Can Mouthwash and Dental Cleanings Cause High Blood Pressure?

Nitric Oxide

Gum disease, also called periodontal disease, is highly correlated to high blood pressure. Conversely, the nitric oxide (NO) pathway found in healthy mouths is crucial for maintaining metabolic and cardiovascular health in humans. Nitric oxide should not be confused with nitrous oxide, also known as laughing gas, which dentists use during procedures to quell anxiety. The NO pathway in the human body involves the mouth and salivary glands. Nitric oxide, a versatile signaling molecule, is synthesized in the cells lining our blood vessels by NO synthases (NOSs). It plays an essential role in blood pressure control by regulating vascular tone (the rigidity of blood vessels). Furthermore, by lowering blood pressure, it also helps in preventing heart disease and atherosclerosis.

The Enterosalivary Cycle of Nitrate

The mouth plays a significant role in the production of nitric oxide (NO) through a process called the enterosalivary cycle of nitrate. This process involves friendly nitrate-reducing bacteria in the oral cavity, predominantly on the tongue, which reduce dietary nitrate (NO3) from vegetables, meat, and drinking water to nitrite (NO2). The nitrite is then further reduced to NO, which helps regulate systemic blood pressure. This pathway highlights how important oral health is to cardiovascular health.

Removing Plaque and its Effect on Blood Pressure

The use of antiseptic mouthwashes, like those containing chlorhexidine, a germ killer, can disturb plaque, which is a good oral microbiome in the absence of processed carbohydrates in the diet. This disturbance can decrease the production of nitrate-reducing bacteria, which can impair the function that helps regulate blood pressure by dilating blood vessels. However, contrary to what you may have read on the internet, studies show that the increase in blood pressure due to the use of chlorhexidine mouthwash is generally not significant. The reason may be that the mouthwash can’t penetrate the fissures of the tongue, where most of the nitrogen-fixing bacteria reside. The rise in systolic and diastolic pressure is modest, with an increase of only 2-3.5 millimeters of mercury. The changes in blood pressure caused by oral health are relatively minor compared to the changes caused by dietary factors such as salt intake. Salt intake can alter blood pressure by at least 5 millimeters of mercury. The relationship between oral health and high blood pressure highlights the connection between oral microbiota and systemic health, especially gum disease (periodontitis) and hypertension. Although the direct link between nitrate-reducing bacteria and hypertension requires further investigation, it is clear that maintaining a balanced oral microbiome, which I will address next, is crucial for endothelial health and blood pressure regulation.

How to Nurture Healthy Plaque

The best way to establish and maintain healthy plaque is to eat a whole-food diet devoid of processed carbohydrates and seed oils like soybean oil. Minimizing a dry mouth is also important. Many medications can result in a dry mouth. Consult with your physician if you suspect you may be on a medication that dries the mouth. Also, mouth-breathing, especially at night, is a major cause of dry mouth. Consult with your dentist if you are mouth-breathing. Medical grade tape meant for skin or mouth tape can help with dry mouth. Lastly, smoking and vaping are also causes of dry mouth, so quitting them is always a great idea.

Probiotics and Nitric Oxide

Probiotic interventions can be used to manage hypertension by restoring oral flora and enhancing NO activity. These interventions aim to replenish nitrate-reducing bacteria, which support the endogenous NO pathway and its cardiovascular benefits.

Conclusion

The NO pathway is integral to cardiovascular health, with oral nitrate-reducing bacteria playing a pivotal role in mediating the effects of dietary nitrate on blood pressure. While antiseptic mouthwashes can disrupt this beneficial microbiota, leading to a slight increase in blood pressure, the overall impact is relatively minor. Maintaining a healthy oral microbiome through diet, careful use of oral hygiene products, and probiotic supplementation could support cardiovascular health by enhancing the bioavailability of NO.

Source:

Pignatelli P, Fabietti G, Ricci A, Piattelli A, Curia MC. How Periodontal Disease and Presence of Nitric Oxide Reducing Oral Bacteria Can Affect Blood Pressure. Int J Mol Sci. 2020 Oct 13;21(20):7538. doi: 10.3390/ijms21207538. PMID: 33066082; PMCID: PMC7589924.