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  • Cup 

    cup is an open-top vessel (container) used to hold liquids for drinking, typically with a flattened hemispherical shape, and often with a capacity of about 100–250 millilitres (3–8 US fl oz).[1][2] Cups may be made of pottery (including porcelain), glassmetal,[3] woodstonepolystyreneplasticlacquerware, or other materials. Normally, a cup is brought in contact with the mouth for drinking, distinguishing it from other tableware and drinkware forms such as jugs. They also most typically have handles, though a beaker has no handle or stem, and small bowl shapes are very common in Asia.

    Cups of different styles may be used for different types of liquids or other foodstuffs (e.g. teacups and measuring cups), in different situations (e.g. at water stations or in ceremonies and rituals), or for decoration.[4][5]

    Minoan pottery cups 1800–1700 BC, Kamares ware

    The history of cups goes back well into prehistory, initially mostly as handle-less beakers or bowls, and they have been found in most cultures across the world in a variety of shapes and materials. While simple cups have been widely spread across societies, high-status cups in expensive materials have been very important status symbols since at least the Bronze Age, and many found in burials.

    Modern household shapes of cup generally lack a stem, but this was not always the case. The large metal standing cup or covered cup with a base and stem, and usually a cover, was an important prestige piece in medieval houses that could afford them, and often used as a “welcome cup”, or for toasts. The form survives in modern sporting trophies, and in the chalices of church liturgy. The 15th-century silver Lacock Cup is a rare English secular survival.[6] These were the sort of cup offered by cup-bearers, historically often an important office in courts.

    Definitions

    [edit]

    The English word “cup” has meant a drinking vessel since at least 1000 AD.[7][8] The definition of a cup is fluid, and is likely to be wider in specialist areas such as archaeology than in modern common speech. As an example, Anna Wierzbicka (1984) notes that in the 1970s the “older generation” expected a cup to be made of porcelain and have both a handle and a saucer, so that the plastic cup with neither a handle, nor a saucer, was not a “real cup”, while the “younger generation” made no such distinction, and used “coffee cup” or “teacup” to indicate the traditional cups. Twelve-year-olds had two different shapes of a cup in mind, one for hot liquids, one for juices.[9]

    Names for different types of cups vary regionally and may overlap (in American English “cups” include “mugs[10]). Any transparent cup, regardless of actual composition, is more likely to be called a “glass“; therefore, while a flat-bottomed cup made of paper is a “paper cup”, a transparent one of very similar shape, is likely to be called a “tumbler“, or one of many terms for glasses, instead. Penelope Stock, a lexicographer, stated that cups, mugs and glasses are “near-synonyms“, although “sufficient differences” can be found that divide them into different groups.[11]

    Wierzbicka and Keith Allan (in his work “On Cup”, 2020) compare definitions of the cup:[12][13]

    TraitWilliam Labov[14]Jerrold J. Katz[15]OED[2]Cliff Goddard[16]Webster’s 2nd ed.[17]
    ShapeTapering, circularVertically oriented, “upwardly concaveHemisphericalThin round sides, smooth top edge, flat bottomOpen, bowl-shaped
    ProportionsSimilar width and depthHeight close to the top diameter that is greater than the bottom oneSmallNot big, bottom narrower than topSmall
    FunctionDrinking hot liquidsDrinkingDrinkingDrinking hot liquids with one hand“Chiefly” drinking, commonly used for hot liquids
    MaterialOpaque “vitreous”Hard and smooth
    HandleOneOptionalOne, in “many things”Optional, one or more
    SaucerPresentPresentCommon
    StemUncommon (usually found in the chalice)Optional
    LidUncommon, not part of the “cup” itselfOptional
    A mug and a cup side-by-side

    Many languages − including French, Italian, Polish, Russian, German − use two separate words for mugs and cups. Wierzbicka suggests that this situation is due to a slightly different functionality: the traditional cups are designed for drinking while sitting down at the table, while the mug is supposed to be used anywhere. This, in her opinion, explains all the specific features:[18]

    • the saucer of the cup helps to protect the table surface, but is an inconvenience away from the table;
    • the tapered shape of the cup accommodates the saucer, the cylindrical design of the mug is due to the absence of the saucer;
    • larger handle of a mug allows carrying the mug around when putting it down is not an option;
    • thicker walls of a mug allow cupping it with a second hand for convenience and reduce the chance of the mug being broken during long periods of handling;
    • sitting at the table implies a more formal occasion, so cups are made to be more elegant, and sold in sets (like a tea set or a coffee service). Mugs are informal and usually sold individually;
    • mug holds more liquid than the cup, as the latter is used in a close proximity of a teapot anyhow. Since limiting the area of the exposed surface of the liquid helps keeping the temperature, this increase in volume is achieved through mug being taller, while tapered cups are lower for stability.

