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NO, the Silent Killer, Mouthwash, and Kissing

written by Risë’s Pieces |

Hypertension has been labeled the silent killer. It earned this label because people with high blood pressure rarely experience any symptoms. Hypertension is defined by blood pressure that’s consistently greater than 130 mmHg systolic and 80 mmHg diastolic. You may have had a reading in this category and forgotten about it because most of the time you don’t feel anything when your blood pressure is elevated.

Hypertension can go undetected for a long time, and for some, the first symptom might be a heart attack or a stroke. Reportedly 47.7 percent of American adults have elevated blood pressure. That’s nearly one out of every two people—almost half the adult population! This is a serious problem, but what does it have to do with the nitric oxide molecule we started learning about last month? Potentially a lot.

We’ve learned that among other things, nitric oxide (NO) keeps blood vessels elastic and promotes vasodilation. This makes it extremely significant when it comes to blood vessel health and pressure, and some scientists are identifying inadequate levels as a major contributor. “Nitric oxide is a naturally produced vasodilator that controls and regulates vascular tone and therefore controls and regulates blood pressure. Research over the past 40 years reveals that loss of nitric oxide production, termed endothelial dysfunction, is the earliest event in the development of hypertension. Strategies aimed at preventing the loss of nitric oxide production and/or therapeutic strategies designed to restore nitric oxide production will likely have a positive effect on patients’ health and lead to better management of blood pressure.”1

Believe it or not, research has actually linked mouthwash as a common household item that affects our nitric oxide production. In a medical article titled, “Over-the-counter mouthwash use, nitric oxide and hypertension risk,” the authors of a study revealed that “Participants who used mouthwash twice daily or more had a significantly higher incidence of hypertension compared to less frequent users and non-users. The associations persisted even after adjusting for various confounders and among never smokers.”2

Why the correlation between mouthwash and hypertension? The human mouth, like the colon, is colonized with numerous microbes called the oral microbiome, oral microbiota, or oral flora. Like the colon, these diverse bacteria, viruses, and fungi coexist in the mouth, with variations in bacterial populations occurring in specific locations such as the teeth, tongue, cheeks, and gums. In other words, unique populations live on the tongue, and these differ from the community that lives on the teeth.

A kiss on the lips transfers some 80 million bacteria. That may sound disgusting until you realize that this may actually be beneficial. Remember, God made man from the dust of the earth, which is a highly microbial substrate. Microbes are there because that’s what we were made of.

There are multiple ways our health is improved through the transfer of beneficial microbes (from probiotics, fermented foods, and gardening). Perhaps we can add kissing to that list. Beneficial bacteria in the mouth keep the bad guys from forming cavities, causing periodontal disease, and supporting NO production.

Mouthwash advertises itself as being able to kill 99.9 percent of the bacteria in our mouths—as if that is a good thing. If we do, we may develop dysbiosis—where an unhealthy community of microbes becomes unbalanced. Simply put, we might describe dysbiosis as the bad guys over-populating the good guys; and in any neighborhood, that can lead to big problems. Just as frequent antibiotic use harms the gut microbiome, using mouthwash can harm the oral microbiome. Mouthwash disrupts and destroys healthy microbial balance in the mouth. It can harm the beneficial bacteria that produce compounds that are converted to nitric oxide that maintains healthy blood pressure.

Next month, we’ll learn more about the role of the mouth and food as it pertains to nitric oxide.

1 Bryan, N. S. (2022). Nitric oxide deficiency is a primary driver of hypertension. Biochemical Pharmacology, 206, 115325. https://doi.org/10.1016/j.bcp.2022.115325

2 Joshipura, K., Muñoz-Torres, F., Fernández-Santiago, J., Patel, R. P., & Lopez-Candales, A. (2020). Over-the-counter mouthwash use, nitric oxide and hypertension risk. Blood pressure, 29(2), 103–112. https://doi.org/10.1080/08037051.2019.1680270