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Supporting Your Practice

Does over-the-counter mouthwash put you at risk of pre-diabetes/diabetes?

It was interesting to read an article and question a routine habit such as using mouthwash twice daily. My interview with Dr. Kaumudi Joshipura pushes us to think about oral health products that have become essential to maintain good oral health, but which have not thoroughly been tested through rigorous research. For the benefit of our Canadian dentists, we at CDA Oasis thought it important to bring you this piece and let you know that this type of research is underway. 

The statement made in the article was challenged by the American Diabetes Association and we are in the process of arranging an interview with Dr. William Cefalu to allow him the opportunity to explain his perspective. We will bring you that interview as soon as it takes place. 

We hope you find the conversation informative and look forward to receiving your thoughts, feedback, and suggestions at oasisdiscussions@cda-adc.ca

Until next time! 

Chiraz Guessaier, CDA Oasis Manager


  • Over-the-counter mouthwash comprises part of routine oral care for many; however, potential adverse effects of the long-term daily use have not been evaluated.
  • Most mouthwash contain antibacterial ingredients, which could impact oral microbes critical for nitric oxide formation, and in turn predispose to metabolic disorders including diabetes.
  • The aim of the study was to evaluate longitudinally the association between baseline over-the-counter mouthwash use and development of pre-diabetes/diabetes over a 3-year follow-up.
  • The San Juan Overweight Adults Longitudinal Study (SOALS) recruited 1206 overweight/obese individuals, aged 40-65, and free of diabetes and major cardiovascular diseases; 945 with complete follow-up data were included in the analyses.
  • The Poisson regression models were used adjusting for baseline age, sex, smoking, physical activity, waist circumference, alcohol consumption,
    pre-hypertension/hypertension status; time between visits was included in the models as an offset.
  • Many participants (43%) used mouthwash at least once daily and 22% at least twice daily. Participants using mouthwash ≥twice daily at baseline, had a significantly elevated risk of pre-diabetes/diabetes compared to less frequent users (multivariate IRR ¼ 1.55, 95% CI: 1.21e1.99), or non-users of mouthwash (multivariate IRR ¼ 1.49; 95% CI: 1.13e1.95).
  • The effect estimates were similar after adding income, education, oral hygiene, oral conditions, sleep breathing disorders, diet (processed meat, fruit,
    and vegetable intake), medications, HOMA-IR, fasting glucose, 2hr post load glucose or CRP to the multivariate models.
  • Both associations were also significant among never-smokers and obese individuals.
  • Mouthwash use lower than twice daily showed no association, suggesting a threshold effect at twice or more daily.
  • Frequent regular use of over-the-counter mouthwash was associated with increased risk of developing pre-diabetes/diabetes in this population.

Full Interview (16.44″)



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