    History

    [edit]

    Imperial “Chicken Cup”, used by the Chenghua Emperor (d. 1487) and his consort for both tea and wine; some 3 inches across, these are now the most expensive cups in the world.[19]

    Cups have been used since the Stone Age and have been found at archeological sites throughout the world.[20] A large number of the earliest cups are excavated from burials, and may have held offerings or supplies for the afterlife. Cups do not feature strongly in the earliest pottery found in most areas; the wares were thick and heavy, as were the carved stone vessels found in several early cultures. Probably cups in organic materials that have now decomposed, such as wood, bamboo and dried gourds were widely used. Large shells and birds’ eggs have been used in some areas almost up to the present. Very simple single-use kulhar cups in unglazed terracotta, and sometimes unfired clay, are still used in South Asia, now mainly at tea stalls, and are very similar to those found at sites of the Bronze Age Indus Valley Civilization.

    The Bell Beaker culture, is an important archaeological culture named after the distinctive inverted-bell pottery beaker cups it used,[21] marking the beginning of the European Bronze Age from around 2800 BC. The Ringlemere Cup is a solid gold cup, with handle, from around 1600 BC, with the Rillaton Gold Cup one of two such cups known from England, with a handful of other locations and materials (such as the Hove amber cup) making up the “unstable” (round-bottomed) cups in precious materials from the Bronze Age.

    Achaemenid Persian Lion Rhyton in gold, c. 500 BC

    Animal horns must often have been used as cups from very early on, and the rhyton is a cup that imitates their shape, to a greater or lesser degree, in metal or pottery. It was the general elite type of cup throughout the Mediterranean in the Iron Age, from Greece to Ancient Persia and beyond. Only some had feet or bases that allowed them to be rested on a flat surface. Large numbers were decorated with or as animal heads, or terminated in the figure of an animal.

    Other than the rhyton, ancient Greek drinking cup shapes were mostly very wide and shallow bowls, usually on short stems and with two handles, generally oriented horizontally, along the same plane as the mouth of the cup, rather than at 90 degrees to it, as in modern teacups. Survivals in ancient Greek pottery are numerous, and often brilliantly painted, but all probably were made also in silver, where survivals are extremely rare, as grave robbers did not bother with pottery.[22] The most important shapes are the kylixkantharosskyphoslip cup, and the breast-shaped mastos with no base.[23]

    The Roman Empire used cups throughout Europe, with “goblet”-type shapes with shortish stems, or none, preferred for luxury examples in silver,[24] like the Warren Cup, or Roman glass, such as the Lycurgus Cup in color-changing glass,[25][26] or the spectacular carved-glass cage cups. By the 2nd century AD even the wealthy tended to prefer drinking from glass, as adding no taste to the drink.[27]

    Box with set of six flanged cups in lacquer, Western Han

    An ancient shape of cup in various parts of Eurasia was the “flanged cup” with either one or two flat horizontal strips attached to part of the top of the cup, acting as handles. These are found as grave goods in elite burials from around the Warring States Period (c. 475 to 221 BC), in Chinese lacquerware (wood coated with resin from a tree) with two flanges at the sides of an ovoid cup. These are also called “eared cups” (耳杯) and “winged goblets”.[28] A form with a flange on only one side appears in ancient Persian silver, and then later in Chinese porcelain, apparently gradually developing into a shape for brush-washers on the calligrapher’s desk.[29]

    Most ancient types of cup from the Americas were pottery, but around the Gulf of Mexico, Native American societies used the shells of the Horse conch for drinking cups, among other purposes.[30] The tall, decorated and slightly waisted qiru or keru of Andean civilizations first appears in the Early Intermediate Period (100–600 AD). They seem to have been high-status objects. Maya elites drank from elaborately painted pottery beakers such as the Fenton Vase and Princeton Maya Vase with God L.[31]

    In what is now the south-eastern US, traces of Yaupon tea containing caffeine have been found in pottery cups of an unusual shape: straight-sided, with a single thick spike as a handle near the top, opposite a slight pouring lip.[32]

    “unstable” palm cup in Anglo-Saxon glass

    In the Early Middle Ages glass remained in production in northern Europe, especially Germany, probably as a luxury material. Anglo-Saxon glass had several types of cup, most shared with continental areas, including “palm cups” with no flat bottom, claw beakers, glass horns, and different types of beaker.

    In the European Middle Ages the shapes of most ordinary cups were closer to mugstankards, and goblets rather than modern cups, in wood, pottery, or sometimes boiled leather. But the elite preferred cups with stems, and often covers, in metal, with glass a less common alternative. Large “ceremonial” or feasting cups, sometimes called grace cups or “welcome cups”, and drinking horns, including ivory, with metal mounts, were important prestige pieces, typically too large to drink from all evening, so passed around or drunk from once. The name for the very wide ancient Greek wine-cup kylix ended up via Latin as chalice, typically a handle-less goblet in metal, used in the Catholic mass, but also a secular shape. Many individual examples have served both secular and liturgical uses over their history.[33]

    Chinese export porcelain tea cup and saucer in the Western style with handle; 1745; diameter: 10.2 cm. The deep saucer is typical of the period

    By the end of the Middle Ages glass was becoming a much cheaper material, and over the Early Modern Period it replaced pottery and other materials as the norm for cups intended for cold drinks, especially wine and beer. The “wine cup” that had been a major prestige category since classical antiquity was largely replaced by the wineglass, and cups for beer went the same way. Timothy Schroder places this change in England around the end of the 17th century, though others put it nearer the beginning[34] The OED records the first dated use in English of “glass” as a term for a vessel, rather than just the material, in 1393-4.[35] A new wave of hot drinks came to dominate the range of cups.

