Mouthwash - and oral cancer?
What is mouthwash?
Mouthwash is a personal care product that can assist you in keeping your teeth and gums healthy and giving you fresh breath.
Mouthwashes come in different types. They can be primarily for fresh breath, or also include fluoride and other active ingredients to reduce dental plaque, tooth sensitivity or gum disease. Antibiotic and anaesthetic mouthwashes for sore throats are also available by prescription.
Different mouthwashes contain different ingredients. Some contain the alcohol ethanol, which is the same alcohol as in alcoholic beverages.
What’s the myth?
It has suggested that use of alcohol-containing mouthwash products is associated with increased risk of oral cancer.
This recurring myth does not have the support by cancer organisations and professional dental bodies.
FACT: The weight of evidence does not support a link between mouthwash and oral cancer
There has been speculation and numerous studies into the possible link between use of alcohol-containing mouthwash and oral cancer. The speculation likely arose because drinking large quantities of alcohol is a proven risk factor for development of oral cancer.
However, no link between use of alcohol-containing mouthwashes and mouth cancer has been proven. Studies and reviews have yielded mixed results, with some supporting an association and others finding no association. The overall weight of evidence suggests that there is no increased risk for oral cancer from use of alcohol-containing mouthwash.
A 2008 Review in the Australian Dental Journal[1] stirred up a mini media storm, with headlines such as “Mouth cancer warning…Listerine” and “Will mouthwash give you cancer” appearing in Australian papers .
However this review did not refer to any new studies, and was criticised for failing to cover all of the available literature. It was also criticised for highlighting one study[2] in particular without reporting key shortcomings of that study – shortcomings that the authors themselves take pains to point out with advice that the “mouthwash results should be interpreted with caution”.
FACT: Major cancer organisations do not list mouthwash use as a risk factor for oral cancer
Major cancer research organisations and dental associations agree that there is insufficient evidence to conclude that use of alcohol-containing mouthwashes increase the risk of oral cancer.
The Australian Cancer Council, Cancer Research UK and the US National Cancer Institute list smoking and heavy alcohol consumption as the major risk factors for oral cancer, with the risk compounded for people who smoke and drink. Other minor risk factors listed by these organisations make no mention of mouthwash use.
Similarly, dental associations such as the British Dental Health Foundation do not list mouthwash use as a risk factor for development of mouth cancer.[3]
FACT: Mouthwashes are regulated for safety in Australia
In Australia, the way that mouthwashes are regulated depends on the claims that are made regarding the product.
Mouthwashes that make a therapeutic claim, e.g. “fights gingivitis” or “kills germs that cause gum disease” are regulated by the Therapeutic Goods Administration. Mouthwashes that do not make a therapeutic claim are regulated as cosmetics by NICNAS, the national industrial chemicals regulator. And additionally the Australian Competition and Consumer Commission has strong powers to remove unsafe products from sale.
Regulatory controls imposed by these agencies ensure that mouthwash products are safe for use. This means monitoring any new information that could shed new light on the safety of products or their ingredients.
The bottom line? You can continue to use mouthwash, including alcohol-containing mouthwash, with confidence.
There is no evidence to prove that use of these products increases your risk of developing oral cancer.
Sources
[1] McCulloch, M. J. and Farah, C. S. 2008, “The role of alcohol in oral carcinogenesis with particular reference to alcohol-containig mouthwashes”, Australian Dental Journal, Vol. 53, pp 302-305
[2] Guha, N., Boffetta, P., Filho, V. W., Neto, J. E., Shangina, O., Zaridze, D., Curado, M. P., Koifman, S., Matos, E., Menezes, A., Szeszenia-Dabrowska, N., Fernandez, L., Mates, D., Daudt, A. W., Lissowska, J., Dikshit, R., Brennan, P. 2007, “Oral Health and Risk of Squamous Cell Carcinoma of the Head and Neck and Esophagus: Results of Two Multicentric Case-Control Studies”, American Journal of Epidemiology, Vol. 166 (10), pp. 1159-1173.
