Preprocedural Antimicrobial Mouthrinses


What is it?

 Antimicrobial mouth rinses are another adjunct to our armamentarium when used prior to patient treatment.

Antimicrobial mouth rinses are much more powerful than your everyday over-the-counter mouthwashes, meaning that they can reduce the number of microbes or bacteria in the mouth to an almost undetectable level.

Chlorhexidine is the most commonly prescribed antimicrobial mouth rinse that we use to reduce the number of bacteria in the mouth as part of our treatment regimen.

Why Use them?

Antimicrobial mouth rinses used by patients before a dental procedure are intended to reduce the number of microorganisms released by a patient in the form of aerosols or spatter that subsequently can contaminate equipment, operatory surfaces, and dental health care personnel.

No scientific evidence indicates that preprocedural mouth rinsing prevents clinical infections among patients or dental health care personnel. However, studies have shown that a preprocedural antimicrobial mouth rinse product can reduce the level of oral microorganisms generated in aerosols or spatter during routine dental procedures with rotary instruments.



Preprocedural mouth rinses can be most beneficial before procedures (e.g., prophylaxis with a cup, prophy jet or ultrasonic scaling).  


Antimicrobial mouth rinses used by the patient before a dental procedure can decrease the number of microorganisms introduced into the patient’s bloodstream during invasive dental procedures.

The American Heart Association (1997) suggests that patients at risk for bacterial endocarditis use an antimicrobial mouth rinse before dental treatment. CDC makes no recommendation regarding the use of preprocedural antimicrobial mouth rinses to prevent clinical infections among dental health care personnel or patients.

 One study found that even a preliminary rinse with water temporally reduced the bacteria aerosol by 61 %, brushing by 85% and an antimicrobial mouth rinse by 97%.  Prevent bacteria from floating around the office by having the patient rinse before begging an aerosol producing procedure.

 Another report showed the efficiency of antimicrobial mouth rinses, containing pharmaceutical grade denatured alcohol as a vehicle to deliver antimicrobial ingredients, mainly Listerine, completely killed microorganisms in 10 to 30 seconds.


How to use them:

– Choose a brand

– Give the patient 15 ml in a cup

– Have patient swish for 30 seconds

– Have patient expectorate after swishing.  It is not intended for ingestion.
– Start  planned procedure.


Given the growing evidence of the connection between oral health and whole-body health, dental practitioners may seek to respond to their patients’ oral hygiene needs by providing research-based products with “naturally occurring” active ingredients that achieve the desired antimicrobial and anti-inflammatory effects.



Products that contain such natural ingredients as grapefruit seed extract may be appealing because they work without alcohol,1 artificial preservatives, or artificial flavors and colors.


The Natural Dentist Healthy Gums Daily Oral Rinse (The Natural Dentist, Medford, Mass.) (formerly named Herbal Mouth and Gum Therapy) has been shown to have beneficial effects in the oral environment—such as reducing gingival bleeding and gingivitis 2and inhibiting the growth of aerobic, microaerophilic and anaerobic bacteria.3


Why not have your patients rinse with an antimicrobial mouthrinse for 30 seconds before starting any dental procedure, it can’t hurt.



                 Wyler D Miller, Micik R. Efficacy of self-administered preoperative oral hygiene procedures in reducing the concentration of bacteria aerosols generated during dental procedures. J Dent Res. 1990;124:556-58.

1.Giamperi L, Fraternale D, Bucchini A, Ricci D. Antioxidant activity of Citrus paradisiseeds glyceric extract. Fitoterapia 2004;75(2):221–224.[Medline]

2. Scherer W, Gultz J, Lee SS, Kaim J. The ability of an herbal mouthrinse to reduce gingival bleeding. J Clin Dent 1998;9(4):97–100.[Medline]

3.Gultz J, Kaim JM, DeLeo J 4th, Scherer W. An in vivo comparison of the antimicrobial activities of three mouthrinses. J Clin Dent 1998;9(2):43–45.[Medline]