A significant portion of the population suffers from bad breath, gingivitis, high cavity risk, and other tooth/gum diseases. Many of us reach for a bottle of mouthwash to help alleviate the symptoms of these conditions. However, studies are now showing that there is an association between regular mouthwash use and increased risk for high blood pressure, or hypertension.

Hypertension is defined as a blood pressure of ≥130/80 mm Hg or currently using a medication to lower blood pressure, and according to the CDC, over 47% of adults fall into these criteria¹. Uncontrolled hypertension can lead to cardiovascular disease, chronic kidney disease, heart attack, stroke, and more.

What is the Oral Microbiome and Nitric Oxide?

The human body is home to a diverse microbiome, which includes bacteria, fungi, and viruses that live in and on the body. The microbiome plays key roles in digestion, immune system function, and overall health. The oral microbiome is that which resides in the mouth. The mouth is the entry point for the gastrointestinal system and is intimately connected to the rest of the body. Thus, changes in oral health and the microbiome can have effects throughout the rest of the body.

Nitrates are a common nutrient found in leafy and root vegetables. Bacteria in the oral cavity are responsible for converting nitrates to nitrites, which plays an important role in nitric oxide signaling in the body. So, why is nitric oxide (NO) important? One of the major roles of NO is to dilate or widen blood vessels. Imagine two hoses — one narrower than the other. With the same amount of water flowing through each, the pressure on the walls of the narrower hose will be greater than the wider. This is the same for your blood vessels. Narrower blood vessels with the same amount of blood flow through them have increased pressure on the walls, resulting in higher blood pressure.

What is the Literature Saying?

Studies are showing that antibacterial mouthwashes reduce the number of bacteria that help convert nitrates to nitrites, thus limiting nitric oxide signaling and reducing the amount of blood vessel dilation²⁻³.

One study focused specifically on the antimicrobial ingredient chlorhexidine. This study found that rinsing with a 0.2% chlorhexidine rinse twice a day for two weeks reduced the conversion of nitrates to nitrites in the oral cavity by 90%. They also found a statistically significant increase in both systolic and diastolic blood pressure readings².

A second study did not limit the types of mouthwashes used by participants. This study found that irrespective of the type of mouthwash used, two or more daily uses of mouthwash resulted in a statistically significant increase in hypertension risk over a three year period³.

While no causation has be proven, an association persists. More research is needed to determine which specific antimicrobial ingredients target the bacteria responsible for nitrate conversion and how much and how long the blood pressure is affected by consistent use. Because there are numerous alternative options to antiseptic mouthwashes, we advise the use of caution if picking up an antimicrobial mouthwash.

What Alternative Options Are There?

For those who are suffering from bad breath, gingivitis, high cavity risk, or the various conditions where a mouthwash might help, the question becomes what are the alternative options for treatment.

In certain instances of oral bacterial infection, antimicrobial mouth washes may be indicated but are to be used as directed by your dentist and for a short period of time.

At Adams Dental, we offer all-natural rinses and dentifrices to help freshen breath and restore health. If you are not ready to give up your daily mouth rinse use, let us help guide you to the product that is best suited for you.


Studies are showing that frequent antimicrobial mouthwash use can lead to increases in blood pressure by reducing the number of nitrate-converting oral bacteria. Uncontrolled hypertension can lead to numerous health conditions including cardiovascular disease, chronic kidney disease, heart attack, stroke, and more.

As we learn more about the effects of long-term use of antimicrobial mouth rinses, we will keep our patients updated. Our goal is to promote not only the health of the oral cavity, but also the entire body as a whole. A healthy microbiome can lead to a happy and healthy life. When you are in next, ask us about which alternatives may be most beneficial for you.


  1. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2015–2018. Atlanta, GA: US Department of Health and Human Services; 2021.
  2. Kapil V, Haydar SMA, Pearl V, Lundberg JO, Weitzberg E, Ahluwalia A. Physiological role for nitrate-reducing oral bacteria in blood pressure control. Free Radical Bio Med. 2013;55:93-100.
  3. Joshipura K, Muñoz-Torres F, Fernández-Santiago J, Patel RP, Lopez-Candales A. Over-the-counter mouthwash use, nitric oxide and hypertension risk. Blood Press. 2020;29(2):103-112. doi: 10.1080/08037051.2019.1680270.
Dr Garrison Adams Dental

About the author

Dr. Garrison is a passionate dental practitioner who is dedicated to providing comfortable and positive dental experiences to each individual patient. In 2017, she graduated as valedictorian of her undergraduate class at Muhlenberg College where she obtained her bachelor’s degree in chemistry with a minor in business administration. In 2021, she became a repeat valedictorian by graduating 1st in her class of 364 students at the New York University College of Dentistry, where she earned a Doctor of Dental Surgery degree. Dr. Garrison’s favorite part about dentistry is the people. She enjoys getting to know her patients and tailoring their care to their own individual needs. Dr. Garrison likes to live an active lifestyle. In her free time, you can find her at the gym or doing outdoor activities. She also enjoys escaping the cold weather and visiting her parents who retired in Florida