[3] www.mouthcancer.org/page/risk-factors
Mouthwash is a personal care product that can assist you in keeping your teeth and gums healthy and giving you fresh breath.
Mouthwashes come in different types. They can be primarily for fresh breath, or also include fluoride and other active ingredients to reduce dental plaque, tooth sensitivity or gum disease. Antibiotic and anaesthetic mouthwashes for sore throats are also available by prescription.
Different mouthwashes contain different ingredients. Some contain the alcohol ethanol, which is the same alcohol as in alcoholic beverages.
What’s the myth?
It has suggested that use of alcohol-containing mouthwash products is associated with increased risk of oral cancer.
This recurring myth does not have the support by cancer organisations and professional dental bodies.
FACT: The weight of evidence does not support a link between mouthwash and oral cancer
There has been speculation and numerous studies into the possible link between use of alcohol-containing mouthwash and oral cancer. The speculation likely arose because drinking large quantities of alcohol is a proven risk factor for development of oral cancer.
However, no link between use of alcohol-containing mouthwashes and mouth cancer has been proven. Studies and reviews have yielded mixed results, with some supporting an association and others finding no association. The overall weight of evidence suggests that there is no increased risk for oral cancer from use of alcohol-containing mouthwash.
A 2008 Review in the Australian Dental Journal[1] stirred up a mini media storm, with headlines such as “Mouth cancer warning…Listerine” and “Will mouthwash give you cancer” appearing in Australian papers .
However this review did not refer to any new studies, and was criticised for failing to cover all of the available literature. It was also criticised for highlighting one study[2] in particular without reporting key shortcomings of that study – shortcomings that the authors themselves take pains to point out with advice that the “mouthwash results should be interpreted with caution”.
FACT: Major cancer organisations do not list mouthwash use as a risk factor for oral cancer
Major cancer research organisations and dental associations agree that there is insufficient evidence to conclude that use of alcohol-containing mouthwashes increase the risk of oral cancer.
The Australian Cancer Council, Cancer Research UK and the US National Cancer Institute list smoking and heavy alcohol consumption as the major risk factors for oral cancer, with the risk compounded for people who smoke and drink. Other minor risk factors listed by these organisations make no mention of mouthwash use.
Similarly, dental associations such as the British Dental Health Foundation do not list mouthwash use as a risk factor for development of mouth cancer.[3]
FACT: Mouthwashes are regulated for safety in Australia
In Australia, the way that mouthwashes are regulated depends on the claims that are made regarding the product.
Mouthwashes that make a therapeutic claim, e.g. “fights gingivitis” or “kills germs that cause gum disease” are regulated by the Therapeutic Goods Administration. Mouthwashes that do not make a therapeutic claim are regulated as cosmetics by NICNAS, the national industrial chemicals regulator. And additionally the Australian Competition and Consumer Commission has strong powers to remove unsafe products from sale.
Regulatory controls imposed by these agencies ensure that mouthwash products are safe for use. This means monitoring any new information that could shed new light on the safety of products or their ingredients.
The bottom line? You can continue to use mouthwash, including alcohol-containing mouthwash, with confidence.
There is no evidence to prove that use of these products increases your risk of developing oral cancer.
Sources
[1] McCulloch, M. J. and Farah, C. S. 2008, “The role of alcohol in oral carcinogenesis with particular reference to alcohol-containig mouthwashes”, Australian Dental Journal, Vol. 53, pp 302-305
[2] Guha, N., Boffetta, P., Filho, V. W., Neto, J. E., Shangina, O., Zaridze, D., Curado, M. P., Koifman, S., Matos, E., Menezes, A., Szeszenia-Dabrowska, N., Fernandez, L., Mates, D., Daudt, A. W., Lissowska, J., Dikshit, R., Brennan, P. 2007, “Oral Health and Risk of Squamous Cell Carcinoma of the Head and Neck and Esophagus: Results of Two Multicentric Case-Control Studies”, American Journal of Epidemiology, Vol. 166 (10), pp. 1159-1173.
[3] www.mouthcancer.org/page/risk-factors
