April 3, 2009: Alcohol in Oral Mouth Rinses
The following statement was approved by the Board of Directors at their meeting in Miami Beach, Florida, on April 3, 2009.
The International Academy of Periodontology (IAP) is concerned about a recent article, published in the AustralianDental Journal in December, 2008 by McCullough and co-author Camile Farah which concludes there is now "sufficient evidence" to suggest that alcohol containing mouthwashes are a contributing factor to oral cancer.1 However, it should be noted that this issue was evaluated by the United States Food and Drug Administration, the American Dental Association and the National Cancer institute over 10 years ago with the conclusion that alcohol in mouthrinses does not cause cancer.2
More recently a review article by Lewis in Great Britain reaches he same conclusion3 as do three thorough review papers: one in Australia, one in Brazil and one in Italy. These papers all agreed that, relative to an association between alcohol in mouthrinses and oral cancer risk, there is no "relevant association between alcohol containing mouthrinses and oral cancer risk." The Brazilian paper stated, "The alleged correlation between oral cancer and alcohol-based mouthrinses presents little, weak, inconsistent and even contradictory evidence in the literature that any kind of risk-warning to patients would be uncalled for." 4, 5, 6 In view of the current trend towards evidenced based decisions in medicine and dentistry, the International Academy of Periodontology encourages a well designed systematic review of this topic when adequate studies are available.
The International Academy of Periodontology is in agreement with the following positions of the British Dental Health Foundation and the British Dental Association.
British Dental Health Foundation Statement: "A recent, and more thorough review of all available evidence carried out by leading experts on behalf of the foundation concluded there were no proven links between alcohol-containing mouthwashes and increased incidence of mouth cancer. The public should not worry."
British Dental Assocition Statment: "Excessive consumption of alcohol and tobacco are well recognised in the UK as risk factors for developing oral cancers. This paper raises interesting issues but the evidence showing any link between the prolonged use of mouthwashes containing alcohol and oral cancer is not conclusive. Further research is required to establish if there is a genuine connection. "Where patients are in any doubt about using mouthwash, they shouldconsult their dentist."
1. McCullough, MJ and Farah, CS. The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Aust Dent J 2008; 53(4): 302-5.
2. Ciancio SG, ed. Alcohol in mouthrinse: lack of association with cancer. Biol Ther Dent 1993; 9(1):1–2
3. Lewis, MAO and Murray S. Safety of alcohol containing mouthwashes. A review of the evidence. Dental Health Volume 45 No 1 of 6, January 2006.
4. La Vecchia, C. Alcohol Containing Mouthwash and Oral Cancer Risk: An Update. Oral Oncol. 2009 Mar;45(3):198-200
5. Lemos-Junior CA & Villoria GEM. Reviewed Evidence About the Safety of Alcohol Based Mouthrinses. Braz Oral Res 2008; 22 (Spec Iss 1): 24-31.
6. Walsh LJ. Are alcohol containing dental mouthrinses safe? A critical look at the evidence. Australian Dental Practice (2008) 64-68