Hi, and welcome—or welcome back. This is The Perio Hygienist Podcast, a podcast primarily for my professional colleagues in the world of dentistry, both dentists and dental hygienists along with hygiene and dental students, and anyone else who cares to listen. My name is Dr. Ben Young, and I am a periodontist in private practice working in the beautiful city of San Antonio in the great State of Texas. You’re listening to Episode 80, entitled A New Mouthwash Consideration.
I think you will find this one very interesting and important to you personally.
Essentially, in today’s podcast I would like to take you with me to analyze a chemical compound new to me and as I consider incorporating it into my patient care protocols.
You will listen to me modifying a procedure protocol almost in real time and what often goes into making such a change.
And let me add, this isn’t unique to me. It happens to healthcare providers all the time. We come across literature, do research, and then consider treatment options. Is whatever-it-is worth incorporating into practice or is it just another marketing ploy – of which there are many?
Just the other day, I came across an article by Robert W. Malone, MD, on his Substack discussing hypochlorous acid, not Hydrochloric acid abbreviated HCl – which is a strong, colorless, highly corrosive chemical compound, but hypochlorous acid or HOCl.
I knew Hydrochloric acid from back in my high school and college chemistry days, but until now I really had not studied or remembered HOCL or hypochlorous acid – not enough to make it memorable at least.
Dr. Mallone described it as a kind of “trusted molecule” already used by the immune system and suggested that it could improve patient care when used as an antiseptic.
By definition, an antiseptic is a substance that kills or inhibits microorganisms on living tissues to prevent infection. Here are the names of five such chemicals: Chlorhexidine, Povidone-iodine, Hydrogen peroxide, Ethanol, and Isopropyl alcohol. Hypochlorous acid is apparently one of these.
So, now, let me walk you through what hypochlorous acid actually is, what the science says rather than the marketing, whether it can replace chlorhexidine or other mouthwashes in the short term after surgery or even in long-term daily use, and finally, the big question of whether it can reduce our reliance on antibiotics.
This episode will be shared with both clinicians and patients across my two podcasts, this one, The Perio Hygienist Podcast and also my one for patients that I still in general recommend dental offices listen to – The Perio Patient Podcast. So you are off the hook having to listen to that one this time.
If you have specific questions, drop me a line. But again, I’ll try to keep this grounded and understandable. Finally, at the end of my written script, I will leave some references to literature for those who wish to explore this topic further. I believe all my podcast scripts can be found on my website, dryoungperiodontics.com. Warning, you might have to dig for a few of them. And again, if you want a script, drop me a line.
Let’s start with a description of hypochlorous acid or HOCL.
First, it is not new, and it was not invented in a laboratory.
It is something produced by certain cells in our bodies continually.
When neutrophils, which are one of several types of white blood cells circulating in the bloodstream, encounter microorganisms, they generate hypochlorous acid through the myeloperoxidase pathway. In simple terms, this process converts hydrogen peroxide and chloride ions into a highly reactive antimicrobial substance. Put even more simply, your immune system already uses HOCl as a chemical weapon. This turns out to be well supported in the scientific literature.
Looking more closely, hypochlorous acid is extremely reactive, very short-lived, and highly dose-dependent in its effects.
At low levels, meaning at the cellular level of production, it can signal and modulate inflammation.
At higher levels, however, it can damage host tissues, including proteins, lipids, and even DNA. Because of this, HOCl is not inherently “safe” in all situations. Its effects depend entirely on concentration, formulation, and context.
Now let’s bring this discussion into dentistry.
Dentistry routinely deals with open surgical wounds, biofilm-heavy environments, and the constant tension between antimicrobial control and tissue healing. When I refer to biofilm, I’m talking about what dentistry has traditionally described to patients as plaque. Both terms describe early bacterial colonies that adhere to hard surfaces and rapidly reproduce into thick, complex communities containing numerous organisms, including pathogens responsible for tooth decay and periodontal disease. While controlling bacteria is essential, we also want to avoid damaging healthy tissues, as doing so can delay wound healing.
Traditionally, we have relied heavily on chlorhexidine, antibiotics, and mechanical debridement. Chlorhexidine is essentially an antimicrobial soap—marketed as Hibiclens in hospitals — used for surgical scrubbing. In dentistry, it is formulated as a mouthwash with flavoring agents to mask its bitter taste without reducing its antimicrobial effectiveness against bacteria, viruses, and fungi. Two brands of chlorhexidine are Peridex and Perio Guard.
