Social media users claim that using mouthwash containing alcohol is “the new smoking,” as it impacts the oral microbiome and can cause health issues like high blood pressure. Oral health experts say more research is needed, but mouthwash probably doesn’t pose a danger.

Is Mouthwash Safe to Use?

Some people respond better to mouthwash than others, but mouthwash is safe to use when addressing things like bad breath, Diana K. Nguyen, DDS, division chief of clinical general dentistry at UCSF Dental Center, told Verywell Health.

There are two main types of mouthwash. Therapeutic products have active ingredients like fluoride that are formulated to help with specific issues like plaque and cavities, and cosmetic products are primarily used to mask bad breath. Some contain alcohol and flavors.

Concerns about mouthwash with alcohol fall into these general categories:

Can Mouthwash Increase Risk for Cancer?

Remember that mouthwash isn’t meant to be swallowed. Because it’s topically applied, it’s not the same risk as drinking alcohol, which has well-documented negative health effects.

While there’s evidence that mouthwash with alcohol can exacerbate both dry mouth and oral irritation, Nguyen said the link between mouthwash with alcohol and a higher risk of cancer is “largely inconclusive.” 

Can Mouthwash Impact Your Oral Microbiome?

Mouthwash can affect your oral microbiome, or the community of beneficial and harmful bacteria that live inside your mouth.

Anything you put in your mouth affects it, said Deepak Saxena, MS, PhD, professor of molecular pathobiology at NYU College of Dentistry, who studies the oral microbiome.

“If you are using mouthwash that contains a lot of alcohol, then it kills the bacteria in your mouth and may change your microbiome,” Saxena said. 

Oral health plays a role in your overall health, and bad oral hygiene contributes to chronic disease. However, mouthwash causes temporary changes.

“There are thousands of bacteria in the oral cavity, and whatever you do is reducing the burden of the microbiome rather than eliminating it,” he said. It’s also unclear whether mouthwash negatively impacts the oral microbiome more than anything else.

Can It Affect Your Heart Health?

Studies have linked oral health, particularly periodontitis, with an increased risk of heart disease.

For example, using chlorhexidine mouthwashes could decrease the healthy bacteria that reduce nitrates into nitric oxide, which is key for heart health because it regulates blood flow.

Using these mouthwashes could negate the benefits of a nitrate-rich diet, said Apoena de Aguiar Ribeiro, DDS, PhD, director of the cardiology curriculum and oral microbiology laboratories, and professor at UNC Adams School of Dentistry.

While further studies are needed, “there is an association of antiseptic mouthwash use with the risk of developing hypertension,” said de Aguiar Ribeiro.

One meta-analysis that included adults ages 40 to 60 who had mild hypertension symptoms found that those who used antiseptic mouthwash twice a day had a “slightly but significantly elevated risk” of developing hypertension compared to people who used it less or not at all.

Should You Use Mouthwash?

Whether you should use mouthwash depends on what you want it to do. “Like any oral health product, it should be used when clinically appropriate, not simply as a daily habit without purpose,” said Nguyen.

Nguyen said that using mouthwash once daily for about 30 seconds is sufficient. When using prescription mouth rinses, follow your dentist’s instructions.

Saxena recommended not smoking and a healthy diet for a healthy oral microbiome, and be sure to brush and floss daily and keep up with regular dental checkups.