Wounds taking weeks to heal on skin disappear in a week inside the mouth (2013)

Which reminds me of a rant:

You know what doesn't do either of those things? Any mouthwash you can buy in the mouthwash aisle.

Ask a dentist about mouthwash. They'll recommend it—but only because the alcohol temporarily shrinks your gums, which allows a toothbrush and/or floss to scrape plaque out that was embedded deeper between the gum and the tooth. Mouthwash doesn't kill bacteria. (Or, it does, but only for the 30 seconds it's in your mouth—meaning that you'll have just created a power-vacuum that other, worse bacteria from e.g. the back of your throat can intrude into. And now the alcohol has also dried out your mucous membranes!)

If a dentist needs to prescribe you a mouthwash, on the other hand—for example, to keep a wound inside your mouth clean post-surgery—they'll prescribe something with ingredients completely unlike that in "regular" mouthwash. Here's (https://www.amazon.ca/Chlorhexidine-Gluconate-Antiseptic-Pep...) an example of one.

The primary ingredient of "mouthwash that actually works" is chlorhexidine—that's a chemical more commonly used as a surgical antiseptic (i.e. a "scrub" doctors will sanitize their hands with before putting them inside your body.) Conveniently, the fact that it's safe to touch your internal organs with, also means that it's safe to touch your mucous membranes with. (Though it's not entirely safe; it says stringently on such mouthwashes not to swallow any—but not because it'd harm you per se, just that it'd likely kill your intestinal flora in much the same way an antibiotic would.)

Interestingly, chlorhexidine and xylitol work in similar ways—they're both things bacteria intentionally take up into themselves, that then destroy the bacteria from the inside. Xylitol just stalls the bacteria's metabolism, starving it to death; while, IIRC, chlorhexidine throws off the bacteria's osmotic regulation until it pops, much like highly-saline environments do—but without doing the same to animal cells. Unlike xylitol, though, chlorhexidine will stick around in the mucous membranes (until you do any of the stuff I mentioned in the previous post) for eight hours, protecting you all the while. It's great. Everyone should use it, at least at night.

It's kind of weird, given all this, that it's not well-known, and not used in regular mouthwashes, no? Well, much like you just can't convince some people that a HWRNG-seeded CSPRNG is a valid source of OS entropy, you just can't convince some people that long-term chlorhexidine use wouldn't result in bacterial resistance—even though, in both cases, if there was any potential for it to fail in "normal" use (OS entropy; mouth-washing), it would have failed a long time ago in the "heavy-duty" use-case where it's already being used (cryptography; surgery.)

Or, to put that another way: if doctors will put chlorhexidine on their hands every day without worrying about growing MRSA under their fingernails, you can put it in your mouth every day without worrying about growing MRSA in your throat.

(Bonus pleasant fact: most prepared chlorhexidine mouthwash solutions are sweetened with xylitol. So you're getting a double-effect from that.)

On the other hand, prepared chlorhexidine mouthwash isn't very cheap (the one I linked above was $15 for a bottle that'll last less than a month), and preparing such a mouthwash yourself from concentrate is really a hassle (pure 2-4% chlorhexidine gluconate is much cheaper, but just diluting it with water/alcohol would create a solution that only retains potency for ~1 day; you'd need to add other chemicals to make it shelf-stable.)

But, if you can't (or just don't want to) get chlorhexidine mouthwash, I still wouldn't recommend using alcohol-based mouthwash. For battling gingivitis or a canker sore or whatever else, Xylitol actually works pretty well as a "quick-fix" alternative. That is, it works well if you exploit the very property I mentioned before—increased mucous-membrane absorption and retention under dehydration. So, here's a "life hack":

• Go buy a box of xylitol sweetener packets (the kind you'd pour into coffee. You can probably find them sorted into the "nutrition products for diabetics" area of a drug store.)

• Before you sleep, brush your teeth, floss, swish with water, spit. And then...

• Dump one of those xylitol sweetener packets directly into your mouth, not dissolved in liquid or anything. Spread it around; get it onto the insides of your lips, onto your teeth, etc.

