Best and Worst Mouthwashes for Your Oral Microbiome, Bad Breath, Teeth and Gums

Originally published on Mamavation: August 31, 2021

Do you need a good nontoxic mouthwash you can trust that is good for your oral microbiome, bad breath, teeth, and gums? While we are all thinking about brushing, flossing, and gum disease, Mamavation took a look at the most popular 100+ mouthwash products and ranked them for you based on ingredients that support your oral microbiome according to the most recent research.

You’ve trusted Mamavation to bring you topics like best and worst nontoxic toothpaste, best nontoxic collagen, and best probiotics, now join us as we bring you the best nontoxic mouthwashes for your oral microbiome, bad breath, teeth, and gums.

Disclosure: This post was medically reviewed by Sondra Strand, RN, BSN, PHN. It also contains affiliate links.

Mouthwashes Can Throw Your Oral Microbiome Into Disarray

In 2019, a study found that reengineering the oral microbiome by using common mouthwashes and other bacteria-killing dental treatments to prevent disease doesn’t work. In other words, when your oral care routine includes products that can destroy your oral microbiome, which is the natural bacteria inside your mouth, you can delay the healing process and immunity your body naturally has for disease.

Just like how antibiotics can be overused, so can mouthwashes that contain bacteria-killing ingredients. There is good bacteria inside your mouth, neutral bacteria, and bad bacteria. Because mouthwashes indiscriminately remove ALL bacteria, the good and neutral bacteria are not left behind to help your mouth heal. Good bacteria supporting your oral microbiome is needed to decrease the risk of common issues like cavities, gingivitis, and bad breath.

The Ingredients in Mouthwash Are Linked to Diabetes

Some studies have linked the overuse of mouthwash to diabetes and other similar symptoms. In 2019, researchers published a study linking frequent regular use of over-the-counter mouthwash with an increased risk of developing pre-diabetes/diabetes. The study was a longitudinal study looking 1,206 overweight patients in San Juan around the age of 40 to 65 years.

At the beginning, the patients were free from diabetes and other major cardiovascular diseases. Over the period of years, the ones that overused mouthwash was more likely to develop diabetes. Some researchers surmise this is linked to the oral microbiome and therefore good oral hygiene, depending on the products used, can have an effect on your health.

Mouthwash Linked to More Cavities and Decrease of Saliva

According to Ask The Dentist, “contrary to popular belief, the killing of ‘99.9% of germs’ does not actually aid your dental health by preventing cavity formation.”

They explain that your oral microbiome exists to help the natural remineralization of your teeth, which is needed for natural cavity protection. If you kill ALL the bacteria inside your mouth with mouthwashes, you are not only killing the bad bacteria, but also the good and neutral bacteria you need. We’ve been so programmed by marketing to think that antigingivitis and antiplaque are behavior is all about strong mouthwashes, but the truth is more complicated.

In addition to killing bacteria, Ask The Dentist also claims that most mouthwashes also reduce the amount of saliva in your mouth, which is another key component to killing cavities. You need your saliva to support the remineralization process because it reorganizes the oral bacteria that cause decay while also depositing minerals like phosphorus, magnesium, and vitamin K2 in your teeth.

Fluoride — Should It Be Used Inside Mouthwashes or Drinking Water?

The topic of fluoride is confusing and everyone seems to have a very strong opinion about it. Especially after May of 2020 when a group of 25 scientists published a meta-analysis on all the studies that have been done on fluoride thus far.

The scientists stated very clearly that “fluoride is a human developmental neurotoxicant that reduces measures of intelligence in children, placing it into the same category as toxic metals (lead, methylmercury, arsenic) and polychlorinated biphenyls.”

Prior to that, in 2019, a group of 512 Canadian pregnant mothers and their children were studied and IQ tests were taken of the children at 3 to 4 years of age. The tests demonstrated that levels of fluoride present in drinking water had potentially robbed the children of 3 to 4 IQ points. These findings indicate the need to reduce fluoride intake during pregnancy.

