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Scientists find link between mouthwash Erectile Dysfunction, High Blood Pressure & Gut Problems

Scientists find link between mouthwash use and raised blood pressure

HOUSTON, U.S.: A balanced oral microbiome can contribute to good cardiovascular health by converting dietary nitrate into nitric oxide (NO), a signaling molecule that helps maintain normal blood pressure. Now, a new study has suggested that chlorhexidine, an antiseptic substance found in mouthwash, may kill NO-producing bacteria and raise systolic blood pressure.

The researchers used 16S rRNA gene sequencing and analysis to examine whether using chlorhexidine antiseptic mouthwash twice a day for one week would change the oral bacterial communities and blood pressure levels in 26 healthy individuals. They collected samples of the participants’ saliva and tongue scrapings and measured their blood pressure at baseline as well as seven, ten and 14 days later.

The results indicated that using chlorhexidine twice a day was associated with a significant increase in systolic blood pressure and that recovery from use resulted in an enhancement in nitrate-reducing bacteria on the tongue. Individuals with relatively high levels of bacterial nitrite reductases had lower resting systolic blood pressure.

“The demonstration that the presence of NO-producing bacteria in the oral cavity can help maintain normal blood pressure gives us another target to help the more than 100 million Americans living with high blood pressure,” said lead researcher Dr. Nathan S. Bryan, an adjunct professor in the Department of Molecular and Human Genetics at the Baylor College of Medicine in Houston. “Two out of three patients prescribed high blood pressure medication do not have their blood pressure adequately managed,” he added. “None of the [current] drugs for management of hypertension are targeted towards these NO-producing bacteria.”

According to Bryan, owing to the widespread nature of the molecule, oral bacteria may have other profound effects on human health besides regulating blood pressure. “We know one cannot be well without an adequate amount of NO circulating throughout the body. Yet, the very first thing over 200 million Americans do each day is use an antiseptic mouthwash, which destroys the ‘good bacteria’ that help to create the NO. These once thought good habits may be doing more harm than good,” he said.

The study, titled “Frequency of tongue cleaning impacts the human tongue microbiome composition and enterosalivary circulation of nitrate,” was published online on March 1, 2019, in Frontiers in Cellular and Infection Microbiology. source

Can mouthwash raise your blood pressure?

New research, published in the journal Frontiers in Cellular and Infection Microbiology, shows that an antiseptic compound found in mouthwash destroys “friendly” oral bacteria that help maintain normal blood pressure levels.
New research finds that mouthwash could destroy ‘friendly’ oral bacteria, which may have important consequences for a person’s cardiovascular health.

Scientists know that the bacteria in our guts influence overall health, but perhaps less obvious is the connection between oral bacteria and a variety of health conditions.

For instance, Medical News Today recently reported on a range of studies that linked gum disease and the buildup of certain bacteria in the mouth with Alzheimer’s disease, cardiovascular disease, and respiratory conditions.

Another recent article showed how a specific oral bacterium could speed up the progression of colorectal cancer and make the disease more aggressive.

These studies focused on bacteria that cause disease, but, just like our guts, our mouths also contain “friendly” bacteria, which are necessary for maintaining good health.

An oral microbiome with a good balance between these different kinds of bacteria can keep disease at bay. StudiesTrusted Source have found that when this balance is upset it “contributes to oral and whole-body systematic diseases” as diverse as inflammatory bowel disease, Alzheimer’s, rheumatoid arthritisobesityatherosclerosis, and diabetes.

New research points out that a balanced oral microbiome helps maintain good cardiovascular health by helping the conversion of dietary nitrateTrusted Source into nitric oxide (NO) — a signaling molecule that helps maintain normal blood pressure.

Worryingly, however, the new study shows that chlorhexidine, an antiseptic substance in mouthwash, may kill NO-producing bacteria, which in turn, may raise systolic blood pressure.

Nathan Bryan, Ph.D., from the Department of Molecular and Human Genetics at Baylor College of Medicine in Houston, TX, led the new research.

