Can Mouthwash Really Lead to Cancer? Listerine & The Major New Questions About Alcohol Based Brands

Earlier this year, one scientist claimed that the Cool Mint flavor of Listerine mouthwash may increase cancer risk and daily use of this product was linked to heightened levels of two oral bacteria linked to esophageal and colorectal cancer, according to a recent study.

The study, published this summer in Microbiology Society, concluded, that Listerine use “was associated with an increased abundance of common oral opportunistic bacteria previously reported to be enriched in periodontal diseases, esophageal and colorectal cancer, and systemic diseases,” ultimately suggesting “regular use of Listerine mouthwash should be carefully considered.”

Jolein Lauman, a PhD student in the Department of Clinical Sciences, who led the study said in a statement following the research being published, “Alcohol-based mouthwashes are widely available. The public may use them daily to tackle bad breath or prevent periodontitis, but they should be aware of the potential implications.

“Ideally, long-term usage should be guided by healthcare professionals.”

Meanwhile, another study published in the National Library of Medicine a couple years ago, looked into alcohol-based mouthwash as a risk factor of oral cancer, and notes that over the past three decades, “There has been an attempt to find a possible association between the use of mouthwash with alcohol and its relationship with oral cancer. However, epidemiologically, there has been no conclusive evidence.”

Researchers concluded that “alcohol-based mouthwash consumption significantly increases salivary acetaldehyde levels in the first few minutes,” but “no evidence exists if long-term salivary acetaldehyde levels may increase with a high frequency of mouthwash use.”

“There is still insufficient evidence of whether the use of alcohol-based mouthwash is an independent risk factor for oral or oropharynx cancer. Nonetheless, it does increase the risk when it occurs concomitantly with other risk factors such as smoking or alcohol,” the study authors add.

A study from 2017 also points out how a majority of mouthwashes are made with alcohol, which is known to cause head and neck cancers—concluding that risks do exist for long-term and frequent mouthwash users when it comes to various types of head and neck cancers.

Prior to that, a study from 2014, published in Oral Oncology, suggests that poor oral hygiene and dental care are risk factors for upper aerodigestive tract cancer risk in Europe, but more research is needed.

More recently, mouthwash users have claimed they were put at a higher risk of cancer by using Johnson and Johnson’s Cool Mint flavor Listerine mouthwash

The Daily Mail reported this month that a class action lawsuit was recently filed in California, claiming Johnson & Johnson didn’t warn about their mouthwash product and it’s alleged link to cancer.

Since researchers have found that mouthwash use leads to heightened Fusobacterium nucleatum and Streptococcus anginosus bacteria, both which have been connected to esophageal cancer and colon cancer.

As per the Daily Mail, Johnson & Johnson has claimed “no evidence” exists that this alcohol-based mouthwash can lead to cancer.

The Mouth is the Gateway to the Stomach

Bacteria that grows in your mouth when you have gum disease could be making their way into your gut. This type of bacteria can also get into your bloodstream.

“If there’s inflammation in the gums, it lets bacteria into the blood stream and carries it away to distant organ sites,” Yvonne Kapila, DDS, vice-chair of periodontology at the Helen Diller Family Comprehensive Cancer Center at UC San Francisco, told SurvivorNet in an earlier interview.

RELATED: Floss Today to Slash Your Chances of Stomach and Esophageal Cancer Tomorrow

Inflammation also wreaks all sorts of other havoc. “In general, inflammation increases risk of chronic diseases, including heart disease and cancer,” says Hitendra Patel, MD, a medical oncologist who treats gastrointestinal cancers at UC San Diego Moores Cancer Center.

However, Patel advises that whatever the state of your oral health, take note of your risk factors for gastrointestinal cancers. Multiple factors add up to higher risk.

RELATED: Even ‘Brushing Your Teeth Becomes Really Painful’ – The Dental Side Effects of Chemo that No One Talks About

You can reduce your odds of developing these cancers, Patel says, “By not smoking, minimizing alcohol intake, avoiding processed foods and meats, eating more fresh fruits and vegetables, getting adequate exercise and maintaining a healthy body weight.”

The Importance of Keeping Your Mouth Clean During Chemo

Since chemotherapy can affect your immune system, making potential bacterial infections in your mouth all the more serious, it’s especially important for people going through chemo to stay on top of their oral hygiene. (Additionally, dry mouth can have the effect of accelerating tooth decay.)

Dr. Christina Wood, a dentist at Willamette Dental Group in Portland, Ore. told SurvivorNet in an earlier interview that when it comes to preventing cavities and periodontal (gum) disease during chemotherapy, the best bet is preventative care, meaning before treatment begins.

“Try to get dental treatment completed before chemotherapy, if possible, Dr. Wood says, explaining that after chemotherapy, doctors usually recommend avoiding dental work for 1-2 weeks, during which time patients are usually most vulnerable to infection, and can bruise and bleed more easily.

If you go see your dentist before chemo starts, you may be able to have fluoride trays, Dr. Wood added. “These provide a high dose of fluoride for your teeth to help increase mineralization of the enamel [strengthen the teeth] and prevent mucositis [painful mouth inflammation].”