Antibiotics are used both systemically and locally. When used locally they are usually delivered in powder or paste forms. In spite of all this – antiseptics vs antibiotics, local vs systemic applications, mechanical debridement remains a cornerstone of biofilm management. This means none of this replaces flossing and brushing – gently and frequently. These are mantras of mine and are repeated over and over in previous podcasts over the years. Go back and listen to them if you haven’t already or recently.
However, chlorhexidine comes with well-known downsides, including staining, taste alteration, increased calculus formation, and cytotoxic effects on the very cells responsible for healing. And the reason it has these problems is due to its ability to stick to the soft tissues of the mouth and release over twelve hours following a single dose. We call this Substantivity. HOCL and other mouthwashes do not have the substantivity of chlorhexidine. But then again, HOCL, unlike chlorhexidine, does not injure or irritate new tissue as it is healing following surgical procedures. And this is the reason I no longer prescribe chlorhexidine following surgical procedures. It interferes with wound healing and also causes the staining, calculus formation and rest.
During early wound healing, the developing soft tissue cells are called fibroblasts, and the bone-forming cells are called osteoblasts. Both are vulnerable to damage from non-selective irritating antiseptics – especially when they are in low (acidic) or high (basic) pH ranges.
Because of these drawbacks, the idea of an alternative that is antimicrobial, better tolerated, and potentially supportive of healing is very appealing.
Regarding HOCl, across multiple studies and reviews, it has consistently demonstrated broad-spectrum antimicrobial activity against bacteria, fungi, and some viruses. In fact, it gained wider attention during the COVID-19 pandemic when it was shown to inactivate the SARS-CoV-2 virus. It also has rapid kill times and has proven useful in wound irrigation and surface decontamination. Several studies suggest that HOCl can reduce bacterial burden in wounds, improve certain healing metrics, and exert potential anti-inflammatory effects, which clinically translate to reduced redness, swelling, and pain. At least one oral health study has shown that an HOCl mouthwash can reduce salivary bacterial counts in patients with periodontal disease.
While not the focus of this podcast dealing primarily with mouthwashes, I am also looking at HOCl surface disinfectants in the home as well as dental office to replace those that risk irritation to eyes and skin. HOCl can be sprayed directly on foods to kill microorganism without risks of sickness or poisoning to humans.
Back to dentistry.
In wound-care models, low-concentration HOCl solutions sometimes underperform against established biofilms. Again, this aligns with what we already know — that mechanical disruption is the most effective way to manage established biofilms. In other words, rinsing with HOCl as a substitute for going to the dentist to correct bleeding gums, for example, is a very bad idea.
Brushing and flossing remain far more effective than any mouthwash, and no antiseptic is intended to replace those fundamentals. And for those who have problems going on in their mouths, brushing and flossing isn’t enough either. First disease needs to be treated by professionals and then daily homecare will help manage health, still assuming that there is a reasonable frequency of preventive procedures being performed in a dental office.
Now we arrive at the big question that Dr. Malone emphasizes strongly: can HOCl reduce the need for antibiotics?
The honest answer is possibly, but only in specific contexts.
Modern medicine is increasingly focused on antimicrobial stewardship, reducing unnecessary antibiotic use, and controlling bioburden early with topical antiseptics. HOCl fits within this framework because it can reduce surface bacterial load and may help prevent infections from progressing.
In theory, better local control could reduce the need for systemic antibiotics.
However, there is currently no strong evidence that HOCl can replace antibiotics in infected surgical cases, prevent all post-operative infections, or eliminate the need for prophylaxis in higher-risk patients.
In dentistry, antibiotics are often required for cases involving systemic symptoms, spreading infections, or immunocompromised patients, and HOCl does not address these scenarios. Practically speaking, HOCl may help reduce antibiotic overprescription, decrease reliance on topical antibiotics, and lower early-stage infection risk, but it does not replace systemic antibiotics when they are truly indicated.
Does hypochlorous acid promote healing?
Some studies suggest that HOCl may improve fibroblast migration, enhance epithelial healing, and reduce inflammatory burden. At the same time, these benefits are highly dependent on dose and formulation. There is an inherent paradox with HOCl because the same molecule that kills bacteria can also damage host tissue at higher concentrations. This makes controlled, low-concentration, stabilized formulations essential, and it also explains why not all products perform equally.
So where does this leave us?
