Alcohol-Containing Mouthwashes Increase Oral Cancer Risk The Role of Alcohol in Oral Carcinogenesis With Particular Reference to Alcohol-Containing Mouthwashes

Background: Despite all advances in prevention and therapy, the 5-year survival rate for oral carcinoma remains at 50%. Cigarette and cigar smoking, alcohol drinking, and smokeless tobacco chewing are known carcinogenic habits. In addition, the incidence of human papilloma viral-related oral cancers has increased. Other agents implicated are Epstein-Barr virus and oral Candida albicans. Also, a diet low in carotenoids and vitamin A and poor oral hygiene are risk factors for oral cancer. The combination of alcohol consumption and smoking raises the risk for oral cancer by 50-fold. Therefore, the more frequently the oral mucosa is exposed to alcohol and smoke products, the greater the likelihood of carcinoma developing. Objective: To assess the alcohol content of various mouthwashes and to evaluate the level of alcohol exposure required to increase the risk of oral carcinoma. Results: A prospective study in health professionals (58% were dentists) found that alcohol consumption alone was a risk for oral premalignant lesions. The proposed mechanism for alcohol carcinogenesis is that alcohol exposure enhances the penetration of carcinogens like tobacco smoke into the oral mucosa. Alcohol can alter the lipid portion of the cell membrane of the spinous layer. Mucosa of the floor of the mouth has been shown to have increased permeability by a short-term exposure to 15% alcohol. Alcohol is routinely used in oral rinses. At 10% to 12% concentration, the alcohol acts as a preservative and antiseptic in these products. This article lists a number of ethanol containing oral rinses. At the top of the list was Listerine® (26% alcohol). The alcohol content of all the related Listerine products ranged from 22% to 26%. Some of the products with no ethanol were Biotene®, Amosan®, Oral-B®, and Curasept®. The in vitro studies showed an epithelial effect with short-term exposure to 15% alcohol. Conclusions: There is a risk for generating oral carcinoma with the use of ethanol-containing oral rinses. Reviewer's Comments: This article reviewed many published articles, both basic science and clinical, and the authors concluded that there is a problem with using alcohol-containing mouthwashes. What does this mean for the clinical dentist? Many of us prescribe chlorhexidine, an alcohol-containing product. Chlorhexidine has been shown to be effective when used for 2 weeks followed by a 2-month to 3-month hiatus. This would minimize the patient's exposure to the high alcohol content of the chlorhexidine rinse and it would minimize tooth staining. It is probably not a good idea for us to prescribe agents that contain higher concentrations of alcohol for chronic use. (Reviewer-Dennis Flanagan, DDS).