The evidence of fluorinated drinking water stealing IQ points from American children continues to mount. However, every time a new study comes out, it seems as if the American Academy of Pediatrics (AAP) doubles down on their support of fluoride in drinking water, toothpaste, and in dental treatments as a way to safeguard children from cavities.

Our advisors do not believe that fluoride in drinking water is wise. However, their opinion of fluoride in toothpaste and dental treatments is positive. This idea in general is incredibly controversial in the scientific and medical world. As explained in the video below, the AAP is trading several IQ points for essentially ONE cavity.

What the Experts on Hormone Disruption in Children Say About Mouthwashes and Fluoride

So should you use a minty flavor of fluoride toothpaste or mouthwash or not? Well, it’s complicated. It’s a totally different exposure level, so we had questions.

We reached out to Dr. Leo Trasande, Director of Environmental Pediatrics at the New York University Grossman School of Medicine, and one of our pediatric advisors. Dr. Trasande has been very active in warning parents about the problems behind hormone-disrupting chemicals.

In his book, “Sicker, Fatter, Poorer” Trasande reveals the alarming truth about hormone-disrupting chemicals effect on our daily lives and what we can do to protect ourselves and fight back. Because of his unique position with one foot in the medical world and one foot in the activist world, we felt he was uniquely positioned to advise us on this issue.

His response may be surprising for some of us, but it is logical and makes sense. Protecting children from the perils of cavities, which can result in the creation of other chronic diseases down the road, he supports the use of fluoride in toothpaste and dental treatments like mouthwash.

However, he believes using fluoride in water is another issue that can be problematic because it’s ingested. In terms of mouthwash, you are spitting most of it out and getting very little exposure. This is where he says that fluoride has a legitimate use in toothpaste and mouthwash as a chemical that can prevent worse things down the road.

We also reached out to Dr. Bruce Lanphear, MD, MPH, who’s a Clinician Scientist and Medical Doctor at the Child and Family Research Institute, BC Children’s Hospital. He’s also a Professor in the Faculty of Health Sciences at Simon Fraser University in Vancouver, British Columbia and is well versed on the perils of fluoride and children.

In fact, he was called as a witness to testify at the TSCA fluoride trial against the EPA and continues to be an expert on fluoride and exposure to children. He had a very similar take on fluoride in toothpaste as Dr. Leo Trasande and felt it was problematic in water, but not so problematic in toothpaste and mouthwash.

The reasoning behind that is it’s more of a nuanced issue and the exposure levels are just nowhere as high as you would find in things like drinking water.

Bottom line: Both of them seemed to think that fluoride as an active ingredient was not as much of a problem in mouthwash as it is in drinking water. So for the purposes of this investigation, we’ve looked at the other ingredients and clearly marked the products with fluoride for you so you can decide.

Problematic Ingredients to Avoid in Mouthwashes for Healthy Oral Microbiome

Some of the ingredients listed below are linked to killing bacteria indiscriminately in your mouth, which means they will kill bad bacteria plus the good bacteria you need to support a healthy oral microbiome. This list also contains ingredients made from petroleum and other ingredients linked to hormone disruption, allergic reactions, sores, or cancer.

Alcohol	Parabens	Polysorbates
Artificial colors	PEGs (polyethylene glycol)	Natural flavors
Chlorine dioxide	Propylene glycol	Sodium hydroxide
Chlorhexidine	Poloxamer 407	Cocamidopropyl betaine
Sodium benzoate	Potassium sorbate

Mamavation’s Investigation of Mouthwashes

Mamavation evaluated over 100+ different mouthwashes for ingredients linked to hormone disruption, allergic reactions, cancer, other types of human health problems, and environmental concern.

About the Author

Leah Segedie is the President and Founder of Mamavation.com. Mamavation produces award-winning content and independent consumer studies examining the intersection of endocrine-disrupting chemicals (EDCs) and everyday products brought into American households. She’s been referred to by many as “the real FDA.”

Since 2008, Mamavation has been helping everyday moms navigate the grocery store by commissioning consumer studies on food, beverages, personal care products and other such products and thus democratizing science and testing for everyone.