    Chinese and Japanese cups have been shaped as small, rather wide, bowls for some 2,000 years, smaller versions of the shape used for eating and serving food. As well as the Chinese porcelain that very gradually overtook it, lacquer is a prestige material. The same shapes are typically used in East Asia for both tea and wine or sake, and when they appeared in Europe in the 16th century, this shape was initially used for locally-made cups for the new drinks of tea and coffee.[8]

    By the early 18th century, the European taste for handles on cups, strongly evident from antiquity, reasserted itself and a single vertical handle was added to a slightly more upright Chinese-style bowl to create both the very similar forms of the Western teacup and coffee cup, as well as a saucer. This was initially rather deeper than modern saucers, as it was considered usual to pour the hot liquid into the saucer to cool it slightly before drinking. Apart from a more shallow saucer the essential elements of these two forms in many contemporary examples have changed little since the mid-18th century. European porcelain manufacturers encouraged the development of different sizes of cup, and shapes of pot, for tea and coffee services.[36]

    The 20th century brought the plastic cup, in both disposable and permanent washable forms, and the paper cup, normally disposable. Materials such as processed bamboo have also come into use.

    Cultural significance and use

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    The Royal Gold Cup, before 1391, 23.6 cm high, 17.8 cm across at its widest point; weight 1.935 kg, British MuseumSaint Agnes appears to her friends in a vision.

    Since cups have been an integral part of dining since time immemorial, they have become a valued part of human culture. Cups are used across a wide range of cultures and social classes.

    Court culture

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    Historically, monarchs have been concerned about assassination via poisoning. To avoid this fate, they often used dedicated cups, with cup-bearers to guard them. A “divining cup” was supposed to be able to detect poison. In the BibleJoseph interpreted a dream for Pharaoh‘s cup-bearer,[37] and a silver divining cup played a key role in his reconciliation with his brothers.

    The Royal Gold Cup is an exceptionally rare survival, made before 1391 for John, Duke of Berry, a French prince, who gave it to his uncle, Charles VI of France. It is in gold, decorated with jewels and scenes in enamel, with a cover and a boiled leather carrying case. It once had a triangular stand which has been lost. It weighs 1.935 kilos, so was perhaps used ceremonially rather than throughout meals.[38]

    Religion

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    A two-handled Natla (נַטְלָה) cup used for ritual washing in Judaism

    Practices in many religions around the world, including the Ancient Greek and Roman religions included libations, the pouring of a small amount of liquid onto an altar, image or just onto the ground. Some shapes of cup, such as the wide and shallow Greek phiale (Roman patera, more a dish than a cup) seem mainly to have been used for this, while others were used for both this and drinking. The rhyton, especially the types with a hole in the bottom, was one of many cup shapes used for libations. Libations were common at the start of informal social occasions involving drinking, where the normal cups were presumably often used.

    The most traditional Chinese ritual bronze vessel for libations, the jue, has a large pouring lip, and may be regarded as a type of jug rather than a cup.

    In the Christian ritual of Communion, adherents drink from a cup of wine (or a wine substitute) to commemorate the Last Supper of Jesus.[39] A chalice is often used for this purpose. Chalices are usually handleless metal cups on stems; originally such shapes were standard secular elite drinking cups, and many examples such as the Royal Gold Cup have been used for both religious and secular purposes over their history.

    Cuisine

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    The word “cup” is also used as a unit of capacity: the capacity of a “typical” cup, varying slightly from place to place; it is mostly used in recipes. The measuring cup, an adaptation of a simple cup, is a standard tool in cooking that has been in use at least as far back as Roman times.

    Apart from serving as drinking vessels, cups can be used as an alternative to bowls as a receptacle, especially, for soup. Recipes have been published for cooking various dishes in cups in the microwave.[40] Although mainly used for drinking, cups can also be used to store solids for pouring (e.g., sugar, flour, grains, salt).[41]

    Medicine

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    Cupping therapy uses heated cups applied to the body to raise the skin, for which a variety of health benefits are claimed. In the Western world, this is regarded as alternative medicineAntimonial cups were made of antimony. If wine was kept in them for some hours, and then drunk, there was an emetic or laxative effect.

    Coconut cups, in Europe typically expensive standing cups with silver mounts, were long believed to have a range of medical benefits, including (like the rarer rhinoceros horn cups), the ability to detect or neutralize poisoned drinks.

    Spa cups are special cups that are used to drink mineral or thermal water directly from a spring, developed in north-west Bohemia during the 17th century[42] and are now part of Czech folklore.

    Heraldry

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    Chalices are sometimes used in heraldry, especially ecclesiastical heraldry. A Kronkåsa is a type of elaborate wooden cup which was used by the Swedish nobility during the Renaissance.

    Child development

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    Drinking from a cup is a significant step on a baby’s path to becoming a toddler; it is recommended that children switch from bottles to cups between six months and one year of age.[43][44] Sippy cups are typically used for this transition. Like other cups for children, these are normally plastic cups. Special cups for infants seem to date back to the Neolithic age, some shaped like animals, apparently just to engage the child.

