It is a frequently quoted maxim that habits make or break the man. As we enter the year 2018, it is a good time to reflect and make better decisions on our good and bad habits. With that in mind, this post is dedicated to answering questions we get about mouthwash and the risk factors involved.

A recent published study discovered that a combination of chemicals in mouthwash may increase the risk of developing diabetes by affecting the bacteria in your mouth possibly by impairing their ability to turn nitrate into nitrite. The study also investigated the link between the use of mouthwash AND hypertension.

The study found that participants who used mouthwash had a nearly 50% chance of developing a pre-diabetic or diabetic state after using mouthwash compared to those who used less or not at all after controlling for a variety of factors such as medication, income, education, diet and breathing disorders.

Why does this happen?

Like in your gut, there is beneficial bacteria in your mouth but there can also be harmful bacteria. These exist in a balance and play a major role in your health. Mouthwash, like antibiotics, kill all of these bacteria indiscriminately.

The oral microbiome is important for your health and has been linked a wide variety of chronic diseases – particularly cardiovascular disease. In fact, gum diseases increases your risk for a heart attack by 50% and advanced periodontal disease may further increase your risk of a fatal heart attack.

This is because having an unhealthy oral microbiome is also linked to chronic low-grade inflammation in the body and balancing it is crucial to achieving good health. The more precise mechanism involves the infiltration of bad bacteria into the bloodstream causing a release of C-reactive Protein or CRP from the liver. This CRP then encourages the development of chronic disease via chronic inflammation.

In fact, an earlier study showed that nitrate-rich vegetables actually reduced the risk of gastric ulcers – the nitrates were converted to nitrite by bacteria in the mouth which was then converted into nitric oxide by the stomach. Another study published in the Journal of Periodontal Research found that multiple types of bacteria were associated with the risk of obesity and Type 2 Diabetes. Those who suffered from Type 2 Diabetes had less of a specific type of bacteria in their mouth than those who didn’t. The author Dr. Kamudi Joshipura explains:

“Many bacteria in the mouth are able to metabolize nitrate into nitrite, which is then swallowed into the gastrointestinal tract, and then converted to nitric oxide. Most of these antibacterial ingredients in mouthwash is not selective. In other words, they do not target specific oral bacteria — instead, these ingredients can act on a broad range of bacteria.”

How dramatic is the dip? Researchers with the University of London found that using mouthwash for just 7 days led to a reduction in oral nitrite production by 90% and blood nitrite levels by 25% – this led to a spike in blood pressure after one day that continued during the seven days! Dr. Nathan Bryan, Ph. D., says

“Recent discoveries reveal that oral bacteria provide the human body with continuous sources of nitric oxide. Nitric oxide is one of the most important molecules produced in the human body. It controls and regulates blood pressure and is a major factor in preventing cardiovascular disease. Loss of nitric oxide is the earliest event in the onset and progression of cardiovascular disease (CVD), the leading killer of men and women worldwide.

Poor oral hygiene, the use of antiseptic mouthwash or antibiotics can kill these commensal bacteria and disrupt nitric oxide production putting patients at risk for CVD. For example, there is strong data that demonstrates that antiseptic mouthwashes may eliminate “bad breath,” but, at the same time, they raise a significant risk of killing “good”, i.e., beneficial, oral bacteria that in turn, raises blood pressure. The rise, as much as 26 mm Hg, causes essential hypertension in healthy individuals.”

 

So, what’s the right answer? Stay tuned for our next article to learn more!