Alcohol-containing mouthwash and oropharyngeal cancer: a review of the epidemiology

J Am Dent Assoc. 2003 Aug;134(8):1079-87. doi: 10.14219/jada.archive.2003.0322.


Background: There has been concern that the use of alcohol-containing mouthwash may increase the risk of developing oropharyngeal cancer, or OPC. The authors examine the epidemiologic literature relating to this issue.

Types of studies reviewed: The authors identified all nine English-language epidemiologic studies of OPC that made reference to mouthwash. The findings and major strengths and limitations of each study are described. In addition, the authors reanalyzed data from one of the studies.

Results: The results of six of the studies reviewed are negative and provide no support for the hypothesis that use of alcohol-containing mouthwash increases the risk of OPC. One of the three studies with positive results was a case series and included a follow-up case-control study, the results of which were negative. The authors reanalyzed the study with the most positive results. This analysis found that the study results were just as positive for nonmucosal cancers developing in the mouth as they were for the usual type of OPC. The authors concluded that this study's positive finding resulted from recall bias.

Clinical implications: It is unlikely that the use of mouthwashes that contain alcohol increases the risk of developing OPC.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Alcohol Drinking / adverse effects
  • Bias
  • Ethanol / adverse effects*
  • Female
  • Humans
  • Male
  • Mouthwashes / adverse effects*
  • National Institutes of Health (U.S.)
  • Oropharyngeal Neoplasms / chemically induced*
  • Oropharyngeal Neoplasms / epidemiology
  • Sex Factors
  • Smoking / adverse effects
  • United States / epidemiology


  • Mouthwashes
  • Ethanol