    Sports

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    Many trophies take the form of a cup. In sports, competitions themselves often take on the name of the cup-shaped trophy awarded.

    Many trophies take the form of a decorated cup, generally in metal. In cases such as the FIFA World Cup and the Stanley Cup, the competition itself may grow to take on the name of the trophy that is awarded to the winner. Owing to the common usage of cup-shaped trophies as prizes for the winners, a large number of national and international competitions are called “cups”.[45]

    For large examples, the two-handled form based on the ancient kantharos is very often used. The size of many means that “vase” would be a more appropriate name, but “cup” has become established. Early trophies, mostly for horse-racing, were generally more simple goblet shapes.

    Games

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    In Tarot divination, the suit of cups is associated with the element of water and is regarded as symbolizing emotion, intuition, and the soul.[46][47] Cards that feature cups are often associated with love, relationships, fears, and desires.[46][48]

    Various cups have been designed so that drinking out of them without spilling is a challenge. These are called puzzle cups.

    The cup game involves rhythmically striking plastic cups.[49]

    Promotion

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    In the developed world, cups are often distributed for promotional purposes.[50] For example, a corporation might distribute cups with their logo at a trade show, or a city might hand out cups with slogans promoting recycling. There are companies that provide the service of printing slogans on cups.[51]

    For hot beverages

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    Teacups on saucersJapanese export porcelain, 19th century

    While in theory, most cups are well suited to hold drinkable liquids, hot drinks like tea are generally served in either insulated cups or porcelain teacups.

    Metal and glass cups can use a double wall construction with a vacuum-sealed space in-between to reduce the loss of heat and keep outside surfaces cooler.[citation needed]

    Disposable

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    Assorted plastic cups, commonly used for informal dining.

    Disposable cups are intended to be used only once.[52] They are often used by fast-food restaurants and coffee shops to serve beverages. Institutions that provide drinking water, such as offices and hospitals, may also use disposable cups for sanitary reasons.

    For alcoholic beverages

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    Some styles of cups are used primarily for alcoholic beverages such as beer, wine, cocktail, and liquor. There are over a dozen distinct styles of cups for drinking beer, depending on the precise variety of beer. The idea that a certain beer should be served in a cup of a certain shape may have been promulgated more for marketing purposes, but there very well may be some basis in fact behind it.[53] Wine glasses also come in different shapes, depending on the color and style of wine that is intended to be served in them.

    For measurement, suction and breasts

    [edit]

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  • Mouthwash

    Mouthwashmouth rinseoral rinse, or mouth bath[1] is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.

    Usually mouthwashes are antiseptic solutions intended to reduce the microbial load in the mouth, although other mouthwashes might be given for other reasons such as for their analgesicanti-inflammatory or anti-fungal action. Additionally, some rinses act as saliva substitutes to neutralize acid and keep the mouth moist in xerostomia (dry mouth).[2][3] Cosmetic mouthrinses temporarily control or reduce bad breath and leave the mouth with a pleasant taste.[4]

    Rinsing with water or mouthwash after brushing with a fluoride toothpaste can reduce the availability of salivary fluoride. This can lower the anti-cavity re-mineralization and antibacterial effects of fluoride.[5][6][7] Fluoridated mouthwash may mitigate this effect or in high concentrations increase available fluoride, but is not as cost-effective as leaving the fluoride toothpaste on the teeth after brushing.[5] A group of experts discussing post brushing rinsing in 2012 found that although there was clear guidance given in many public health advice publications to “spit, avoid rinsing with water/excessive rinsing with water”[8] they believed there was a limited evidence base for best practice.[9]

    Use

    [edit]

    Common use involves rinsing the mouth with about 20–50 ml (0.7–1.7 US fl oz) of mouthwash. The wash is typically swished or gargled for about half a minute and then spat out. Most companies suggest not drinking water immediately after using mouthwash. In some brands, the expectorate is stained, so that one can see the bacteria and debris.[10][11][12] Mouthwash should not be used immediately after brushing the teeth so as not to wash away the beneficial fluoride residue left from the toothpaste. Similarly, the mouth should not be rinsed out with water after brushing. Patients were told to “spit don’t rinse” after toothbrushing as part of a National Health Service campaign in the UK.[13] A fluoride mouthrinse can be used at a different time of the day to brushing.[8]

    Gargling is where the head is tilted back, allowing the mouthwash to sit in the back of the mouth while exhaling, causing the liquid to bubble. Gargling is practiced in Japan for perceived prevention of viral infection. One commonly used way is with infusions or tea. In some cultures, gargling is usually done in private, typically in a bathroom at a sink so the liquid can be rinsed away.[14]

    Dangerous misuse

    [edit]

    Main article: Surrogate alcohol

    Serious harm and even death can quickly result from ingestion due to the high alcohol content and other substances harmful to ingestion present in some brands of mouthwash.[15] Zero percent alcohol mouthwashes do exist, as well as many other formulations for different needs (covered in the above sections).

