The Mouthwash Debate

For years medical consultant Gerard Einhorn, now 54, suffered from breath so bad that he avoided getting too close to clients and family members and even covered his mouth when he spoke. "You're going to sleep at night and your wife is next to you and says, 'Your breath is bad. Did you brush your teeth?'" he says. Today, thanks to good oral health habits, including an alcohol-free mouthwash, he has conquered his problem.

But millions of other Americans are still fighting breath that smells like rotten eggs. Should they turn to mouthwash too? And if so, should they use traditional alcohol-containing ones, like Listerine, or should they use alcohol-free ones, like Crest Pro-Health? After all, the original, gold-colored Listerine contains a scary-sounding 26.9 percent alcohol—twice the amount in wine, and more than five times the amount in beer.

Critics of alcohol-containing products say that alcohol dries the mouth, which could potentially worsen breath. (Think of dry, stinky morning breath after a night of drinking.) Listerine says its product does not dry the mouth when used as directed. Even if that's true, say critics, it's better to use any of the growing number of alcohol-free products, from Crest Pro-Health to Tom's of Maine to ACT. After all, why expose kids and alcoholics to a potentially toxic product? Meanwhile, Listerine officials say their century-old product is the most studied mouthwash and boasts the American Dental Association's seal of acceptance for helping reduce plaque and gingivitis. They say they're not working on an alcohol-free Listerine for adults, although just this month the company introduced an alcohol-free cavity-fighting, fluoride-containing product for kids called Listerine Smart Rinse.

An estimated 25 percent of Americans suffer from chronic bad breath, called halitosis. Many more suffer from it occasionally (say, post-onions) or are at risk of it from periodontal disease. About 70 percent of Americans suffer from some periodontal disease—a problem, since cavities and swollen gums are a good place for foul-smelling bacteria to hang out. Offensive mouth odor typically comes from bacteria in the mouth that release sulfur compounds—hence the rotten egg smell.

Why could alcohol be bad for breath? "It's well known that alcohol is a drying agent," says Matt Doyle, a senior scientist for Procter & Gamble, manufacturer of alcohol-free Crest Pro-Health and alcohol-containing Scope. "If you dry out the tissues, the smelly compounds that the bacteria produce are no longer naturally washed away, and you get a pungent experience." Dr. Harold Katz, a dentist who makes alcohol-free TheraBreath mouthwash, agrees: "The drier your mouth, the less saliva you have, which is nature's way of keeping your breath fresh."

"It is true that alcohol, at high concentrations, contributes to dry mouth, which exacerbates bad breath and the growth of germs," says Laura Brinker, a spokeswoman for Procter & Gamble. "Alcohol draws moisture out of the tissues in your mouth, and also slows salivary flow … Since saliva is limited, the bacteria is not being diluted or washed out. This means bad-breath germs and other germs become concentrated in the mouth." (John Coelho, director of clinical research for Johnson & Johnson Consumer & Personal Products, which makes Listerine, notes that a study at the State University of New York at Buffalo on people with dry mouths found that using Listerine even three times a day didn't make their mouths any drier. Without the alcohol, the active ingredients don't "penetrate" the plaque as well, says Coelho.)