Before You Rinse Again, Watch This — The Truth About Mouthwash | Dr. Mandell

The video explores the connection between mouthwash use, oral bacteria, and cardiovascular health. It explains how beneficial oral bacteria convert nitrates from food into nitrites, which then become nitric oxide (NO) in the bloodstream. NO is crucial for relaxing blood vessels, improving circulation, and regulating blood pressure. Strong antiseptic mouthwashes, particularly those containing alcohol, chlorhexidine, or cetylpyridinium chloride, can indiscriminately kill these beneficial bacteria, potentially lowering NO levels and increasing blood pressure. Studies suggest that even short-term use of such mouthwashes can negatively impact NO levels and blood pressure, with cumulative effects on the cardiovascular system.

The American Heart Association and numerous studies highlight the link between oral health and heart health, noting that oral bacteria, gum disease, and inflammation can contribute to systemic inflammation, arterial stiffness, and atherosclerosis. This underscores the importance of maintaining a healthy oral microbiome and supporting NO production for overall cardiovascular well-being. The speaker advocates for "strategic use" of mouthwash, emphasizing its role in specific situations like gum inflammation or post-dental care, rather than as a daily routine. Safer alternatives like saltwater rinses or alcohol-free mouthwashes with mild essential oils are recommended, alongside good oral hygiene practices and a nitrate-rich diet.

Ultimately, the message is about finding balance: keeping the mouth clean without sterilizing it, protecting gums while preserving beneficial bacteria that support NO production and healthy blood pressure. The mouth is presented as a gateway to the cardiovascular system, and its care is a simple yet powerful way to reduce inflammation, improve circulation, and promote longevity.

• Beneficial oral bacteria convert nitrates into nitrites, which become nitric oxide (NO).
• Nitric oxide relaxes blood vessels, improves circulation, and regulates blood pressure.
• Strong antiseptic mouthwashes kill beneficial bacteria, lowering NO and raising blood pressure.
• Oral health is directly linked to cardiovascular health; mouth issues can cause systemic inflammation.
• Strategic use of mouthwash is advised; saltwater or mild alcohol-free options are safer alternatives.

The Heart-Mouth Connection: Mouthwash's Impact on Nitric Oxide [0:02]

• The video questions whether mouthwash helps or harms heart health.
• It addresses concerns about nitric oxide, oral bacteria, and the potential negative effects of certain rinses.
• Nitric oxide (NO) is a vital signaling molecule that relaxes blood vessels, improves circulation, enhances oxygen delivery, supports brain and immune function, and regulates blood pressure.
• The mouth is the starting point for the body's nitric oxide system.
• Beneficial bacteria on the tongue and oral surfaces convert nitrates from foods like beets, spinach, and kale into nitrites, which then become NO in the bloodstream. This is known as the "enterosalivary nitrate nitrite nitric oxide pathway."

"Nitric oxide, often called N O, is one of the most powerful signaling molecules in the human body."

Antiseptic Mouthwash vs. Beneficial Bacteria [0:35]

• Strong antiseptic mouthwashes, especially alcohol-based ones or those containing chlorhexidine or cetylpyridinium chloride, are designed to kill bacteria.
• However, these mouthwashes indiscriminately destroy beneficial bacteria crucial for generating nitric oxide.
• Multiple studies indicate that just 7 days of using a strong antiseptic mouthwash twice daily can lower nitric oxide levels and increase systolic blood pressure by 2-3 millimeters of mercury.
• This seemingly small increase can have a measurable long-term effect on the cardiovascular system, particularly for individuals managing high blood pressure or circulation issues.

"And I truly appreciate that feedback because it keeps us learning together and gives me the opportunity to go even deeper into the science."

Oral Health as a Gateway to Cardiovascular Health [2:27]

• Science confirms a direct connection between the mouth and the heart.
• Organizations like the American Heart Association and numerous PubMed studies demonstrate that oral bacteria, gum disease, and chronic oral inflammation can contribute to systemic inflammation, arterial stiffness, and plaque buildup in blood vessels.
• Harmful bacteria escaping from the gums into the bloodstream can trigger immune responses that damage blood vessel walls and promote atherosclerosis (hardening and narrowing of arteries).
• Cardiovascular disease often begins silently in the mouth long before symptoms manifest.
• Maintaining a healthy oral microbiome, low inflammation, and supporting nitric oxide production are powerful strategies for protecting both oral and cardiovascular health.

"And this means that cardiovascular disease often begins quietly inside the mouth, long before symptoms appear."

Strategic Mouthwash Use and Safer Alternatives [3:31]

• Mouthwash is not always detrimental; it has its place for specific issues like gum inflammation, plaque, bad breath, and short-term bacterial control post-dental care.
• However, making mouthwash a twice-daily, long-term habit can sterilize the mouth and disrupt the delicate bacterial balance needed by the body.
• The recommended approach is "strategic use," employing mouthwash with a specific purpose, not as a routine.
• For most people, a simple saltwater rinse is a safe and effective option, being natural, anti-inflammatory, gentle, and preserving beneficial bacteria.
• Alcohol-free mouthwashes with mild essential oils are also effective without disrupting the oral microbiome.
• Combining these with brushing, flossing, tongue cleaning, and a diet rich in nitrate-containing foods (leafy greens, celery, beets) naturally boosts nitric oxide and circulation.

"The smarter approach is what I call strategic use. Using mouthwash within purpose, not as routine."

Embracing Scientific Evolution for Health [5:09]

• The speaker emphasizes sharing science and peer-reviewed research to empower informed health decisions.
• Studies by various researchers have clearly demonstrated the link between oral bacteria, nitric oxide, and cardiovascular health.
• Science evolves, and individuals should adapt their practices accordingly.
• If currently using strong mouthwash daily, the advice is not to panic but to make small changes, using it only when truly needed.
• Allowing the body time to restore healthy bacteria will help reactivate nitric oxide pathways naturally, benefiting blood vessels, circulation, and heart health.
• The core takeaway is balance: maintaining oral cleanliness without sterilization, protecting gums while preserving good bacteria for NO production and healthy blood pressure.

"Science evolves, and when it does, we should evolve with it."