Mouthwash, Erectile Dysfunction, High Blood pressure, & Digestive Health.

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Unless prescribed by your Doctor or Dentist for a specific condition, avoid the use of antibacterial mouthwashes and here are the reasons why you should.

In December 18, 1992, the Science Journal named it as the molecule of the year and in 1998, it was the topic that awarded three Pharmacologists the Nobel Prize for furthering our understanding of how it impacts cardiovascular health. Nitric Oxide (NO), the 1992 molecule of the year is involved in a variety of systems and processes in the body including:
  •  Proper erectile function for men
  •  Enhancement of gastric motility and the overall digestive health
  • Improving of blood circulation and thus lowering of blood pressure.

Other processes include impacting memory and behavior, enhancing immunity, decreasing inflammation, improving sleep quality, enhancing endurance and strength, and insulin signaling.


The Nitric Oxide (NO) Pathway and the Enterosalivary Circuit

Nitric Oxide (NO) which is produced by the endothelial cells lining the walls of the arteries as well as that which is obtained from dietary sources (vegetables) exist in the body for only a short time. When we exercise, the endothelial cells produce nitric oxide which causes vasodilation of the blood vessels thereby increasing oxygenation of the muscle cells. Ere long, the NO is metabolized into Nitrate (NO3-) which is absorbed via the enterosalivary circulation by the salivary glands and secreted with saliva into the mouth.

The bacteria in the mouth act on the nitrate, converting it to Nitrites (NO2-), which when swallowed is rapidly absorbed in small portion into the blood stream and can form new NO. The enterosalivary circuit is what guarantees the continued blood pressure lowering effect experienced after a workout (post exercise hypotension).

Clinical studies have shown that antibacterial mouthwashes deplete oral nitrate reducing bacteria and decrease systemic nitric oxide bio-availability. In order words, the use of antibacterial mouthwash decreases nitric oxide levels in the body. It is interesting to know that as people age, the body produces less nitric oxide due to the decrease in testosterone levels and an increase in the levels of the stress hormone cortisol. The effects of this decline are;
  • Weak erection and impotence in men
  •  Less stamina for exercise
  • High blood pressure leading to cardiovascular diseases, heart attacks, and stroke
  • Problems with gut health.


Fig 2: Nitric Oxide (NO) Pathways

Rinsing the mouth with antibacterial mouthwash can affect the make-up of the oral bacterial microbiome negatively which in turn causes problems with the gut lining in the stomach hence leading to a greater risk of developing stomach ulcers. Also, the cardiovascular benefits of exercise can be limited by antibacterial mouthwashes as they tend to eliminate the “Good Guys” in the mouth. Our oral microbiome and the bacteria it houses may be more important to our heart health than we ever thought.

Action Plan

  • Brush your teeth and tongue twice a day (if possible) using an antibacterial free toothpaste
  • Use of fresh mints and mouth fresheners
  • Eat healthy diets (dietary nitrate supplementation)
  • Exercise

As health care professionals, this would be a wake up call for most of us. When we recommend interventions involving physical activities for high blood pressure, we also must pay attention to the oral environment.


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