Stripping away both hype and skepticism, hypochlorous acid is biologically relevant, broadly antimicrobial, generally well tolerated, and useful in wound care. At the same time, it is not a universal replacement for systemic antibiotics even though it might reduce the need to prescribe them prophylactically for healthy patients.
From a practical standpoint in dentistry, clinicians might consider HOCl for post-extraction rinses, implant surgery maintenance, and soft tissue healing support following LANAP or other periodontal surgical procedures. Hypochlorous acid is certainly not a magic bullet, but it appears to be a useful tool in a broader shift toward better wound care, reduced antibiotic overuse, and more biologically aligned treatments.
If you found this helpful, consider sharing it with a friend, family member, colleague, fellow dental hygiene or dental student, anyone really, who’s curious about innovations in modern surgical care.
This concludes this episode of The Perio Hygienist Podcast. I am still Dr. Ben Young. Thanks for listening.
References:
- Block MS, Rowan BG. “Hypochlorous Acid: A Review” (2020) — Review
A broad clinical overview of HOCl covering chemistry, antimicrobial activity, safety, and practical office use. It is a good starting paper if you want one article that frames why HOCl keeps appearing in wound, dermatology, and infection-control discussions. (PubMed) - Pullar JM, Winterbourn CC, Vissers MCM. “The effects of hypochlorous acid on mammalian cells” (2000) — Review
This is one of the key mechanistic papers. It focuses less on commercial products and more on how HOCl interacts with mammalian cells, proteins, lipids, and signaling pathways, which is useful for understanding both antimicrobial benefit and host-tissue risk. (PubMed) - Andrés CMC et al. “Hypochlorous Acid Chemistry in Mammalian Cells—Influence on Infection and Inflammation” (2022) — Review
A more modern mechanistic review that updates the biology of endogenous HOCl formation and reactive chlorinated species. It is especially helpful if you want the inflammation/immunology angle rather than only topical antisepsis. (PMC) - Del Rosso JQ, Bhatia N. “Status Report on Topical Hypochlorous Acid: Clinical Relevance of Specific Properties and Considerations for Optimal Use” (2018) — Review
This paper emphasizes topical HOCl in dermatologic practice, highlighting antimicrobial, anti-inflammatory, and immunomodulatory properties. It is a practical review if your interest is in skin, peri-procedural use, or office-based protocols. (PMC) - Boecker D et al. “Antimicrobial efficacy, mode of action and in vivo use of hypochlorous acid and sodium hypochlorite” (2023) — Review
A useful higher-level review comparing HOCl-related antiseptic activity, mechanisms, and in vivo use. It is especially valuable because it places HOCl in context with sodium hypochlorite rather than discussing it in isolation. (PMC) - Sakarya S et al. “Hypochlorous Acid: an ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency” (2014) — Research article
This study supports stabilized HOCl as a wound-care agent with strong antimicrobial and antibiofilm activity while also discussing wound-healing relevance. It is one of the more frequently cited papers when HOCl is promoted for chronic wound management. (PubMed) - Robson MC et al. “Hypochlorous Acid as a Potential Wound Care Agent” (2007) — Research article
An earlier wound-care study showing topical HOCl activity in an experimental wound context. It is useful historically because it helped establish HOCl as more than just a disinfectant concept and pushed it toward therapeutic wound use. (PMC) - Harriott MM et al. “Comparative Antimicrobial Activity of Commercial Wound-Care Solutions on Bacterial and Fungal Biofilms” (2019) — Research article
This comparative study found that HOCl-based wound solutions performed better than some alternatives in eliminating bacterial and fungal biofilms. It is practical when you want product-class comparison rather than single-agent theory. (PubMed) - Rembe JD et al. “Antimicrobial Hypochlorous Wound Irrigation Solutions Demonstrate Lower Anti-Biofilm Efficacy Than Established Wound Antiseptics” (2020) — Research article
This is an important counterweight to the very favorable HOCl literature. In this study, low-dose HOCl wound irrigation solutions showed limited biofilm penetration and eradication compared with some established antiseptics, so it is worth reading if you want a balanced view of HOCl’s limitations. (PubMed) - Lin YC et al. “Effects of hypochlorous acid mouthwash on salivary bacteria in patients with periodontal disease” (2023) — Research article
This is the most directly relevant paper here for oral use. It reported that a 100 ppm HOCl mouthwash reduced salivary bacterial measures in patients with periodontal disease, making it a good entry point if you are specifically thinking about periodontal or oral antimicrobial applications. (PubMed)