite as the active ingredient, which then breaks down to release chlorine dioxide.

  • CloSYS®, ProFresh®, TheraBreath®, DioxiCare® - chlorine dioxide
  • TriOral®, SmartMouth®, Oxygene®, Oxyfresh® - chlorine dioxide + zinc

[See "best to use" section below for comparisons about effectiveness.]

b) Zinc.

Properties: Affects Volatile Sulfur Compound Formation

Metal ions (such as zinc, sodium, tin, copper, and magnesium) have the ability to oxidize (react with) the thiol (sulfur based) molecule groups found on the precursor components of VSC's. (Cortelli 2008) (FYI: Thiol's are the smelly compounds added to natural gas to give it its stinky smell.)

As a possible second benefit, a study by Dadamino (2013) suggests that zinc also has antibacterial properties.

The compound used in a mouthwash's formulation might be zinc chloride, lactate, acetate, citrate or nitrate.

Effectiveness in mouthwash.

Zinc is the metal of choice for rinses used to treat bad breath. Not because it's the most effective one (copper is) but because it provides a benefit, yet has low toxicity and does not create tooth staining (like other metals can, especially tin and copper).

  • Studies have shown that 1% zinc acetate mouthwash has a significant effect on VSC levels, even 3 hours after use. (Cortelli 2008)
  • It's common for a rinse to include zinc as just one of its active ingredients (combination treatment).
Criticisms.

Some people may notice that mouthwashes that contain zinc compounds have a metallic taste or odor. (Most products contain masking agents that are able to keep this issue in check.)

Zinc products to look for:
  • Halita® - chlorhexidine + cetylpyridinium chloride + zinc lactate
  • Breath Rx® - cetylpyridinium chloride + zinc + essential oils
  • TriOral®, SmartMouth®, Oxygene®, Oxyfresh® - chlorine dioxide + zinc
  • Breeze® - triclosan, zinc

Which is the best mouthwash to use?

If you're thinking that there's a voluminous amount of hard scientific evidence about which mouthwash brand or product makes the best choice for treating bad breath, you'll be disappointed. Here's what we found.

There's no shortage of low-quality information.

When initially creating this page, we leaned heavily on the findings of The Cochrane Collaboration's review of mouthrinses for treating halitosis conducted by Fedorowicz (2008).

That's because the papers published by this organization characteristically take the form of a literature review, where stringent standards have been set that the research papers selected for inclusion must meet. For their oral rinses report:

  • The authors identified 555 research publications to evaluate. But only 5 of them met the standards that were set.
  • The paper actually states: "... although there have been a large number of studies conducted over the last 30 years, it was somewhat surprising to find so few high quality randomised controlled trials ...".

Whether the design shortfalls of most studies is purposeful (so to create a bias for a manufacturer's product), or is due to other factors, is open to conjecture. But bottom line, and despite what advertising claims may be made, the findings of most studies on this subject are quite open to debate.

Update.

A more recent literature review (Slot 2015) on which we relied heavily during our most recent update of this page encountered the same difficulty. Out of 1054 studies identified, only 12 met the set standards for inclusion.

What types of mouthwashes were found to be best?

According to both reviews of this subject (Slot 2015, Fedorowicz 2008), we can state that:

  • Picking a product that takes a combination approach seems to make the best choice.
  • That means selecting a product that contains both some ingredients that are antibacterial (chlorhexidine, cetylpyridinium chloride, triclosan) and others that disrupt VSC formation (chlorine dioxide, zinc).

a) Which types of rinses had the most convincing research evidence?

Both reviews concluded that the most compelling evidence (a study by Roldan 2003) supported the use of a mouthwash that contained the ingredients:

  • chlorhexidine (0.05%) + cetylpyridinium chloride (0.05%) + zinc lactate (0.14%)

(Blom [2012] who also authored a review of this subject came to the same conclusion.)

The study determined that after 2 weeks of use this formulation reduced VSC levels and improved breath odor but had no real affect on the amount of tongue coating that existed (the primary harbor for the bacteria that cause bad breath).

What product is this?

Our search of the web only identified a single rinse that had this formulation, Halita®. It's manufactured by Dentaid, headquartered in Spain.

On their website we could not identify a USA distributor (there is one in Mexico but not in Canada). We easily found an online source that evidently ships this product from Europe.

Precautions.