    These risks may be higher in toddlers and young children if they are allowed to use toothpaste and/or mouthwash unsupervised, where they may swallow it. Misuse in this way can be avoided with parental admission or supervision and by using child-safe forms or a children’s brand of mouthwash.

    Surrogate alcohol use such as ingestion of mouthwash is a common cause of death among homeless people during winter months, because a person can feel warmer after drinking it.[16]

    Effects

    [edit]

    The most-commonly-used mouthwashes are commercial antiseptics, which are used at home as part of an oral hygiene routine. Mouthwashes combine ingredients to treat a variety of oral conditions. Variations are common, and mouthwash has no standard formulation, so its use and recommendation involves concerns about patient safety. Some manufacturers of mouthwash state that their antiseptic and antiplaque mouthwashes kill the bacterial plaque that causes cavitiesgingivitis, and bad breath. It is, however, generally agreed that the use of mouthwash does not eliminate the need for both brushing and flossing.[17][18][19] The American Dental Association asserts that regular brushing and proper flossing are enough in most cases, in addition to regular dental check-ups, although they approve many mouthwashes.[20] For many patients, however, the mechanical methods could be tedious and time-consuming, and, additionally, some local conditions may render them especially difficult. Chemo­thera­peutic agents, including mouthwashes, could have a key role as adjuncts to daily home care, preventing and controlling supra­gingival plaque, gingivitis and oral malodor.[21]

    Minor and transient side effects of mouthwashes are very common, such as taste disturbance, tooth staining, sensation of a dry mouth, etc. Alcohol-containing mouthwashes may make dry mouth and halitosis worse, as they dry out the mouth.[22][23] Soreness, ulceration and redness may sometimes occur (e.g., aphthous stomatitis or allergic contact stomatitis) if the person is allergic or sensitive to mouthwash ingredients, such as preservatives, coloring, flavors and fragrances. Such effects might be reduced or eliminated by diluting the mouthwash with water, using a different mouthwash (e.g. saltwater), or foregoing mouthwash entirely.

    Prescription mouthwashes are used prior to and after oral surgery procedures, such as tooth extraction, or to treat the pain associated with mucositis caused by radiation therapy or chemotherapy. They are also prescribed for aphthous ulcers, other oral ulcers, and other mouth pain.[24] “Magic mouthwashes” are prescription mouthwashes compounded in a pharmacy from a list of ingredients specified by a doctor.[25][26] Despite a lack of evidence that prescription mouthwashes are more effective in decreasing the pain of oral lesions, many patients and prescribers continue to use them. There has been only one controlled study to evaluate the efficacy of magic mouthwash; it shows no difference in efficacy between the most common magic-mouthwash formulation, on the one hand, and commercial mouthwashes (such as chlorhexidine) or a saline/baking soda solution, on the other. Current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief and in shortening the healing time of oral mucositis from cancer therapies.[24]

    History

    [edit]

    Listerine advertisement, 1932
    Swedish ad for toiletries, 1905/1906

    The first known references to mouth rinsing is in Ayurveda[27] for treatment of gingivitis.[28] Later, in the Greek and Roman periods, mouth rinsing following mechanical cleansing became common among the upper classes, and Hippocrates recommended a mixture of salt, alum, and vinegar.[29] The Jewish Talmud, dating back about 1,800 years, suggests a cure for gum ailments containing “dough water” and olive oil.[30] The ancient Chinese had also gargled salt water, tea and wine as a form of mouthwash after meals, due to the antiseptic properties of those liquids.[31]

    Before Europeans came to the Americas, Native North American and Mesoamerican cultures used mouthwashes, often made from plants such as Coptis trifolia.[32] Peoples of the Americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as teething and mouth ulcers.[32]

    Anton van Leeuwenhoek, the famous 17th century microscopist, discovered living organisms (living, because they were mobile) in deposits on the teeth (what we now call dental plaque). He also found organisms in water from the canal next to his home in Delft. He experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. Next he tried rinsing the mouth of himself and somebody else with a mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. He concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms.[33] In 1892, German Richard Seifert invented mouthwash product Odol, which was produced by company founder Karl August Lingner (1861–1916) in Dresden.[34]

    That remained the state of affairs until the late 1960s when Harald Loe (at the time a professor at the Royal Dental College in Aarhus, Denmark) demonstrated that a chlorhexidine compound could prevent the build-up of dental plaque. The reason for chlorhexidine’s effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours.[35]

    Since then commercial interest in mouthwashes has been intense and several newer products claim effectiveness in reducing the build-up in dental plaque and the associated severity of gingivitis, in addition to fighting bad breath. Many of these solutions aim to control the volatile sulfur compound–creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste.[11][10][36][37][38] For example, the number of mouthwash variants in the United States of America has grown from 15 (1970) to 66 (1998) to 113 (2012).[39]

    Research

    [edit]

    Research in the field of microbiotas shows that only a limited set of microbes cause tooth decay, with most of the bacteria in the human mouth being harmless. Focused attention on cavity-causing bacteria such as Streptococcus mutans has led research into new mouthwash treatments that prevent these bacteria from initially growing. While current mouthwash treatments must be used with a degree of frequency to prevent this bacteria from regrowing, future treatments could provide a viable long-term solution.[40]