• Let it absorb. Don't swallow it; just let it sit.

• Go to sleep, just like that.

That will protect your mouth, at least a little. Far more than Listerine ever would.

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Oh, and as a separate thought: if you have recurring canker sores, oral thrush, throat/sinus infections, ear infections, etc., despite good oral hygiene—there's likely a "hidden fortress" of bacterial biofilm somewhere out of reach, probably your maxillary sinuses or adenoids or Eustachian tubes. These areas are "safe" for bacteria because they're damp from breathing, but few actual fluids reach them.

Want a permanent solution? Flush them out. For the nose, I see people trying nasal lavage ("neti pots" et al), and for the ears, I see people going to an ENT to get microsuction. Neither of these are really needed. The biofilms aren't invincible; they're just dry—too dry for your body's natural defences to loosen them. Drip a few drops of mineral oil down your nose/into your ears, once per day. After two days, you should start to feel the need to clear your sinus passages by snorting, inwards. Just keep doing that. And voila, the hidden fortress has been destroyed.

Personally I found my worst heartburn was at night, so sleeping with a wedge pillow stopped me from needing pills.

(Disclaimer: I am not a doctor.)

As for histamines, mast cells are designed to respond to them and rupture as part of your inflammatory cycle. They release more cytokines, recruiting neutrophils and in general telling your immune system to attack.

In regard to the second, I can say this: in the ER, a human bite is considered FAR more dangerous than a dog bite, because the human mouth has more — and more dangerous — pathogens. The mouth is much dirtier (not cleaner) than skin.

They semi-specifically target a receptor on C. albicans and other pathogens. They're also cationic [1], so they bind anionic lipids in bacteria and mitochondria that aren't found (in large quantities) on the mammalian cell surface.

> 2. Do mouth wounds simply heal faster because the mouth is cleaner?

From that second abstract:

"..histatins were actively internalized by epithelial cells and specifically used the extracellular signal-regulated kinases 1/2 (ERK1/2) pathway, thereby enhancing epithelial migration."

It's a relatively simple assay: Just grow a lawn of the skin cells, scrape a line down the middle, and see how quickly the line is filled in (with or without exogenous histatin).

So those peptides tend to do both: kill bacteria and lead to wounds healing faster.

[1] http://aps.unmc.edu/AP/database/query_output.php?ID=00505

Povidone iodine in wound healing: A review of current concepts and practices

Abstract

BACKGROUND: Of the many antimicrobial agents available, iodophore-based formulations such as povidone iodine have remained popular after decades of use for antisepsis and wound healing applications due to their favorable efficacy and tolerability. Povidone iodine's broad spectrum of activity, ability to penetrate biofilms, lack of associated resistance, anti-inflammatory properties, low cytotoxicity and good tolerability have been cited as important factors, and no negative effect on wound healing has been observed in clinical practice. Over the past few decades, numerous reports on the use of povidone iodine have been published, however, many of these studies are of differing design, endpoints, and quality. More recent data clearly supports its use in wound healing.

METHODS: Based on data collected through PubMed using specified search criteria based on above topics and clinical experience of the authors, this article will review preclinical and clinical safety and efficacy data on the use of povidone iodine in wound healing and its implications for the control of infection and inflammation, together with the authors' advice for the successful treatment of acute and chronic wounds.

RESULTS AND CONCLUSION: Povidone iodine has many characteristics that position it extraordinarily well for wound healing, including its broad antimicrobial spectrum, lack of resistance, efficacy against biofilms, good tolerability and its effect on excessive inflammation. Due to its rapid, potent, broad-spectrum antimicrobial properties, and favorable risk/benefit profile, povidone iodine is expected to remain a highly effective treatment for acute and chronic wounds in the foreseeable future.

Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA.

Int J Surg. 2017 Aug;44:260-268. doi: 10.1016/j.ijsu.2017.06.073. Epub June 23 2017.

http://www.journal-surgery.net/article/S1743-9191(17)30536-8...