Mouthwash ‘may do more harm than good’

Bryan and colleagues used “16S rRNA gene sequencing and analysis” to examine whether using chlorhexidine antiseptic mouthwash twice a day for 1 week changed the oral bacterial communities and blood pressure levels in 26 healthy individuals.

After 1 week, the 26 study volunteers went back to their usual oral hygiene practices.

The researchers collected samples of the participants’ saliva and tongue scrapings and measured their blood pressure at four different points throughout the study: at baseline, then 7, 10, and 14 days later.

Bryan and colleagues report that “twice-daily chlorhexidine usage was associated with a significant increase in systolic blood pressure after 1 week of use and recovery from use resulted in an enrichment in nitrate-reducing bacteria on the tongue.”

“The demonstration that the presence of NO-producing bacteria in the oral cavity can help maintain normal blood pressure gives us another target to help the more than 100 million Americans living with high blood pressure,” comments the study’s senior author.

“Two out of three patients prescribed high blood pressure medication do not have their blood pressure adequately managed,” he adds, and “this may provide an explanation as to why. None of the [current] drugs for management of hypertension are targeted towards these NO-producing bacteria.”


The researcher continues to explain the mechanisms underlying the findings, saying that NO “is one of the most important signaling molecules produced in the human body.”

Because of the “ubiquitous” nature of this molecule, “the systemic effects of orally produced bacteria may have other significant effects on human health beyond maintenance of blood pressure,” Bryan says. source


We know one cannot be well without an adequate amount of NO circulating throughout the body. Yet, the very first thing over 200 million Americans do each day is use an antiseptic mouthwash, which destroys the ‘good bacteria’ that helps to create the NO. These once thought good habits may be doing more harm than good.”

Nathan Bryan, Ph.D.


Does mouthwash kill the mouth’s healthy bacteria?

WHETHER YOU’RE TRYING to get rid of garlic breath, prevent cavities or stave off gum disease, you may be concerned that swishing mouthwash will upset the balance of bacteria/”bugs” in your mouth and cause health issues.

The chance is very low, especially if you use it on a temporary basis. Mouthwash acts as a barrier, reducing the bacteria from attaching to the teeth. And, because it has such a short amount of contact with those bugs, there isn’t much concern that it could wreak havoc in your mouth. Read on for answers to more common questions about mouthwash and the mouth’s microbiome.

Is mouthwash safe to use?

Mouthwashes are cleared by the U.S. Food and Drug Administration, endorsed by the American Dental Association and, in general, safe to use. But keep in mind that they are used for prevention of oral health issues and will not treat those issues.

What is the microbiome in the mouth, and how does mouthwash affect it?

The microbiome is the balance of healthy and unhealthy bacteria in the mouth. Mouthwash can change the proportion, but there’s not much evidence to show this is cause for concern, especially when it’s used on a temporary basis.

What are benefits of mouthwash?

Mouthwash can help reduce the chance of getting gingivitis, which causes inflammation of the gums, the soft tissue around the teeth. Gingivitis can lead to worsening gum disease that ultimately involves losing jawbones around teeth (periodontitis).

Mouthwash also can be useful on a temporary basis to help prevent cavities for people wearing braces or who have recently had gum surgery and have difficulty brushing their teeth.

It’s important to emphasize that you need to use mouthwash before problems develop. Once you progress to gum disease or jawbone loss, or once bacteria become calcified (calculus), mouthwash won’t help.

What are some drawbacks of using mouthwash?

Sometimes mouthwash can stain teeth after a few weeks of use, because certain formulas attach to the tooth. In some people, the chemicals can affect taste.

Also, many mouthwashes contain alcohol and can be detrimental to people who are sensitive to alcohol. Mouthwashes with alcohol also should be avoided by children and pregnant people.

Is there a link between the oral microbiome and high blood pressure?

There is some correlation between oral hygiene and heart health. Patients with poor oral hygiene habits have a higher chance of developing cardiovascular complications when compared with patients with good oral hygiene habits. However, there could be other factors at play. For example, patients with poor oral hygiene habits may tend to have other habits that contribute to heart disease.