We should note that chlorhexidine products characteristically cause tooth staining, tongue discoloration and altered taste sensation.

At 0.05% (about 1/2 the most common prescription formulation in the US which is 0.12%) and with just short-term use (2 weeks in the Roldan study), this might be somewhat less of a concern. But it only makes sense to use this product with your dentist's supervision.

b) What other rinses were found to be effective?

The following studies that also met the Cochrane Collaborations review's standards provided the following insights.

Borden (2002)

This study found that ...

  • A rinse containing cetylpyridinium chloride + zinc (BreathRx®) was more effective in reducing breath malodor and VSC levels than ...
  • ... an essential oils preparation (Listerine®)  or  chlorine dioxide + zinc mouthwash (Oxygene®).
Codpilly 2004

In direct contrast to the Borden study, this one determined that ...

  • Sodium chloride (chlorine dioxide) + zinc mouthwash (TriOral®) was more effective than ...
  • ... mouthwash containing cetylpyridinium chloride + zinc rinse (BreathRx®, the product favored by the first study).
Kozlovsky (1996)

This older study confirmed that ...

  • Cetylpyridinium chloride mouthwashes are more effective than ...
  • ... those formulated with essential oils (Listerine®).

Conclusions about which is the best mouthwash based on the findings of the above studies.

The above research seems to suggest that:

  • The best products typically contain a combination of ingredients rather than relying on the performance of just one.
  • Halita® (chlorhexidine + cetylpyridinium chloride + zinc lactate) evidently has the best evidence for being effective.

    It's important to state however that all three of the literature reviews cited above only considered this evidence of effectiveness to be "very low to moderate" (Blom 2012) or "weak" (Fedorowicz 2008, Slot 2015). (Keep in mind, this is the level of evidence for the best bad breath mouthwash.)

    We'll also remind you that this "best" rinse had no significant affect on the amount of tongue coating (the harbor of bad breath bacteria). This should be a clear indication to you that the use of a mouthwash alone (without proper oral home care) is unlikely to be effective to the degree that you'd hope.

  • Also from the above studies, it seems you could conclude that there's no overwhelming evidence that favors the use of chlorine dioxide + zinc mouthwashes (like Oxygene®, TriOral®, SmartMouth®) vs. cetylpyridinium chloride + zinc ones (Breath Rx®).
  • Additionally, all of the above products and formulations seem to have been proven to be more effective than the use of essential oils preparations (Listerine® and antiseptic mouthwash generic equivalents).

Mouthrinses for bad breath and their active ingredients.

We've done our best to organize the following list but we must leave it to the reader to confirm these details when making their purchase. If you have information about additional brands or products to share, please leave it as a comment below.

  • Peridex®, Perioguard®, Paroex® - chlorhexidine gluconate
  • Perio-Aid® - chlorhexidine + cetylpyridinium chloride
  • Halita® - chlorhexidine + cetylpyridinium chloride + zinc lactate
  • Listerine® and generic "antiseptic" mouthwashes (of which there are many) - essential oils
  • Breath Rx® - cetylpyridinium chloride + zinc + essential oils
  • Crest Pro-Health®, Scope®, Cepacol®, Colgate Plax®, Act Advanced Care®, KForce Balance® - cetylpyridinium chloride
  • TriOral®, SmartMouth®, Oxygene®, Oxyfresh® - chlorine dioxide + zinc
  • CloSYS®, ProFresh®, TheraBreath®, DioxiCare® - chlorine dioxide
  • Breeze® - triclosan, zinc

It's important that the manufacturer's instructions and recommendations are followed when using these products.


How to use mouthwash so you get the most benefit from it.

1) When should you rinse?

As a general rule, you'll get the most out of using an oral rinse if you use it after you have brushed and flossed your teeth and cleaned your tongue. Here's why.

  • It's difficult for rinses to penetrate oral films (plaque that has built up on and around a person's teeth, gums and tongue).
  • As a result, the bacteria (and their waste byproducts) situated in deep within it go largely unaffected.

By rinsing after you have cleaned your mouth, that plaque that still remains will at least have been disrupted and exposed. As a result, it will be more easily penetrated and therefore more vulnerable to the actions of the compounds found in the rinse you are using.

Halitosis is usually caused by plaque accumulation on the back part of the tongue.

Why you need to gargle as far back as possible.

2) Gargling.

When you use a rinse, it's best to gargle it.

