In January 2009 we heard in the Australian media that leading independent experts from University of Melbourne have issued this strong warning after investigating latest scientific evidence linking alcohol-containing mouthwashes to Oral Cancer. In this issue of our Newsletter we try to reflect an updated overview of the debates about when and how we should use mouthwashes. We are only reflecting what has been said in the media and some Dental Journals and this does not reflect our practices stance about use of mouthwashes which we believe, with accordance to New Zealand Dental Association NZDA guidelines, to be safe if used according to instructions given by the manufacturer.

 

Lead review author Prof McCullough, chair of the Australian Dental Association’s (ADA) therapeutics committee and associate professor of oral medicine at the University of Melbourne, is calling on the ADA to urgently re-assess its seal of approval on mouthwashes containing alcohol.

The ethanol in mouthwash is thought to allow cancer-causing substances to permeate the lining of the mouth more easily and cause harm. Acetaldehyde, a toxic by-product of alcohol that may accumulate in the oral cavity when swished around the mouth, is also believed to be a cancer causing product.

This review published in the Dental Journal of Australia, concludes there is now ``sufficient evidence'' that "alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer''. However this review recommended mouthwash be restricted to ``short-term'' medical use or replaced by alcohol-free versions. "(We) further feel it is inadvisable for oral health-care professionals to recommend the long-term use of alcohol-containing mouthwashes,'' they concluded.

However Cancer Council NSW chief executive Andrew Penman said the review was "interesting'', but called for further research."I think it's quite a well-thought-out proposition, but it does warrant further investigation,'' he said.

Also Professor Laurence Walsh, head of the School of Dentistry at the University of Queensland says there is no established link between mouthwash and oral cancer. He criticizes the authors of the review for drawing on a "small and selective group of studies" and says "A wide range of critical and systematic reviews over many years have failed to show any statistically significant association between mouthwash use and oral cancer. There is certainly nothing in the current paper to change our thinking in that regard."

Furthermore, Dr Andrew Dean, Oncologist and Medical Director of the Virtual Medical Centre said "it is known that there are a number of risk factors for oral cancer, including smoking, alcohol, tobacco chewing and betel nut chewing, also drinking petrol." 

Previous research found that there was 50 times the risk of developing oral cancer in heavy alcohol drinkers and smokers. Alcohol consumption alone also puts patients at risk of developing pre-cancerous mouth lesions (abnormal tissues).

 

Dr Dean recommends "daily or multiple daily use of a strong alcoholic mouthwash should probably be avoided. People who smoke are likely to be at particular risk and so the practice of masking the smell of cigarette smoke by frequent multiple uses per day should definitely be avoided. People who do use an alcoholic mouthwash should rinse their mouth well with clean water after the mouthwash which might reduce some of the risk."

Also Dr Dean advises "anyone with a mouth ulcer that is slow to heal, or a new lump in the mouth should see their GP, a dentist, an oral surgeon or an ear nose and throat surgeon for advice."

There has been no link between mouthwashes that do not contain alcohol and oral cancer.

 

References:

1.      AUSTRALIA'S top-selling mouthwashes can cause oral cancer and should be pulled from supermarket shelves immediately.The Daily Telegraph (Australia), January 11, 2009

2.      Experts divided over mouthwash cancer claim news.com.au, January 11, 2009

3.     Mouthwash linked to oral cancer, virtualmedicalcentre.com, January 11, 2009