Over-the-counter mouthwash use, nitric oxide and hypertension risk

Joshipura, Kaumudi; Muñoz‐Torres, Francisco J.; Fernández-Santiago, Jeanpaul; Patel, Rakesh P.; López‐Candales, Angel

doi:10.1080/08037051.2019.1680270

Cited by 30 publications

(26 citation statements)

References 35 publications

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“…The use of the mouthwash less than 6 times a week and once a day compared to non-use was not significantly associated with the risk of arterial hypertension (IRR 1.58; 95% CI 0.78–3.18 and IRR 1.30, 95% CI 0.70–2.41, respectively). The study authors conclude that frequent, regular use of over-the-counter mouthwashes was associated with an increased risk of hypertension, regardless of the major risk factors for hypertension and several other potential confounding factors [ 71 ••]. It is worth mentioning that the same researchers showed that too frequent use of mouthwash with chlorhexidine increased the risk of type 2 diabetes [ 72 ].…”

Section: Use Of Mouthwash and The Risk Of Arterial Hypertensionmentioning

confidence: 99%

Periodontitis, Blood Pressure, and the Risk and Control of Arterial Hypertension: Epidemiological, Clinical, and Pathophysiological Aspects—Review of the Literature and Clinical Trials

et al. 2021

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Purpose of Review Arterial hypertension is an important risk factor for cardiovascular disease. In the world, about 45% of people suffer from arterial hypertension, while good blood pressure control is achieved by only approximately 50% of all hypertensive patients treated. The reason for the high prevalence of arterial hypertension and its poor control is low knowledge of hypertensinogenic factors. One such factor is periodontitis, which is a disease of social importance. Recent Findings It has been shown that the occurrence of periodontitis leads to an increase in blood pressure, increasing the risk of arterial hypertension. Periodontitis can also lead to ineffectiveness of antihypertensive treatment. Some interventional studies have shown that treatment of periodontitis reduced blood pressure in patients with arterial hypertension. The pathogenesis of arterial hypertension in periodontitis is complex and concerns mainly the impairment of the vasodilatation properties of the endothelium. Summary Hygiene and periodontitis treatment should be a method of preventing arterial hypertension and a method of increasing the effectiveness of antihypertensive treatment.

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Section: Use Of Mouthwash and The Risk Of Arterial Hypertensionmentioning

confidence: 99%

Periodontitis, Blood Pressure, and the Risk and Control of Arterial Hypertension: Epidemiological, Clinical, and Pathophysiological Aspects—Review of the Literature and Clinical Trials

et al. 2021

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“…Epidemiological studies have also found a relationship between antiseptic mouthwash use and cardiovascular health. In a cohort of middle-aged (40-65 years) overweight or obese individuals, Joshipura et al evaluated the risk of hypertension developing over 3 years [75]. Twelve percent of 540 individuals developed hypertension.…”

Section: Effects Of Antiseptic Mouthwashes On No Homeostasis and Morbmentioning

confidence: 99%

Antiseptic mouthwash, the nitrate–nitrite–nitric oxide pathway, and hospital mortality: a hypothesis generating review

Blot

2020

Intensive Care Med

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Meta-analyses and several large cohort studies have demonstrated that antiseptic mouthwashes are associated with mortality in hospitalized patients. A clear pathogenic mechanism is lacking, leading to controversy and a reluctance to abandon or limit the use of antiseptic mouthwashes. Here, we generate the hypothesis that a disturbance in nitric oxide homeostasis by antiseptic mouthwashes may be responsible for the observed increase in mortality risk. Nitric oxide is essential in multiple physiological processes, and a reduction in nitric oxide bioavailability is associated with the occurrence or worsening of pathologies, such as atherosclerosis, diabetes, and sepsis. Oral facultative anaerobic bacteria are essential for the enterosalivary nitrate-nitrite-nitric oxide pathway due to their capacity to reduce nitrate to nitrite. Nitrate originates from dietary sources or from the active uptake by salivary glands of circulating nitrate, which is then excreted in the saliva. Because antiseptic mouthwashes eradicate the oral bacterial flora, this nitric oxide-generating pathway is abolished, which may result in nitric oxide-deficient conditions potentially leading to life-threatening complications such as ischaemic heart events or sepsis.

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“…In a second publication using the same study population, Joshipura et al studied whether the frequency of mouthwash use was associated with the devolvement of HTN. [6] For this analysis, data from 540 patients without a prior HTN diagnosis were used. [6] In this study, the investigators demonstrated 85-117% significant increased risk of developing HTN; IRR = 1.85 (95% CI, 1.17 to 2.94) for patients using mouthwash more than twice a day vs less frequent use; IRR = 2.17 (95% CI, 1.27 to 3.71) for patients using mouthwash more than twice a day vs no use [5].…”

Section: Dentists and Physicians' Practices Meet Once Again: Potentiamentioning

confidence: 99%

“…[6] For this analysis, data from 540 patients without a prior HTN diagnosis were used. [6] In this study, the investigators demonstrated 85-117% significant increased risk of developing HTN; IRR = 1.85 (95% CI, 1.17 to 2.94) for patients using mouthwash more than twice a day vs less frequent use; IRR = 2.17 (95% CI, 1.27 to 3.71) for patients using mouthwash more than twice a day vs no use [5]. The authors concluded that while causation is not established, the use of mouthwashes may likely lead to DM II and HTN by reducing the bioavailability of NO [5,6].…”

Section: Dentists and Physicians' Practices Meet Once Again: Potentiamentioning

confidence: 99%

Dentists and physicians’ practices meet once again: Potential unfavorable clinical effects of frequent mouthwash use

Chen

Joshipura

Habash

et al. 2020

Postgraduate Medicine

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Over-the-counter mouthwash use, nitric oxide and hypertension risk

Cited by 30 publications

References 35 publications

Periodontitis, Blood Pressure, and the Risk and Control of Arterial Hypertension: Epidemiological, Clinical, and Pathophysiological Aspects—Review of the Literature and Clinical Trials

Periodontitis, Blood Pressure, and the Risk and Control of Arterial Hypertension: Epidemiological, Clinical, and Pathophysiological Aspects—Review of the Literature and Clinical Trials

Antiseptic mouthwash, the nitrate–nitrite–nitric oxide pathway, and hospital mortality: a hypothesis generating review

Dentists and physicians’ practices meet once again: Potential unfavorable clinical effects of frequent mouthwash use

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