Mouthwashes and Gargles: The Practical

Definitions

Both are aqueous (water-based) liquids, and both are for local action only. They are not meant to be swallowed.

What they are used for

• Freshening the mouth and reducing odour.
• Cleaning the mouth after dental treatment, and as part of oral hygiene.
• Soothing a sore throat or sore mouth.
• Antiseptic action to reduce germs.
• Delivering fluoride, in some mouthwashes, to help protect teeth.

A sore mouth or throat that does not improve in a few days should be seen by a doctor or dentist.

Common ingredients

Typical ingredients, depending on the product, are:

• an antiseptic or astringent;
• salt (sodium chloride) or sodium bicarbonate, in simple home-made rinses;
• flavouring such as peppermint;
• colouring and a sweetener;
• alcohol in some products, which is not suitable for everyone.

Follow the formula for what you are making, and ask the pharmacist about a preparation you do not recognise.

Concentrated products and dilution

Many mouthwashes and gargles are supplied concentrated and are diluted with water just before use. This keeps the bottle small and the product stable, and it protects the mouth, because the concentrate may be too strong to use as it comes.

What does "1 in 4" mean?

People use these wordings loosely. For this reason, always write the actual volumes on the label and check with the pharmacist if you are not sure what is meant.

Worked examples

Example 1. Dilute a concentrated mouthwash 1 in 4 to make 40 mL.

1. Concentrate = 40 ÷ 4 = 10 mL
2. Water = 40 − 10 = 30 mL

Example 2. Dilute 1 in 10 to make 100 mL.

1. Concentrate = 100 ÷ 10 = 10 mL
2. Water = 100 − 10 = 90 mL

Example 3. Directions: add 10 mL of concentrate to 30 mL of water. How much does the patient make each time, and what is the dilution?

• Total = 10 + 30 = 40 mL
• Dilution = 10 ÷ 40 = 1 in 4

Example 4. A 200 mL bottle of concentrate is used 10 mL at a time. How many rinses?

• 200 ÷ 10 = 20 rinses

How to make and supply them

1. Read the prescription or the order and the formula.
2. Calculate the volumes.
3. Measure the concentrate and the water in a clean measuring cylinder, at eye level.
4. Mix gently. Use purified or freshly boiled and cooled water where the formula calls for it.
5. Transfer to a clean bottle, close it and label it.

A diluted product has a short life, because the preservative is weaker. Dilute only what is needed, and give a short discard date if you supply it diluted.

Labelling

A mouthwash or gargle label should show:

• the name of the preparation, the patient's name and the date;
• the directions, for example "Rinse the mouth with 10 mL diluted with 30 mL of water for 1 minute, then spit out. Use twice a day";
• "Not to be swallowed" or "For rinsing the mouth only" or "For gargling only";
• a warning to keep out of the reach of children;
• the discard date, and any storage advice.

Advice for the patient

Mouthwash

• Measure the dose and dilute as directed.
• Rinse for about the time stated, then spit out.
• Do not eat or drink for a short while afterwards if the pharmacist advises it, because food and drink wash the product off.

Gargle

• Tilt the head back, let the liquid reach the back of the throat, and make a gargling sound for about the time stated.
• Spit it out. Do not swallow it.
• Repeat as directed.

Both

• Keep out of the reach of children. Young children may swallow them.
• Stop and see a doctor or pharmacist if the mouth becomes more sore, or if there is a rash or swelling.
• Do not use a mouthwash in place of brushing the teeth.

Safety and records

• Check the name and strength of the concentrate against the order.
• Never put a mouthwash in a bottle that looks like a drink, and always label it.
• Record any dilution made, with the volumes and the discard date.
• Tell the pharmacist if a product has changed colour or become cloudy.