Alcohol vs. alcohol-free mouthwash: which is better?

Does it actually matter if your mouthwash contains alcohol? Some companies make a big deal about it, but that's typically not the detail that matters most to the health of your teeth and gums. Both alcohol-based and alcohol-free mouthwash can support your oral care, and neither type is automatically better. The right choice depends on the active ingredients, why you need a rinse and how it feels in your mouth. Dry mouth, sensitivity, age and recovery from alcohol use may also affect your choice. 

What you will learn in this article: 

• Both types of mouthwash may help control plaque and gum swelling when they contain the right active ingredients. 

• Alcohol-free mouthwash may feel gentler if your mouth is dry or sensitive. 

• Children younger than 6 should not use mouthwash unless a dentist recommends it. 

• People who avoid alcohol as part of recovery may feel more comfortable choosing an alcohol-free rinse. 

If you are not sure which mouthwash fits your needs, schedule an appointment with an Aspen Dental dentist. Your care team can look at your mouth and recommend options that match your needs. 

Does alcohol-free mouthwash work as well as alcohol-based mouthwash? 

It can, but mouthwash products are not all the same. A 60-day study followed 120 adults with mild gum disease. Everyone had a professional cleaning before using one of four rinses. Both alcohol-based and alcohol-free rinses lowered plaque and gum swelling. The differences between the groups were not large enough to rule out chance. Because the products contained different active ingredients, the study does not prove that every formula works the same.¹ 

The active ingredient and purpose of the rinse matter more than whether it contains alcohol. The American Dental Association notes that therapeutic rinses may contain ingredients such as cetylpyridinium chloride, chlorhexidine, essential oils or fluoride. Depending on the formula, a rinse may help control plaque and gingivitis, freshen breath or prevent tooth decay. Mouthwash is an add-on to brushing and flossing, not a replacement for them.² 

Does alcohol in mouthwash cause dry mouth or irritation? 

In the same 60-day study, four people using alcohol-based rinses reported mild discomfort. Researchers found no major visible changes in the mouth. At the cellular level, the alcohol-based rinses caused more cell damage than the alcohol-free ones, though the damage did not reach the level the study defined as toxic. The authors said larger and longer studies are still needed.¹ 

If your mouth already feels dry or sore, an alcohol-free rinse or one made for dry mouth may feel more comfortable. Stop using any rinse that causes ongoing burning, pain, swelling or sores, and tell your dental provider. 

What causes dry mouth? 

Dry mouth means your mouth does not make enough saliva. The National Institute of Dental and Craniofacial Research explains that hundreds of medicines can cause it, including some used for blood pressure, depression and bladder problems. Sjögren’s disease, HIV, diabetes, radiation treatment to the head or neck and nerve damage are other possible causes.³ 

How can you manage dry mouth? 

Sip water during the day. Sugar-free gum or candy may help your mouth make more saliva. Limit caffeine, and avoid tobacco and alcohol because they can make dryness worse. A humidifier may also help at night. 

If the problem continues, talk with your dental provider or doctor. They can review your medicines and health history and may suggest a saliva substitute. Do not stop taking a prescription medicine on your own. 

Is alcohol-based mouthwash safe for kids? 

Children younger than 6 should not use mouthwash unless a dental provider tells them to. Young children may swallow it instead of spitting it out. Swallowing an alcohol-based rinse may cause nausea, vomiting or intoxication. Alcohol-free mouthwash is not safe to swallow either.² 

For an older child who can rinse and spit, follow the age limits on the label. Ask your dentist which product and amount are right for your child. 

Should people in recovery avoid alcohol-based mouthwash? 

People who avoid alcohol as part of recovery may prefer an alcohol-free mouthwash. The smell or taste of alcohol may feel uncomfortable or triggering for some people. If this applies to you, choose a product clearly labeled alcohol-free and tell your dentist about your concerns. 

Alcohol-free does not mean ineffective. A therapeutic alcohol-free rinse may still help with a specific oral health need when it contains the right active ingredient. Your dental provider can help you choose an antibacterial or antiseptic rinse that fits your needs. 

How do you choose the right type of mouthwash? 

There is no single best mouthwash for everyone. Start by thinking about why you need one. 

Alcohol-free mouthwash may be a better fit if you: 

• Have dry mouth or sensitive tissues

• Dislike the burning feeling of some rinses

• Avoid alcohol as part of recovery

• Are choosing a rinse for an older child who can safely rinse and spit

An alcohol-based rinse may be reasonable for an adult who can use it comfortably and whose dentist recommends it. A strong burning feeling does not prove that a mouthwash works better. Check the active ingredient, follow the label and do not swallow the rinse. 

Your drinking habits can affect your oral health beyond the type of mouthwash you use. If you need help choosing a product, set up an appointment with your local dental provider. 

Alcohol vs. alcohol-free mouthwash: Which one should you use? FAQs 

Still have questions about choosing a mouthwash? These answers cover a few common questions. 

Does mouthwash need alcohol to work? 

No. Alcohol is not the ingredient that controls plaque, gum swelling, bad breath or tooth decay. Choose a therapeutic rinse based on its active ingredient and the reason you need it. 

Does alcohol-free mouthwash sting less? 

It may feel gentler, but that depends on the full formula. A strong burn does not mean a rinse is working better. Stop using it and tell your dental provider if it causes ongoing burning, pain or sores. 

Can mouthwash treat gum disease by itself? 

No. Mouthwash may support your daily routine, but it cannot replace brushing, flossing or professional dental care. Bleeding, swollen or sore gums should be checked by a dental provider. 

Does drinking alcohol affect dental treatment? 

Drinking alcohol and using alcohol-based mouthwash are different issues. Tell your dentist how often you drink, especially before a procedure or while taking medicine. 

What if my mouth feels dry no matter which rinse I use? 

Tell your dental provider. Lasting dry mouth may be caused by a medicine or health condition, and it can raise your risk of tooth decay and mouth infections. Your dental provider or doctor can help find the cause and recommend treatment. 

Sources 

¹ National Institutes of Health, Journal of Indian Society of Periodontology: “Efficacy and safety evaluation of alcohol-containing and alcohol-free mouth rinses: A clinicocytological study.” https://pmc.ncbi.nlm.nih.gov/articles/PMC8041073/ 

² American Dental Association, Library and Archives: “Mouthrinse (Mouthwash).” https://www.ada.org/resources/ada-library/oral-health-topics/mouthrinse-mouthwash 

³ National Institute of Dental and Craniofacial Research: “Dry Mouth.” https://www.nidcr.nih.gov/health-info/dry-mouth