    A clinical trial and laboratory studies have shown that alcohol-containing mouthwash could reduce the growth of Neisseria gonorrhoeae in the pharynx.[41][42] However, subsequent trials have found that there was no difference in gonorrhoea cases among men using daily mouthwash compared to those who did not use mouthwash for 12 weeks.[43][44]

    Ingredients

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    Alcohol

    [edit]

    An example of a commercial mouthwash brand which is alcohol-free

    Alcohol is added to mouthwash not to destroy bacteria but to act as a carrier agent for essential active ingredients such as menthol, eucalyptol and thymol, which help to penetrate plaque.[45] Sometimes a significant amount of alcohol (up to 27% vol) is added,[46] as a carrier for the flavor, to provide “bite”.[47][unreliable medical source?] Because of the alcohol content, it is possible to fail a breathalyzer test after rinsing, although breath alcohol levels return to normal after 10 minutes.[48] In addition, alcohol is a drying agent, which encourages bacterial activity in the mouth, releasing more malodorous volatile sulfur compounds. Therefore, alcohol-containing mouthwash may temporarily worsen halitosis in those who already have it, or, indeed, be the sole cause of halitosis in other individuals.[49] Alcohol in mouthwashes may act as a carcinogen (cancer-inducing agent) in some cases (see: Oral cancer § Alcohol).[50] Many newer brands of mouthwash are alcohol-free, not just in response to consumer concerns about oral cancer, but also to cater for religious groups who abstain from alcohol consumption.

    Benzydamine (analgesic)

    [edit]

    In painful oral conditions such as aphthous stomatitis, analgesic mouthrinses (e.g. benzydamine mouthwash, or “Difflam”) are sometimes used to ease pain, commonly used before meals to reduce discomfort while eating.

    Benzoic acid

    [edit]

    Benzoic acid acts as a buffer.[45]

    Betamethasone

    [edit]

    Betamethasone is sometimes used as an anti-inflammatory, corticosteroid mouthwash. It may be used for severe inflammatory conditions of the oral mucosa such as the severe forms of aphthous stomatitis.[51]: 209 

    Cetylpyridinium chloride (antiseptic, antimalodor)

    [edit]

    Cetylpyridinium chloride containing mouthwash (e.g. 0.05%) is used in some specialized mouthwashes for halitosis.[52] Cetylpyridinium chloride mouthwash has less anti-plaque effect than chlorhexidine and may cause staining of teeth, or sometimes an oral burning sensation or ulceration.[53]

    Chlorhexidine digluconate and hexetidine (antiseptic)

    [edit]

    Chlorhexidine digluconate is a chemical antiseptic and is used in a 0.05–0.2% solution as a mouthwash.[54][11][45][55] There is no evidence to support that higher concentrations are more effective in controlling dental plaque and gingivitis.[56] A randomized clinical trial conducted in Rabat University in Morocco found better results in plaque inhibition when chlorohexidine with alcohol base 0.12% was used, when compared to an alcohol-free 0.1% chlorhexidine mouthrinse.[57]

    Chlorhexidine has good substantivity (the ability of a mouthwash to bind to hard and soft tissues in the mouth).[53] It has anti-plaque action, and also some anti-fungal action.[53] It is especially effective against Gram-negative rods.[53] The proportion of Gram-negative rods increase as gingivitis develops, so it is also used to reduce gingivitis.[56][58] It is sometimes used as an adjunct to prevent dental caries and to treat periodontal disease,[53] although it does not penetrate into periodontal pockets well.[59] Chlorhexidine mouthwash alone is unable to prevent plaque, so it is not a substitute for regular toothbrushing and flossing.[59] Instead, chlorhexidine mouthwash is more effective when used as an adjunctive treatment with toothbrushing and flossing.[56] In the short term, if toothbrushing is impossible due to pain, as may occur in primary herpetic gingivostomatitis, chlorhexidine mouthwash is used as a temporary substitute for other oral hygiene measures.[59] It is not suited for use in acute necrotizing ulcerative gingivitis, however.[59] Rinsing with chlorhexidine mouthwash before and after a tooth extraction may reduce the risk of a dry socket.[60] Other uses of chlorhexidine mouthwash include prevention of oral candidiasis in immunocompromised persons,[59] treatment of denture-related stomatitis, mucosal ulceration/erosions and oral mucosal lesions, general burning sensation[56] and many other uses.[59]

    Chlorhexidine mouthwash is known to have minor adverse effects.[60] Chlorhexidine binds to tannins, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth.[53] A systematic review of commercial chlorhexidine products with anti-discoloration systems (ADSs) found that the ADSs were able to reduce tooth staining without affecting the beneficial effects of chlorhexidine.[61] Chlorhexidine mouthwash can also cause taste disturbance or alteration.[56] Chlorhexidine is rarely associated with other issues like overgrowth of enterobacteria in persons with leukemia, desquamation, irritation, and stomatitis of oral mucosa,[53][60] salivary gland pain and swelling, and hypersensitivity reactions including anaphylaxis.[53]

