Monday, January 12, 2009

New Australian Study Links Alcohol Containing Mouthwashes and Oral Cancer


A new study appearing in the December edition of the Journal of the Australian Dental Association finds: "sufficient evidence'' that "alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer."

Leading independent experts have issued this strong warning after investigating latest scientific evidence linking alcohol-containing mouthwashes to the deadly disease.

Their 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''.

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 carcinogenic.

Listerine, the nation's biggest-selling mouthwash and a brand endorsed by the Australian Dental Association (ADA), contains as much as 26 per cent alcohol.
The abstract and link to the piece (yes, you have to pay for it) is here.

The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes

MJ McCullough*, CS Farah
  *Melbourne Dental School, The University of Melbourne, Victoria.
  School of Dentistry, The University of Queensland, Queensland.
Correspondence to Michael McCullough
Associate Professor
Oral Medicine
Melbourne Dental School
The University of Melbourne
720 Swanston Street
Melbourne, Victoria 3010

Worldwide, oral cancer represents approximately 5 per cent of all malignant lesions, with over 800 new intra-oral squamous cell carcinomas registered in Australia each year. Despite recent advances in therapy, the five-year survival rate remains around 50 per cent and the sequelae of treatment can be seriously debilitating. It has been long established that smoking and alcohol consumption are risk factors linked to the development of oral cancer. This review assesses the epidemiological evidence, supportive in vitro studies and mechanism by which alcohol is involved in the development of oral cancer. Further, we review the literature that associates alcohol-containing mouthwashes and oral cancer. On the basis of this review, we believe that there is now sufficient evidence to accept the proposition that alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer and further feel that it is inadvisable for oral healthcare professionals to recommend the long-term use of alcohol-containing mouthwashes.

(Accepted for publication 30 March 2008.)

There are older studies that say that there is no correlation between oral cancer and alcohol-based mouthwashes, including a 2003 study in the Journal of the American Dental Association.

Cole P, Rodu B, Mathisen A.

Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham 35294-0022, USA.

BACKGROUND: There has been concern that the use of alcohol-containing mouthwash may increase the risk of developing oropharyngeal cancer, or OPC. The authors examine the epidemiologic literature relating to this issue. TYPES OF STUDIES REVIEWED: The authors identified all nine English-language epidemiologic studies of OPC that made reference to mouthwash. The findings and major strengths and limitations of each study are described. In addition, the authors reanalyzed data from one of the studies. RESULTS: The results of six of the studies reviewed are negative and provide no support for the hypothesis that use of alcohol-containing mouthwash increases the risk of OPC. One of the three studies with positive results was a case series and included a follow-up case-control study, the results of which were negative. The authors reanalyzed the study with the most positive results. This analysis found that the study results were just as positive for nonmucosal cancers developing in the mouth as they were for the usual type of OPC. The authors concluded that this study's positive finding resulted from recall bias. CLINICAL IMPLICATIONS: It is unlikely that the use of mouthwashes that contain alcohol increases the risk of developing OPC.

And, a 2004 paper here:

Carretero Peláez MA, Esparza Gómez GC, Figuero Ruiz E, Cerero Lapiedra R.

Facultad de Odontología de la Universidad Complutense de Madrid, Spain.

For centuries, mouthwashes have been used in order to provide us with oral health or cosmetic benefits. Nowadays, in most countries, there is a variety of formulas available for the general public in the form of products which may require prescription or not. Alcohol is used in mouthwashes as a solvent of other ingredients and as a preservative of the preparation. For years, different formulas of mouthwashes have been used, however, the question about its alcohol content being a threat for health or not has recently appeared. The high quantity of alcohol in some mouthwashes combined with the fact that they keep in contact with the oral mucosa for much more time than alcoholic drinks, can make us think about a harmful effect from a local mechanism. Mouthrinses increase the time of the mucosa being in contact with alcohol and it has been proved that those with a high content of alcohol do cause hyperkerastosic lesions both in human beings and laboratory animals. At the moment and with the data we have, it has not been possible to establish a causal relationship between the use of alcohol-containing mouthwashes and the development of oral cancer. There is neither an evidence of the fact that alcohol increases the effects of antiplaque agents in mouthwashes.

Flap does not know if the case has been made in the Australian study but will urge his patients to use caution and if they must use a mouthwash then use a non-alcohol based one.

Flap will make the switch (Biotene makes a non-alcohol one) or use none at all - probably none at all. With proper dental hygiene (brushing and flossing) and regular professional care why bother and take a chance?

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  2. Anonymous9:07 PM

    I like your article very informative.
    I learned something new about mouth wash and oral cancer. Thank you for this entry.


  3. Anonymous3:27 AM

    I've been using Listerine so far...hmm...what mouthwash would you recommend for a safe(er) use? Thanks.Anna

  4. At our pratice in Epping, Essex in the UK; we recommend Dentyl PH which is alcohol free. We would never recommend Listerine as we think its too abrasive for s start but that just peronal opinion. Alcohol based mouthwashes such as Retardex (for bad breath, Sensondyne (for sensitive teeth) and Corsodyl (for gingivitis) do have a place though.

    Brian Sidhu
    Crofts Dental Practice

  5. Anonymous11:11 AM

    We are a practice based in Epping, Essex in the United KIngdom. As a practice we would never recommend Listerine as in our opinion it is too abrasive. Our preferred mouthwash if using one is Dentyl PH, this is alcohol free. That said, some low-alcohol based mouthwashes do have their place such as Sensodyne for senstive teeth.

    Brian Sidhu

  6. I used this mouth wash for a long time. Its not just cancer that makes it a bad idea though. It actually leaves your mouth more vulnerable to all sorts of disease because it dries it out so much.