Don’t worry and throw away the mouthwash just yet. Let’s examine the scientific evidence behind this unexpected discovery. This includes determining if certain individuals are more susceptible to elevated blood pressure due to mouthwash use and identifying which minty flavors are less risky.
What does the current research say?
A couple of studies have reported a link between mouthwash and high blood pressure. The most recent observational study, published in 2020 in Blood Pressure, found that people who used mouthwash twice a day or more1 had a higher risk of hypertension, even when other risk factors (like overweight and heart issues) were taken into account.
Another small 2015 study found that using antibacterial mouthwash for just three days raised the top number2 of blood pressure (aka systolic) in people around age 65 with hypertension but didn’t affect the bottom number (aka diastolic).
So, what’s the connection? “A healthy oral microbiome3 is linked to a healthy cardiovascular system,” John Higgins, MD, a sports cardiologist at UTHealth Houston, tells Well+Good. But mouthwash can disrupt that balance of bacteria in your mouth, which can lead to possible complications like high blood pressure, he adds.
In addition to bad bacteria, mouthwash can also kill certain good bacteria that produce a natural chemical called nitric oxide, says Dr. Higgins. This chemical acts as a vasodilator, meaning it widens your blood vessels (so more blood can flow through them) and thereby lowers your blood pressure. But when you use mouthwash, you can, in theory, wipe out good-for-you bacteria and destroy this nitric oxide-generating pathway. As a result, this can potentially affect your blood pressure.
On the other hand, some studies have not found a connection at all. A 2019 study in Free Radical Biology and Medicine reported the use of antibacterial mouthwash did not spike blood pressure4 in vegetarians or omnivores (i.e., people who eat meat and plants). Another 2016 study had similar findings: Three days of rinsing with an antiseptic mouthwash three times daily did not affect blood pressure5 in young, healthy women.
Bottom line? Researchers have developed theories as to why blood pressure can be heightened from mouthwash use, and a few studies support these theories, but more research is needed to confirm their results.
Are certain people more at risk?
Dr. Higgins says certain people are more at risk of developing high blood pressure from mouthwash use. This includes people with a family history of heart problems or with current hypertension or diabetes. Age is also another risk factor, which Dr. Higgins pointed out as most studies that found a link between blood pressure and mouthwash involved older folks.
Aside from family history, preexisting diabetes, and age, other risk factors for hypertension include the following:
- Your assigned sex at birth (Males are more likely to get high blood pressure until age 64, while females are more likely to get high blood pressure after age 65.)
- Your race (Certain racial and ethnic groups, such as Black, Hispanic, and Asian adults, have higher rates of high blood pressure.)
- Chronic kidney disease
- Lack of physical activity
- An unhealthy diet, especially one high in sodium
- Having overweight or obesity
- Drinking too much alcohol
- Sleep apnea
- High cholesterol
- Smoking and tobacco use
- Stress
Does this mean you should stop using mouthwash?
No, you don’t have to pour your mouthwash down the drain just yet, Dr. Higgins says. We need more studies to confirm whether there’s a real connection between mouthwash and high blood pressure, he adds.
In the meantime, if you have existing blood pressure problems (or risk factors for developing hypertension), you might want to play it safe. “For now, limit the use of antiseptic mouthwashes,” Dr. Higgins says. Specifically, he recommends avoiding bactericidal mouthwashes (i.e., those that kill bacteria), which include active ingredients like:
Will your blood pressure return to normal if you stop using mouthwash?
If your blood pressure spikes are stemming from mouthwash use, it’s possible that your levels may return to a healthy range once you stop using mouthwash. According to Dr. Higgins, the uptick in your blood pressure seems to be rather short-lived, only lasting a few days to a week after exposure.
And keep in mind: there are several other possible reasons why your blood pressure reading may be high. To fully determine the underlying cause, it’s best to visit your healthcare provider so they can take your vitals and run some tests.
That said, if you’re still considering ditching mouthwash and looking to protect the delicate balance of your oral microbiome, Dr. Higgins suggests reintroducing probiotic bacteria “by taking oral probiotic supplements.” Just be sure to talk to your healthcare provider before trying any new vitamins or supplements.
Are certain types of mouthwash safer?
A clean mouth isn’t just about having fresh, minty breath. Good oral hygiene is important for heart health, too. So, if mouthwash is part of your routine, you don’t have to skip the swish-and-swirl altogether. “Instead, try natural mouthwashes that are not bactericidal,” Dr. Higgins says. Unlike antiseptic mouthwashes, natural rinses don’t eradicate oral bacterial flora or mess with your nitric oxide production. In other words, they shouldn’t affect your blood pressure.
Okay, so what ingredients should you look for? Mouth rinses including coconut oil, fluoride, salt, and lemon peel oil appear to be safe, Dr. Higgins says. If you’re still unsure which mouthwash is a good fit for you, talk with your healthcare provider or dentist. They can point you in the right direction.
