Int J Evidence-Based Practice Dent Hygienist 3 (2017), No. 2 10. July 2017
A possible association between the use of alcohol-containing mouthrinse and risk for oropharyngeal cancer has been a long-standing concern. Alcohol ingestion is a wellestablished cause of oropharyngeal and other cancers. Multiple mechanisms of carcinogenesis due to alcohol exposure have been documented, including oxidative stress and DNA damage resulting from formation of reactive metabolites. Reactive aldehydes, including acetaldehyde, are carcinogenic and alter lipid membrane permeability, exposing DNA to toxins and other carcinogens found in tobacco smoke. Other mechanisms include altered gene expression, induction of proinflammatory mediators, tumor promotion, and initiating stem cell repair mechanisms in response to cell death. Many species within the oral microbiome have been implicated in carcinogenesis of oral and gastric cancers by their ability to metabolize alcohol to acetaldehyde within the oral cavity. Individuals with genetic mutations that inhibit their ability to metabolize alcohol have higher salivary acetaldehyde levels and may be at greater risk. Rinsing with an alcohol-containing mouthrinse causes an immediate increase in salivary acetaldehyde level followed by a drop in level within minutes. This reduction may be explained by the broad spectrum of alcohol-containing antiseptic mouthrinses, suggesting a possible protective effect of these products against acetaldehyde-producing oral organisms. It is unknown whether alcohol-free variants produce the same effect. Clinical trials of 6 months duration demonstrate both efficacy and safety of alcohol-containing mouthrinses for reduction of supragingival plaque and gingivitis. Clinicians must weigh the benefits of use against the potential risks.
Keywords: alcohol-containing mouthrinses, oral cancer, oropharyngeal cancer