The oral hygiene habit cardiologists are questioning

A familiar scene: Your patient shows up for their annual visit, proudly noting they’ve kicked soda, joined a gym, and are diligently flossing their teeth and rinsing with a mouthwash twice a day.

It sounds harmless—healthy, even. But as cardiologist Jeremy London, MD, says: Not so fast. In a recent TikTok video, Dr. London calls out a commonly overlooked cardiovascular risk: alcohol-based mouthwash.

The unexpected nitric oxide connection

Alcohol-based mouthwashes eliminate odor-producing bacteria, but they’re not selective. They also wipe out nitric-oxide-producing oral flora—species critical for maintaining vascular tone.

Research backs this up: Oral bacteria convert dietary nitrates into nitrites, a key step in endogenous nitric oxide production. When that microbiome is disrupted, systolic pressures can creep up—even in otherwise healthy people. ^[]

It’s not that mouthwash directly causes hypertension—but for millions of patients already hovering near stage 1 thresholds, or those with metabolic risk factors, this daily habit could create meaningful cumulative impact.

And unlike salt intake or exercise adherence, this is a modifiable behavior patients rarely discuss with clinicians.

What’s the smarter recommendation?

Dr. London doesn’t advise ditching oral hygiene—just the products that do collateral damage.

“Oral health isn’t just about white teeth and fresh breath,” he said. “It’s directly connected to your heart health. Protect both."