    Hexetidine[45] also has anti-plaque, analgesic, astringent and anti-malodor properties, but is considered an inferior alternative to chlorhexidine.[62]

    Chlorine dioxide

    [edit]

    In dilute concentrations, chlorine dioxide is an ingredient that acts as an antiseptic agent in some mouthwashes.[63][64]

    Edible oils

    [edit]

    In traditional Ayurvedic medicine, the use of oil mouthwashes is called “Kavala” (“oil swishing”) or “Gandusha”,[27][65] and this practice has more recently been re-marketed by the complementary and alternative medicine industry as “oil pulling“.[27] Its promoters claim it works by “pulling out” “toxins”, which are known as ama in Ayurvedic medicine, and thereby reducing inflammation.[66] Ayurvedic literature claims that oil pulling is capable of improving oral and systemic health, including a benefit in conditions such as headachesmigrainesdiabetes mellitusasthma,[27] and acne, as well as whitening teeth.[67]

    Oil pulling has received little study and there is little evidence to support claims made by the technique’s advocates.[65] When compared with chlorhexidine in one small study, it was found to be less effective at reducing oral bacterial load,[68][69] and the other health claims of oil pulling have failed scientific verification[65] or have not been investigated.[65] There is a report of lipid pneumonia caused by accidental inhalation of the oil during oil pulling.[70][71][72]

    The mouth is rinsed with approximately one tablespoon of oil for 10–20 minutes then spat out.[65][67] Sesame oilcoconut oil and ghee are traditionally used,[67] but newer oils such as sunflower oil are also used.[67]

    Essential oils

    [edit]

    Phenolic compounds and monoterpenes include essential oil constituents that have some antibacterial properties,[45][73] such as eucalyptol,[14] eugenol,[45] hinokitiol,[74] menthol,[75] phenol,[45] or thymol.[45] Essential oils are oils which have been extracted from plants. Mouthwashes based on essential oils could be more effective than traditional mouthcare as anti-gingival treatments.[73][76] They have been found effective in reducing halitosis, and are being used in several commercial mouthwashes.

    Fluoride (anticavity)

    [edit]

    Anti-cavity mouthwashes contain fluoride compounds (such as sodium fluoridestannous fluoride, or sodium monofluorophosphate) to protect against tooth decay.[77][78] Fluoride-containing mouthwashes are used as prevention for dental caries for individuals who are considered at higher risk for tooth decay, whether due to xerostomia related to salivary dysfunction or side effects of medication, to not drinking fluoridated water, or to being physically unable to care for their oral needs (brushing and flossing), and as treatment for those with dentinal hypersensitivity, gingival recession/ root exposure.

    Flavoring agents and xylitol

    [edit]

    Flavoring agents include sweeteners such as sorbitolsucralosesodium saccharin, and xylitol, which stimulate salivary function due to their sweetness and taste and helps restore the mouth to a neutral level of acidity.[2]

    Xylitol rinses double as a bacterial inhibitor,[79] and have been used as substitute for alcohol to avoid dryness of mouth associated with alcohol.[2]

    Hydrogen peroxide

    [edit]

    Hydrogen peroxide can be used as an oxidizing mouthwash (e.g. Peroxyl, 1.5%).[59][80] It kills anaerobic bacteria, and also has a mechanical cleansing action when it froths as it comes into contact with debris in mouth.[59] It is often used in the short term to treat acute necrotising ulcerative gingivitis.[59] Side effects can occur with prolonged use, including hypertrophy of the lingual papillae.[59]

    Lactoperoxidase (saliva substitute)

    [edit]

    Enzymes and non-enzymatic proteins, such as lactoperoxidaselysozyme, and lactoferrin, have been used in mouthwashes (e.g., Biotene) to reduce levels of oral bacteria, and, hence, of the acids produced by these bacteria.[81]

    Lidocaine/xylocaine

    [edit]

    Oral lidocaine is useful for the treatment of mucositis symptoms (inflammation of mucous membranes) induced by radiation or chemotherapy.[82] There is evidence that lidocaine anesthetic mouthwash has the potential to be systemically absorbed, when it was tested in patients with oral mucositis who underwent a bone marrow transplant.[83]

    Methyl salicylate

    [edit]

    Methyl salicylate functions as an antiseptic, antiinflammatory, and analgesic agent, a flavoring, and a fragrance.[49] Methyl salicylate has some anti-plaque action, but less than chlorhexidine.[53] Methyl salicylate does not stain teeth.[53]

    Nystatin

    [edit]

    Nystatin suspension is an antifungal ingredient used for the treatment of oral candidiasis.[84]

    Potassium oxalate

    [edit]

    A randomized clinical trial found promising results in controlling and reducing dentine hypersensitivity when potassium oxalate mouthwash was used in conjugation with toothbrushing.[85]

    Povidone/iodine (PVP-I)

    [edit]

    A 2005 study found that gargling three times a day with simple water or with a povidone-iodine solution was effective in preventing upper respiratory infection and decreasing the severity of symptoms if contracted.[86] Other sources attribute the benefit to a simple placebo effect.[87]

