Mouthwash is an oral hygiene product designed to be swished in the mouth and then expelled, never swallowed. Its purpose is to reduce plaque, freshen breath, and deliver therapeutic agents like fluoride. Despite being a topical agent, ingestion occurs frequently, leading to tens of thousands of calls to poison control centers annually. This practice is dangerous because mouthwash contains chemicals that are toxic when swallowed in significant quantities. Understanding the reasons behind ingestion and the specific dangers involved is essential for safety and harm reduction.
Reasons for Accidental Ingestion
Accidental ingestion is common, particularly among young children. The bright colors and sweet, minty flavors of many formulas can make the liquid appealing. Because of their smaller body size, even a small amount, such as a teaspoon, can result in serious intoxication or toxicity.
Accidental consumption also affects adults, often due to confusion or impaired judgment. Elderly individuals may mistake the product for a drink or medication, especially if they have vision problems or cognitive decline. Improper storage is a significant contributing factor, as leaving mouthwash easily accessible increases the risk for both children and confused adults.
The Crisis of Intentional Misuse
The primary driver behind intentional consumption is the high concentration of ethanol in many popular formulas. While beer contains 3% to 7% alcohol by volume (ABV) and wine around 12% ABV, some mouthwashes contain between 14% and 26.9% alcohol. This high potency makes it an accessible, inexpensive, and readily available source of alcohol for individuals with alcohol use disorder.
Individuals experiencing homelessness, poverty, or those in restricted environments, such as hospitals or correctional facilities, may resort to drinking mouthwash out of desperation. The discreet nature of the product also appeals to those who wish to hide their drinking. Manufacturers add denaturing agents like menthol, eucalyptol, and thymol to make the product taste unpleasant, but these additions are often ineffective. For someone struggling with a substance use disorder, the need for intoxication outweighs the unpleasant taste and health risks.
The Toxic Components of Mouthwash
The danger of consuming mouthwash stems from more than just ethanol; it also contains several chemicals that are toxic when ingested. Ethanol itself can cause severe alcohol poisoning, leading to symptoms like confusion, difficulty breathing, low blood sugar, and coma. Due to the high ABV, intoxication can occur rapidly with a smaller volume than conventional spirits.
Beyond alcohol, many formulas contain essential oils such as eucalyptol, menthol, and thymol, used for flavoring and antiseptic properties. These oils are not meant for internal consumption and can cause central nervous system depression, seizures, and a burning sensation in the digestive tract.
Another hazardous ingredient is methyl salicylate, a wintergreen-flavored compound that can cause rapid-onset salicylate poisoning. This is a severe medical emergency leading to metabolic acidosis, brain swelling, and cardiac arrest. Even non-alcoholic mouthwashes pose a risk, as they often contain fluoride, which can cause significant nausea, vomiting, and diarrhea if swallowed in excess.
What to Do Immediately After Ingestion
If mouthwash ingestion is suspected, the immediate response is to seek expert medical guidance. Contact the national Poison Control hotline at 1-800-222-1222 for immediate advice. It is helpful to have the specific product bottle available so the ingredients and concentration can be relayed to the specialist.
Do not attempt to induce vomiting unless specifically instructed by a medical professional or Poison Control. Inducing vomiting can cause further damage to the esophagus or lead to aspiration. Monitor the person closely for severe symptoms, including persistent vomiting, extreme drowsiness, difficulty breathing, or seizures. If the person becomes unresponsive or has difficulty breathing, call 911 immediately.