There also is some preliminary data that shows bacteria that’s usually found in the oral cavity also being found in the heart of a patient who suffered from heart complications. That’s indirect evidence that somehow oral bacteria may migrate, but it’s not strong evidence.

However, good oral hygiene is simple to achieve, costs very little, and there are many possible benefits. So, if there’s potential to improve your heart health by taking care of your teeth, you should brush and floss regularly and use mouthwash if you choose.

Is there a benefit to probiotic mouthwash?

The concept of probiotic mouthwashes is to supplement the user’s good bacteria. But currently, there’s no strong evidence to show that probiotic mouthwashes are better than standard mouthwashes.

How do I choose a mouthwash?

Choose a mouthwash tailored to what you’re trying to prevent. If you have gingivitis or some initial gum problems, choose one that targets gum inflammation. If you want to prevent decay from occurring, you could choose one that contains fluoride. Consult with your dentist about this.

If you’re pregnant, have children in the home or are susceptible to alcohol, choose one that’s alcohol-free.

Does mouthwash help with bad breath?

The causes of bad breath are gum disease, stomach issues, sleep problems, stress and specific types of bacteria in your mouth. Sometimes mouthwash helps. Sometimes it doesn’t. But it’s just a temporary fix. If you have chronic bad breath, you need to determine the root cause and address it.

How would I know if I have an imbalance of mouth bacteria?

It’s hard to know if the bacteria in your mouth are imbalanced unless you do a bacterial test, which looks at the profile in your saliva. It’s possible you may have symptoms. Some bacteria cause cavities and some cause gum disease. source

You might find it surprising, but there are important things you need to know about the potential harm caused by mouthwash. In this post, I’ll delve into the reasons why mouthwash can cause disease and suggest alternative ways to improve your oral health.

Check out my video on mouthwash to hear what I really think of it!

Did you know that mouthwash can…

  • Disrupt your gut microbiome
  • Reduce your body’s ability to make nitric oxide
  • Increase your risk for cardiovascular disease and diabetes
  • Increase systemic inflammation
  • Raise your blood pressure

These are all scientifically-proven facts. Let’s talk about how mouthwash can promote disease and what to do instead.

The Cascading Effect of a Disrupted Oral Microbiome

mouth bacteria

You’ve probably heard about the importance of the gut microbiome, and if you’ve been around RIFM more than a minute, you definitely have! Research shows that our microbiome is a major key to our health. I’ve discussed on the blog how poor gut health is directly related to chronic diseasecardiovascular disease, and mental health problems.

But crucial bacteria are not limited to just our gut. They also exist in our mouth, on our skin, in our sinuses, and even on our genitalia. Each of these areas has its own unique microbiome or bacterial colonies, and when they are in harmony and balance, they play a beneficial role in maintaining our overall health.

Did you know your gut microbiome is actually seeded by bacteria in your mouth? Maintaining a balanced pH and fostering a healthy bacteria population in your mouth directly influences your gut health.

Now that we know that a disruption in the oral microbiome can directly disrupt the gut microbiome, it’s clear to see how that seemingly innocent bottle of mouthwash on your bathroom counter could be very harmful to your health.

How Mouthwash Affects Nitric Oxide

Ever heard of nitric oxide? It’s the compound responsible for the functioning of medications like Viagra and nitroglycerin. Nitric oxide plays a pivotal role in dilating blood vessels, lowering blood pressure, preventing heart attacks, and promoting healthy sexual function. To ensure its presence in the arteries, it’s essential to consume nitrates found in foods like beets and leafy greens.

The surprising element in the nitric oxide story is that we need specific mouth bacteria to help release these nitrates from foods so that our body can absorb them. What could kill these good bacteria in the mouth, preventing this critical release of nitrates? You guessed it – mouthwash. So now we can see how mouthwash can also prevent the absorption of these critical nutrients from our food.

Without the right bacteria in the mouth – because of mouthwash – nitric oxide fails to reach your system, impacting brain function, blood pressure regulation, and other vital processes.