    PVP-I in general covers “a wider virucidal spectrum, covering both enveloped and nonenveloped viruses, than the other commercially available antiseptics”,[88] which also includes the novel SARS-CoV-2 virus.[89][90][91]

    Sanguinarine

    [edit]

    Sanguinarine-containing mouthwashes are marketed as anti-plaque and anti-malodor treatments.[53] Sanguinarine is a toxic alkaloid herbal extract, obtained from plants such as Sanguinaria canadensis (bloodroot), Argemone mexicana (Mexican prickly poppy), and others.[53] However, its use is strongly associated with the development of leukoplakia (a white patch in the mouth), usually in the buccal sulcus.[53][92] This type of leukoplakia has been termed “sanguinaria-associated keratosis”, and more than 80% of people with leukoplakia in the vestibule of the mouth have used this substance. Upon stopping contact with the causative substance, the lesions may persist for years. Although this type of leukoplakia may show dysplasia, the potential for malignant transformation is unknown.[93] Ironically, elements within the complementary and alternative medicine industry promote the use of sanguinaria as a therapy for cancer.

    Sodium bicarbonate (baking soda)

    [edit]

    Sodium bicarbonate is sometimes combined with salt to make a simple homemade mouthwash, indicated for any of the reasons that a saltwater mouthwash might be used. Pre-mixed mouthwashes of 1% sodium bicarbonate and 1.5% sodium chloride in aqueous solution are marketed, although pharmacists will easily be able to produce such a formulation from the base ingredients when required. Sodium bicarbonate mouthwash is sometimes used to remove viscous saliva and to aid visualization of the oral tissues during examination of the mouth.[51]: 4 

    Sodium chloride (salt)

    [edit]

    Main article: Salt rinse

    See also: Saline (medicine)

    Saline has a mechanical cleansing action and an antiseptic action, as it is a hypertonic solution in relation to bacteria, which undergo lysis. The heat of the solution produces a therapeutic increase in blood flow (hyperemia)[59] to the surgical site, promoting healing.[1] Hot saltwater mouthwashes also encourage the draining of pus from dental abscesses.[94] In contrast, if heat is applied on the side of the face (e.g., hot water bottle) rather than inside the mouth, it may cause a dental abscess to drain extra-orally, which is later associated with an area of fibrosis on the face (see: Cutaneous sinus of dental origin).[95]

    Saltwater mouthwashes are also routinely used after oral surgery, to keep food debris out of healing wounds and to prevent infection. Some oral surgeons consider saltwater mouthwashes the mainstay of wound cleanliness after surgery.[95] In dental extractions, hot saltwater mouthbaths should start about 24 hours after a dental extraction.[95] The term mouth bath implies that the liquid is passively held in the mouth, rather than vigorously swilled around (which could dislodge a blood clot). Once the blood clot has stabilized, the mouthwash can be used more vigorously.[95] These mouthwashes tend to be advised for use about 6 times per day, especially after meals (to remove food from the socket).[95]

    Sodium lauryl sulfate (foaming agent)

    [edit]

    Sodium lauryl sulfate (SLS) is used as a foaming agent in many oral hygiene products, including many mouthwashes. Some may suggest that it is probably advisable to use mouthwash at least an hour after brushing with toothpaste when the toothpaste contains SLS, since the anionic compounds in the SLS toothpaste can deactivate cationic agents present in the mouthwash.[96]

    Sucralfate

    [edit]

    Sucralfate is a mucosal coating agent, composed of an aluminum salt of sulfated sucrose.[97] It is not recommended for use in the prevention of oral mucositis in head and neck cancer patients receiving radiotherapy or chemoradiation, due to a lack of efficacy found in a well-designed, randomized controlled trial.[97]

    Tetracycline (antibiotic)

    [edit]

    Tetracycline is an antibiotic which may sometimes be used as a mouthwash in adults (it causes red staining of teeth in children). It is sometimes use for herpetiforme ulceration (an uncommon type of aphthous stomatitis), but prolonged use may lead to oral candidiasis, as the fungal population of the mouth overgrows in the absence of enough competing bacteria.[51]: 209  Similarly, minocycline mouthwashes of 0.5% concentrations can relieve symptoms of recurrent aphthous stomatitis.[98] Erythromycin is similar.[24]

    Tranexamic acid

    [edit]

    A 4.8% tranexamic acid solution is sometimes used as an antifibrinolytic mouthwash to prevent bleeding during and after oral surgery in persons with coagulopathies (clotting disorders) or who are taking anticoagulants (blood thinners such as warfarin).[99]: 473 

    Triclosan

    [edit]

    Triclosan is a non-ionic chlorinate bisphenol antiseptic found in some mouthwashes.[100] When used in mouthwash (e.g. 0.03%), there is moderate substantivity, broad spectrum anti-bacterial action, some anti-fungal action, and significant anti-plaque effect, especially when combined with a copolymer or zinc citrate.[53] Triclosan does not cause staining of the teeth.[53] The safety of triclosan has been questioned.[101]

    Zinc

    [edit]

    Astringents like zinc chloride provide a pleasant-tasting sensation and shrink tissues.[102] Zinc, when used in combination with other antiseptic agents, can limit the buildup of tartar.[