Dr. Danoosh Amrooei, a breast cancer survivor and dentist at Monaco Dentistry in Apollo Beach, Fla.,  and Dr. Wood shared several additional tips to keep mouths clean during treatment and to minimize any pain:

• Try to have a dental exam and teeth cleaning before chemo starts
• Steer clear of mouthwash with alcohol in it; this can be extremely painful for sensitive gums and teeth
• You might want to stay away from spicy and acidic foods, which can exacerbate pain
• Try eating foods that can soothe the mouth, such as dairy items
• Keep two or three different toothpaste options on-hand; as your tastebuds change during chemo, certain toothpaste flavors you previously enjoyed might suddenly be unappealing
• Steer clear of whitening toothpaste, which has more grit in it — this can further irritate the gums

If your treatment is making you vomit frequently, try mixing 1/4 teaspoon of baking soda with 1/8 teaspoon of salt and 1 cup of warm water as a mouth rinse; this can help make your mouth less acidic, which can protect the enamel on your teeth

Why Radiation Makes It Difficult to Taste, Swallow Food

Understanding Head and Neck Cancer

According to the American Society of Clinical Oncology (ASCO), head and neck cancer is “a broad term encompassing a number of different malignant tumors that develop in or around the throat, larynx, nose, sinuses and mouth. Oral cancer is the most common type of head and neck cancer.

Artist Michael Rees shares unique outlook on facing throat cancer

The two main risk factors for this group of diseases include the following:

• Tobacco use. This is the single largest risk factor for head and neck cancer with researchers estimating that 70 to 80 percent of head and neck cancers being linked to tobacco use. Also worthy of note is that secondhand smoke may increase a person’s risk of developing head and neck cancer.
• Alcohol use. Using alcohol and tobacco together increases your risk even more.

“Head and neck cancer patients, we know that tobacco smoking is a risk but also heavy alcohol use,” Dr. Jessica Geiger, a medical oncologist specializing in head and neck cancer at Cleveland Clinic, previously told SurvivorNet.

“So, drinking more than two or three drinks if you’re a man per day, in addition to smoking. Smoking and alcohol are sort of additive carcinogens. Especially in cancer of the larynx or the voice box, we know that drinking heavily, heavy alcohol use, is just as important of a risk factor as tobacco smoking is.”

What Increases Your Risk for Colon Cancer?

Risk factors are things that make you more likely to get colon cancer. They don’t mean that you’ll definitely get this cancer — only that you’re slightly more likely to be diagnosed.

You may be at greater risk for colon cancer if you:

• Are older. About 90% of cases are in people age 50 or older, according to the U.S. Centers for Disease Control & Prevention (CDC). Yet it is possible to get this cancer earlier in life.
• Have inflammatory bowel disease.  Crohn’s disease or ulcerative colitis can, over time, cause cells in your intestines to turn cancerous.
• Have a family history of this cancer. Just under one-third of people who get colon cancer have family members with the disease.
• Have a gene mutation. About 5% of colorectal cancers are caused by an inherited genetic mutation that causes syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (Lynch syndrome).
• Don’t exercise very often. Staying active can lower your risk.
• Eat a diet that’s high in meat. Regularly eating red meats like burgers and steaks, and processed meats such as hot dogs and bacon might put you at higher risk.  Eating more fruits, vegetables, and whole grains instead might lower your risk.
• Are overweight or obese. Having too much weight increases your risk of both getting colon cancer, and of dying from it.
• Drink a lot of alcohol. Limiting alcohol to one drink a day for women and two drinks daily for men could help lower your risk.
• Use tobacco. Long-term smokers are more likely to get this cancer than are nonsmokers.

Environmental risk factors such as smoking and obesity are important in the development of colon cancer before age 50. Yet, up to a third of people who develop cancer at a younger age have a genetic condition that puts them at high risk.

For that reason, it is important for people of all ages to pay attention to changes in their body or bowel habits.  Weight loss, blood in the stool, and changes in bowel movements that don’t go away are worth seeing your doctor about.

Understanding Esophageal Cancer

Esophageal cancer is a disease that causes cancer cells to form in the tissues of the esophagus, a hollow, muscular tube that food and liquid move through when traveling from the throat to the stomach. The wall of the esophagus is made of up several layers of tissue; cancer begins on the inside lining and spreads to the outer layers of the esophagus as it grows.

Several lifestyle factors, like smoking or heavy alcohol use, can increase a person’s risk of developing esophageal cancer. Approximately 22,370 new cases of esophageal cancer are diagnosed in the U.S. every year, according to American Cancer Society estimates, and it is more common among men.

“Esophageal cancer, we know is a tough one,” Dr. Brendon Stiles, a thoracic surgeon at Montefiore Medical Center, previously told SurvivorNet. “It’s one of the cancers with some of the lowest cure rates out there, but like many cancers, if we find it early, we can often treat it effectively, either with surgery, with surgery and chemotherapy, with chemotherapy and radiation.”

Dr. Stiles recommends that patients report any symptoms that may indicate esophageal cancer to their doctors right away, since there are more treatment options when the cancer is caught early.

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

---