There are studies that associate using mouthwash with an increase in hypertension, but it is important to take into account the active ingredients in each mouthwash.
Videos on social media claim that mouthwash can increase your risk of blood pressure and potentially harm heart health.
According to some of these videos, this happens because mouthwash eliminates “good” bacteria from the mouthimportant for the cardiovascular system. Although it’s an impactful message, don’t throw away your mouthwash just yet. The reality is much more complex.
Our mouth contains a wide variety of bacteria. Together, these bacteria form a balanced and diverse microbiomewhich helps prevent the overgrowth of other bacteria associated with disease, supports normal metabolic functions and contributes to oral and general health.
One of the important functions of these oral bacteria is to convert nitrate present in food (usually from sources such as green leafy vegetables) into nitrite. When we ingest nitrite, the body transforms it into nitric oxide. This happens through the nitrate-nitrite-nitric oxide pathway, also called the enterosalivary pathway. This is just one example of how bacteria contribute to the health of the body.
Nitric oxide plays a essential role in regulating blood pressure and supporting brain and muscle functions.
But according to some online influencers, the reason mouthwash harms heart health is because it affects “healthy” bacteria – the ones that produce nitric oxide.
Relationship between the elixir and heart health
Several small-scale studies have found that the use of mouthwash can alter the balance of the oral microbiota. This can reduce the ability of bacteria to convert the nitrate present in vegetables into nitrite, a substance necessary for the body’s production of nitric oxide.
A study of 19 healthy volunteers revealed that adults who used a chlorhexidine mouthwash for seven days experienced a small increase in blood pressure and a reduction in nitrite levels.
An intervention study also reported that 0.12% chlorhexidine gluconate mouthwash twice daily for one week significantly increased blood pressure in 27 healthy adults.
In another clinical trial with 15 adults who already had hypertension, the use of chlorhexidine for three days increased blood pressure even further.
One crucial detail that may go unnoticed in some of these social media videos is the type of mouthwash used in these studies.
Many of the studies that found a link between mouthwash use and blood pressure administered clorohexidina to the participants. It is a strong antiseptic elixir, sold without a prescription, recommended only for short-term use in people with gum disease or after dental procedures, in which its antimicrobial effects are beneficial.
Chlorhexidine destabilizes oral bacteria, helping to control infections – including bacteria that convert nitrate to nitrite. This makes it an ideal mouthwash for researchers who want to study the nitrate-nitrite-nitric oxide pathway. However, this also means that findings can does not reflect what happens with milder mouthwashesused not day to day.
A study of 12 healthy adults investigated the effect of three different mouthwashes (and gargling with water, which served as a control) on oral bacteria.
After drinking a nitrate-rich juice, the researchers measured the amount of nitrate converted to nitrite by oral bacteria. Water and mild mouthwash (which did not contain harsh ingredients such as chlorhexidine) elicited a typical response, in which nitrate was converted to nitrite.
But mouthwash with cetylpyridinium chloride (which also has strong antibacterial effects) partially blocked the conversion of nitrate to nitrite. The stronger chlorhexidine mouthwash almost completely stopped this process. This is in line with its more potent antibacterial effects. Stronger elixirs have also been associated with higher systolic blood pressure.
O alcohol (ethanol) is another common ingredient in many mouthwashes, although formulations also often include other active ingredients such as essential oils. This makes it difficult to isolate the specific effects of alcohol.
As an antimicrobial, alcohol can influence the oral microbiome. Some studies have even suggested a possible association between alcohol-containing mouthwashes and an increased risk of oral cancer. However, there are currently no studies that have specifically examined the effects of ethanol-only mouthwashes on the oral microbiome or cardiovascular health.
Overall, the evidence suggests that a mild, over-the-counter mouthwash, like the ones most people buy at pharmacies, may have lower probability significantly interfere with the conversion of nitrate to nitrite or affect blood pressure.
In a long-term study of 354 adults, better routine oral hygiene, such as brushing and flossing, was associated with a lower risk of cardiovascular death over nearly 19 years. Regular use of elixir did not appear to have any influence on heart health outcomes. This has been true for both the milder elixirs with fluoride and alcohol and the stronger antibacterial elixirs such as chlorhexidine and cetylpyridinium chloride.
The type of elixir matters
Taken together, these studies suggest that some types of mouthwash (such as chlorhexidine) interfere with the beneficial bacteria in the mouth and the nitrate-nitrite-nitric oxide pathway when used long-term. But more research is needed to really understand the long-term effects of other types of oral rinses on cardiovascular health – including mild brands for daily use and those that contain alcohol.
There are different types of mouthwash for different purposes, so it is important check the active ingredient on the packaging. Milder, alcohol-free elixirs appear to have less of an effect on heart-friendly bacteria than stronger types.
However, pay attention to the ingredients, as even non-alcoholic options may contain antibacterial agents, such as cetylpyridinium chloride. So, it’s better choose one that suits your needs and use it sparingly. Strong elixirs containing chlorhexidine are best used for treating gum disease or oral infections.
It is also worth mentioning that oral health and untreated infections can contribute to heart disease more broadly. For example, a systematic review of 82 studies concluded that chronic oral disease and tooth loss are associated with the risk of heart problems. This is why maintaining a healthy balance of oral bacterial flora is important, in addition to the health of your teeth.
Take care of your oral and general health by brushing and flossing, visiting the dentist regularly and choosing an oral rinse that is right for you.
