Mouthwashes have become popular today, almost everyone seems to be using them. They have antibacterial components that reduce the amount of plaque and encourage better oral health. Back in the day, people began to feel the need to cleanse their mouths with vinegar, brandy, salt water, and some even used urine, tea, and goat’s milk. They moved on to using alcohol to stabilize the solutions and give an antibacterial effect.
Antibacterial Mouthwash
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Mouthwashes now contain strengthening agents like fluoride, antibacterial agents like chlorhexidine, and anti-halitosis agents like cetylpyridinium chloride. Essential oils are also added in some mouthwashes and it has been found effective in reducing halitosis. However, continuous use can lead to negative health effects.
Impact on Nitric Oxide Bioavailability
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Studies have confirmed that repetitive use of strong mouthwashes disrupts nitric oxide metabolism in the oral cavity leading to disrupted systemic functioning. The antibacterial agents kill the bacteria that reduce nitrate to nitrite in the saliva leading to reduced nitric oxide production in the body.
Nitric oxide is a chemical molecule that is very vital in the functioning of the cardiovascular, neurological, and immune systems. Nitric oxide causes vascular dilatation by reducing the tone of the endothelial wall, regulates cardiac stimulation, regulates homeostasis by causing platelet aggregation, regulates inflammation, modulates oxidative processes, and has angiogenic potential. In the nervous system, it acts as a neurotransmitter facilitating both excitatory and inhibitory processes. In the immune system, nitric oxide has antibacterial, antifungal, and antiviral properties.
After nitrate is converted to nitrite, it is then swallowed, absorbed into the circulation, and further reduced to nitric oxide. Therefore, the chronic usage of chlorhexidine mouthwashes has been shown to significantly reduce the blood concentration of nitrite causing elevated blood pressure.
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Also, the reduced availability of nitric oxide in circulation may affect muscle contraction. It has been shown that a short-term intake of beetroot juice which is rich in nitrate improves muscle contraction. This means that chronic mouthwash users can come down with impaired muscular contractility. However, this has not been confirmed in the past.
No affectation of muscle contraction
Edgar Gallardo et al. conducted a study that explored the effects of two times daily usage of cetylpyridium mouthwash on nitric oxide levels and muscular contraction in 26 healthy people. Using sodium chloride mouthwash as a control, the study lasted for 7 days. They measured the levels of salivary nitrate, nitrite, and cyclic guanyl monophosphate, breath nitric oxide, and lower limb muscular contraction. Results showed no significant changes in the concentration of these molecules, however, the concentration of salivary nitrate was significantly reduced.
Clinical Significance
This means that cetylpyridium mouthwash reduces the conversation of nitrate to nitrite but does not significantly cause any disruption of systemic activities. The researchers proposed that either the participants did not follow the instructions or the twice-daily usage for 7 days wasn’t strong enough to alter the oral bacteria.
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Regardless of the results, this shows that using an antibacterial mouthwash does not disrupt muscular activities. So far, this is the first study that measures the effects of cetylpyridium on muscular contraction. Further studies with other types of mouthwash and different study conditions are required to adequately make claims.
References
Effect of antibacterial mouthwash on NO bioavailability and muscle contractile function in young healthy men and women Edgar J. Gallardo, William S. Zoughaib, Ahaan Singhal, Richard L. Hoffman, Andrew R. Coggan medRxiv 2024.05.21.24307698; doi: https://doi.org/10.1101/2024.05.21.24307698
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