Oral Health Out of Balance: It’s Not Just About Pretty Teeth

woman showing gums

One noticeable sign of imbalance in the mouth is the presence of tartar. If you frequently experience tartar buildup or scaling, it indicates the formation of a biofilm that harbors harmful bacteria in your mouth. This condition is linked to various oral problems, such as periodontal disease, gum recession, and cavities, all of which can have a significant impact on your overall oral health. But the effects of an imbalanced oral microbiome extend beyond just the mouth, affecting the entire body.

During my medical career, I’ve observed interesting connections between oral health and other conditions. It’s remarkable how often I encounter diabetic patients or individuals with severe gut issues who also have poor dentition and oral hygiene. New research is showing associations between periodontitis (chronic gum infections) and conditions like Alzheimer’s disease, along with other disease states. We are also seeing a link between the bacteria in your mouth and vascular health.

While I don’t recommend using mouthwash, I always recommend that my patients take their oral health seriously because of its intricate relationship with our overall well-being.

Ways to Promote Oral Health Without Using Mouthwash

There are several simple steps you can take to promote a healthy mouth and oral microbiome. If you’re experiencing things like gum inflammation, tartar buildup, foul-smelling breath, or a white tongue, it’s important to take some steps to address your oral health.

  1. One effective technique is called oil pulling, which involves swishing coconut oil or olive oil in your mouth for about five minutes, twice a day. This practice helps combat harmful bacteria and promotes a healthier balance of microbes in the mouth.
  2. Another option is to incorporate oral probiotics into your routine. These specially formulated probiotics are chewed so that they are lodged on the gums, contributing to a healthier balance of bacteria. Some toothpaste brands even offer probiotic-infused options, providing an additional way to support oral health. See below for the oral probiotic that my family uses.
  3. There are new mouthwashes containing essential oils can be beneficial in controlling bacteria in both your mouth and gut. These mouthwashes have shown positive results in putting periodontal disease into remission, reducing tartar buildup, and enhancing overall oral health.

Beyond Fresh Breath: The Far-Reaching Effects of Imbalanced Oral Microbiome

As you can see, maintaining a healthy oral microbiome is vital for your overall well-being. The bacteria in your mouth have a significant impact on your gut health and can even affect processes like nitric oxide production, blood pressure regulation, blood sugar balance, sexual health, and brain function. Since mouthwash disrupts our microbiome, it’s easy to see how it could be very harmful to your health.

There are simple steps you can take to improve your oral health without relying on mouthwash. Prioritizing your oral health is a great place to start to improve your overall health trajectory and ensure that you get the most benefit from the nutritious foods that you eat. source

The role of dietary nitrate and the oral microbiome on blood pressure and vascular tone


There is increasing evidence for the health benefits of dietary nitrates including lowering blood pressure and enhancing cardiovascular health. Although commensal oral bacteria play an important role in converting dietary nitrate to nitrite, very little is known about the potential role of these bacteria in blood pressure regulation and maintenance of vascular tone. The main purpose of this review is to present the current evidence on the involvement of the oral microbiome in mediating the beneficial effects of dietary nitrate on vascular function and to identify sources of inter-individual differences in bacterial composition. A systematic approach was used to identify the relevant articles published on PubMed and Web of Science in English from January 1950 until September 2019 examining the effects of dietary nitrate on oral microbiome composition and association with blood pressure and vascular tone. To date, only a limited number of studies have been conducted, with nine in human subjects and three in animals focusing mainly on blood pressure. In general, elimination of oral bacteria with use of a chlorhexidine-based antiseptic mouthwash reduced the conversion of nitrate to nitrite and was accompanied in some studies by an increase in blood pressure in normotensive subjects. In conclusion, our findings suggest that oral bacteria may play an important role in mediating the beneficial effects of nitrate-rich foods on blood pressure. Further human intervention studies assessing the potential effects of dietary nitrate on oral bacteria composition and relationship to real-time measures of vascular function are needed, particularly in individuals with hypertension and those at risk of developing CVD. source


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Over-the-counter mouthwash use, nitric oxide and hypertension risk


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