Can Mouth Rinses Impact Blood Pressure? The Nitric Oxide Debate

Strong antiseptic mouth rinses, particularly chlorhexidine can disrupt your oral microbiome in ways that affect more than just your teeth. Research shows these rinses reduce nitrate-reducing bacteria in your mouth, which disrupts the enterosalivary nitrate, nitrite–nitric oxide pathway. This pathway is critical for regulating vascular tone and blood pressure. If you use antibacterial rinses regularly, especially without a dental reason, you may inadvertently undermine your cardiovascular health.
(Intensive Care Medicine, 2021)

What Research Shows

Chlorhexidine's Effect on Nitric Oxide
Chlorhexidine can substantially reduce nitrate-reducing bacteria and lower salivary nitrite (a nitric oxide marker) for several hours, with some studies suggesting effects lasting up to about 12 hours. However, the exact duration varies by study design, dose, and what's being measured, bacterial count versus blood pressure changes.
(Oral Health Programme Ministry of Health Malaysia)

Blood Pressure Changes: The Picture Is Nuanced
Individual clinical trials show that antibacterial mouthwash use can cause small increases in blood pressure. In several controlled studies, chlorhexidine and similar strong antiseptics have been associated with resting systolic blood pressure rises of around 2–5 mmHg in some participants over days of use. However, a recent meta-analysis pooling five trials found no statistically significant average BP rise across all studies combined. A reminder that effects vary considerably depending on the individual, the rinse formulation, and the study design.
(Intensive Care Medicine, 2020)

What this means in practice: While average effects appear modest, individual trials and large epidemiologic studies suggest that frequent, long-term use especially twice-daily use over months or years, is associated with substantially higher risk of developing hypertension. People already managing hypertension may be more sensitive to these small shifts, and population-level effects become significant when millions use strong antiseptics daily without clinical indication.

Not All Rinses Carry the Same Risk
The impact depends heavily on antimicrobial strength. Evidence is strongest for chlorhexidine and other strong antibacterial agents; milder over-the-counter rinses appear less disruptive to nitrate reduction, though data on many common OTC products remain limited and mixed. Some essential-oil or gentler formulations show little or no significant impact on oral nitrate reduction in available studies.
(Oral Health Programme Ministry of Health Malaysia)

Protective Steps

Choose Wisely Avoid strong antibacterial rinses unless your dentist specifically prescribes them for a clinical reason (such as periodontal disease). If you need a rinse, opt for milder, alcohol-free options that preserve your beneficial oral bacteria.

Mechanical Cleaning Is Your Primary Defense Consistent brushing and interdental cleaning are your most effective tools for controlling harmful bacteria and reducing your reliance on harsh chemical agents. This is where daily plaque removal without chemical overkill, makes the biggest difference.

Support Nitric Oxide Production Naturally Nitrate-rich vegetables (spinach, arugula, beets) and regular physical activity support your body's endogenous nitric oxide production and vascular function. By avoiding unnecessary antiseptic rinses, you preserve the same pathway instead of undermining it.

Bottom Line

Some mouth rinses can influence nitric oxide and blood pressure, but the effect depends on the type, strength, and how often you use them. Strong antibacterial rinses like chlorhexidine warrant caution for routine use, particularly if used daily over months or years. Daily mechanical cleaning combined with a nutrient-rich diet and exercise, is a safer, more effective strategy for maintaining both oral and cardiovascular health.