It is generally not permitted to use standard, over-the-counter mouthwash before surgery. Pre-operative safety protocols are strictly enforced to minimize risks during anesthesia, and this usually means abstaining from all unnecessary oral intake. While maintaining good oral hygiene is important, the chemical composition and liquid volume of commercial mouthwash typically violate these safety measures. Anything taken by mouth must be explicitly approved by your surgical care team.
Reasons for Pre-Surgery Restrictions
The main concern regarding mouthwash use is the risk of pulmonary aspiration during general anesthesia or deep sedation. Anesthesia relaxes the protective reflexes, such as coughing and the ability to swallow, making it dangerous to have any liquid or food in the stomach. Even though mouthwash is intended to be spit out, small amounts can be accidentally swallowed, violating the “Nothing By Mouth,” or NPO, guidelines.
Aspiration of fluid, even a small volume, can lead to serious complications like aspiration pneumonitis or pneumonia. The risk is particularly elevated with liquids that are not clear or are acidic. Any ingested volume, however minimal, contributes to the stomach contents present during the procedure.
Many common mouthwashes contain alcohol, which can pose a separate risk by interacting with the medications used during anesthesia. Alcohol consumption can also thin the blood and interfere with clotting, which is a significant factor in surgical safety. Additionally, some colored or flavored mouthwashes contain sugars or dyes. Sugars can affect pre-operative blood glucose levels, especially for patients with diabetes.
Acceptable Oral Hygiene Alternatives
While commercial mouthwash is usually prohibited, maintaining oral cleanliness is encouraged to reduce the bacterial load in the mouth. For most patients, careful brushing is allowed on the morning of surgery, provided no toothpaste or water is swallowed. After brushing, the patient must spit out the residue without rinsing the mouth with water.
The safest alternative for rinsing the mouth is a careful plain water rinse. This rinse must be done with minimal water and the patient must ensure that all of the water is spit out, avoiding any swallowing. This action is typically only permitted up to the established clear liquid cut-off time.
Medical-Grade Rinses
In some cases, particularly for head, neck, or dental surgeries, the surgical team may specifically prescribe a medical-grade rinse. This is often a chlorhexidine gluconate mouthwash, which is a powerful antiseptic used to significantly reduce the number of bacteria in the mouth. It should only be used if explicitly instructed by the surgeon or anesthesiologist.
The Importance of Consulting Your Care Team
All pre-operative instructions are determined by your specific procedure. It is essential to confirm the precise NPO start time with your care team, as the restriction on all food intake, including mouthwash, begins at a specific hour. If you have been instructed to take specific medications before surgery, they may be taken with a small sip of water.
The anesthesiologist is the final authority concerning pre-operative fasting and oral intake. Following their personalized instructions ensures your safety and that the procedure is not delayed or canceled. Never assume that general guidelines apply; always confirm the safety of using any product, even a simple rinse, with your care team.