Does alcohol in mouthwash cause cancer?

Alcohol in mouthwash is one of the most common toxins around, and research shows that using it more than three times a day can significantly increase people’s risk of developing oral cancer.

This is because mouthwash contains a lot of alcohol, which can easily turn into acetaldehyde by staying in the mouth for a long time.

Alcohol in mouthwash is one of the most common toxins around us

The truth:

Before we analyze the problem, we need to clarify the concept of mouthwash.

Mouthwash can be divided into two types. One is prescription mouthwash, which is prepared by individual hospitals according to the needs of patients. These include chlorhexidine mouthwashes, which are common in many hospitals to prevent infection after surgery, and fluorinated mouthwashes for the prevention of dental caries in special populations, such as those who are restricted from using orthodontic brackets. Mouthwashes that contain anesthetic ingredients to soothe sore mouth sores, among others; and over-the-counter mouthwashes that you can buy at convenience stores in supermarkets, all of which you can see on television in the form of over-the-counter mouthwashes.

The “mouthwash” we are talking about here mainly refers to the latter.

Does the alcohol in mouthwash increase the risk of oral cancer?

Alcohol in alcohol-containing mouthwash is mainly used as a cosolvent to help dissolve the fat-soluble components used in it, and the alcohol itself has a certain bactericidal power. Some brands of mouthwash have a higher alcohol content, up to 20% or more. This kind of mouthwash can feel spicy when used.

The theory that alcoholic mouthwashes “cause cancer” has also been debated in academia for years.

Building on the evidence that alcoholism is one of the risk factors for oral cancer, it does not seem surprising that the introduction of alcoholic mouthwash increases the risk of oral cancer. Studies have also measured the amount of acetaldehyde in saliva after the use of alcoholic mouthwash, and found that acetaldehyde did increase [1].

But so far, no study has really established a link between mouthwash and the risk of oral cancer. Although there are a lot of relevant research results, the conclusions fluctuate greatly, and sometimes even conflict with each other.

In 2008, Michael McCullough, an assistant professor at the University of Melbourne School of Stomatology in Australia, published a review of past research on mouthwash and oral cancer [2].

He claims to have found “ample evidence” of a link between alcohol and an increased risk of oral cancer, and says dentists should not recommend alcohol mouthwashes for prolonged, frequent use.

However, once the paper was published, it was questioned by many of its peers. Professor Jim Bi Xiaopu (Jim Bishop), of the new south Wales cancer research institute, said the basis of the review was not yet clear on the extent of the risks, so further research was needed to draw conclusions. There is also an article on Cancer Research (Cancer Research UK) in the UK that specifically disagrees with this conclusion [3].

The article points out that Michael McCullough’s research is actually a review of existing clinical studies, but reviews of clinical research literature for the same period have produced diametrically opposite results. It is believed that there is insufficient evidence to establish a direct link between alcoholic mouthwash and oral cancer.

In addition, although the review claims to be based on a large number of clinical studies in Latin America and Central Europe, which appear to be very credible, in fact these studies include many carcinogenic factors associated with oral cancer; Only a small percentage of them involve alcoholic mouthwash. That said, the actual study data on mouthwash and oral cancer risk in this review is relatively small.

Moreover, the study did not collect data on the specific alcohol content of the mouthwash, the duration of use or the length of time the mouthwash remained in the mouth. The original conclusion of a first-hand study on Latin America and Central Europe was that “certain mouthwashes contain alcohol that may cause cancer”, and one can see that the wording is rather cautious. These studies are clearly not enough to call “sufficient evidence,” and their conclusions need to be interpreted with caution.

In this review, the authors conclude: “in summary, there is insufficient evidence to establish a clear link between mouthwash and oral cancer.” “rather than worrying too much about the dangers of mouthwash, it is more important to take seriously the two known risk factors for oral cancer-smoking and alcohol abuse,” he said.

In a separate meta-analysis in 2012, the researchers pooled 18 studies and found no association between mouthwash use and the risk of oral malignancy, as well as a gradual increase in daily use. There was also no significant upward trend in risk [4].

At present, there is no clear evidence that alcohol in mouthwash is directly associated with the development of oral cancer. What’s more, many mouthwash users don’t use the mouthwash more than three times a day. So we don’t have to worry too much about the safety of alcoholic mouthwashes.

What should I pay attention to when using mouthwash?

“mouthwash causes cancer” need not worry too much, but if used improperly also may endanger oral health. In selecting and using mouthwash, the following should be noted:

Mouthwash is no substitute for brushing your teeth.

Mouthwash is a good complement to oral hygiene and care, helping to better remove gaps in teeth and mucous surfaces that cannot be reached by toothbrushes. Use of mouthwash can help control plaque and gingivitis. However, please bear in mind that mouthwash is no substitute for brushing your teeth, and proper brushing is still the most effective and simple form of household oral cleaning. If it’s easy to gargle without brushing your teeth, it’s more likely that poor oral health conditions, rather than mouthwash, are responsible for tumors in the mouth.

Non-alcoholic mouthwash can be chosen to reduce irritation.

The safety of alcohol-based mouthwashes is generally not a concern, but mouthwashes with a high alcohol content (up to 26%) are indeed irritating, and special groups such as children and people with alcohol allergies need to be cautious. In addition to these alcohol-based mouthwashes on the market, some non-alcoholic mouthwashes can also be easily bought. These non-alcoholic mouthwashes are often formulated with CPC (low concentration of cetylpyridinium chloride) and have good bactericidal properties and safety. And soft on the palate.

Use prescription mouthwash as directed by your doctor.

Prescription mouthwashes containing ingredients such as microbicides are actually a drug and should be used as directed by your doctor. Overuse of overuse may not help maintain oral health, but may also cause maladjustment of the oral flora, xerostomia, or other problems. For example, chlorhexidine mouthwash, long-term use will cause teeth staining, it is difficult to remove.

Buy branded mouthwash.

Buy mouthwash products from big brands with guaranteed credibility, and don’t listen to all kinds of sensational “magic recipes.”

Please keep in mind that mouthwash is only an adjunct to oral health care and cannot be used to treat all kinds of oral diseases.


The claim that mouthwash causes cancer has been around for a long time, but there is a lack of hard evidence to support it. Instead of worrying about mouthwash, be aware of the exact risk factors for oral cancer, such as smoking, alcohol abuse, and betel nut chewing.


[1]Lachenmeier DW1, Gumbel-Mako S, Sohnius EM,et al.
Salivary acetaldehyde increase due to alcohol-containing mouthwash use: a risk factor for oral cancer. Int J Cancer. 2009 Aug 1;125(3):730-5.

[2]MJ McCullough, CS Farah (2008). The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes Australian Dental Journal, 53 (4), 302-305

[3]Does mouthwash cause cancer? – Cancer Research UK

[4]Gandini S, Negri E, Boffetta P, et al. Mouthwash and oral cancer risk quantitative meta-analysis of epidemiologic studies. Ann Agric Environ Med. 2012;19(2):173-80.

[5]N. Guha, P. Boffetta, V. Wunsch Filho, et al. 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, 166 (10), 1159-1173 DOI: 10.1093/aje/kwm193

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