When a person gargles, they should make an "aaahhh" sound. This extends their tongue outward and allows the mouthwash to contact a greater percentage of its posterior region (the area that usually harbors the greatest number of odor producing bacteria.

Note: All mouthrinses should be spit out after gargling. Children should not be given mouthwash because of the possibility that they may swallow it.

3) Swishing.

Besides just focusing on your tongue, you should also swish mouthwash around in your mouth (especially between your teeth) so it can have an affect on the bacterial components located there.


Products other than mouthwash that can be useful in the treatment of bad breath.

a) Breath mints / Lozenges.

Just like with mouthrinses, using breath mints, lozenges, drops or sprays on their own are usually not an effective cure for bad breath. But when used in conjunction with tongue cleaning and tooth brushing and flossing, they can be valuable adjuncts.

Effectiveness.
  • Look for products that contain the exact same agents we discuss above. Especially those that have the ability to neutralize volatile sulfur compounds such as chlorine dioxide, sodium chlorite, and zinc.
  • If you don't see those kinds of ingredients, it's quite likely that the product you're considering has no real effect toward curing the underlying fundamental causes of halitosis but instead just contains flavorings and perfumes used to temporarily mask over oral malodor.
Additional benefits.

When mints or lozenges are used they stimulate the flow of saliva. This action creates a cleansing and diluting effect, both on oral bacteria and the smelly VSC byproducts they create.

Don't be fooled by products that only create a masking effect.

Products that don't contain the type of compounds discussed on this page above likely just create a masking effect that only temporarily hides breath malodor.

If so, the use of this type of product has very limited value. Beyond their short term effect, they offer no type of definitive treatment. Their use may delay an accurate diagnosis.

b) Toothpaste.

There are several compounds that can be incorporated into the formulation of toothpastes to help to control bad breath.

1) Triclosan

This is an antibacterial agent that can help to lower the level of smelly VSC's in a person's breath by way of helping to reduce the number of bacteria that produce them. (Vazquez 2005)

Effectiveness.

A study performed by Sharma (2007) compared the use of two toothpastes, one of which contained triclosan (Colgate Total).

  • At 12 hours following use, testing showed that the use of both pastes produced an effect that reduced VSC levels.
  • But at this point, the VSC levels of subjects that had used the non-triclosan dentifrice had edged above the threshold value of what's generally considered to be unpleasant breath odor, while the levels of the subjects that had used the triclosan paste still remained below.
  • Previous studies had found a similar type of benefit.

Issues and concerns.

The use of products that contain triclosan is controversial. The website of the US FDA discusses this issue.

2) Stannous fluoride.

Toothpastes are well known for containing fluoride. And if the type used is stannous fluoride its antibacterial properties can help to reduce the numbers of bacterial that cause breath odors.

3) Zinc compounds.

Some toothpastes are formulated with zinc compounds. And as explained above, they can help to neutralize VSC's.

Related page: The best toothpastes for helping to control oral malodor.)

c) Chewing gum.

As mentioned above, just the act of having something in your mouth, like chewing gum, can help to decrease halitosis. That's because as you chew your body tends to produce more saliva.

This increase in saliva helps to dilute and wash away the smelly volatile sulfur compounds that cause bad breath. That means this effect isn't a true cure for halitosis, it's just a temporary remedy.

Effectiveness.

Rosing (2009) evaluated VSC levels after test subjects chewed gum , both a regular one and a sugar-free one that also contained zinc.

  • The use of both gums produced a reduction in VSC levels, even out to 60 minutes after chewing (60 minutes was the point after no further testing was done).

The authors of the paper concluded that the lack of difference between the two suggested that the act of chewing, and the increase in saliva production it produced, was more important than the actual components of the gum.

d) Probiotics

It's been proposed that following conventional mechanical cleaning (brushing, flossing, tongue cleansing) that nonodiferous, commensal bacteria might be introduced into a person's mouth so to colonize it (thus reducing the amount of living space for the types of bacteria responsible for creating halitosis).

At this point in time studies involving probiotics treatment has been inconclusive and therefore this approach is not generally accepted by the dental community as a whole as an effective method to control bad breath. (Bartold 2016)


Our next page talks about cures for denture breath. Or jump ahead to our halitosis FYI page, just to make sure you didn't miss anything we covered on our previous pages (see Topic Index below).

 

 
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