Is Alcohol-Based Mouthwash Bad for Oral Health?

00:00:00.000 | Okay, let's talk about mouthwash or mouthwashes plural.

00:00:05.000 | At the beginning of today's episode, I said,

00:00:08.680 | let's determine what category of oral health you are in.

00:00:12.240 | Are you somebody who pays a lot of attention to oral health?

00:00:15.240 | You brush and floss at least twice a day.

00:00:17.400 | You're using mouthwashes, tooth whiteners, perhaps as well.

00:00:20.920 | Or are you in category two or three?

00:00:23.160 | Well, here's the deal.

00:00:25.900 | Most all, most all, not all, but most all mouthwashes,

00:00:30.040 | especially those containing alcohol

00:00:32.880 | are terrible for oral health.

00:00:37.440 | Simply put, they deplete certain components

00:00:41.720 | of the mucosal lining of the mouth,

00:00:43.440 | and they disrupt the healthy components

00:00:45.820 | of the oral microbiome.

00:00:47.760 | So for those of you that rely on such mouthwashes,

00:00:50.900 | I would really encourage you to learn more about them.

00:00:53.840 | You're about to do that now.

00:00:54.880 | You're already doing that now.

00:00:56.080 | And to really consider whether or not they are helping

00:00:58.020 | or harming your oral health.

00:00:59.880 | Now, I'm not suggesting that you create a scenario

00:01:02.080 | where your breath is causing other people to dissolve

00:01:05.120 | into a puddle of tears or back away from you quickly.

00:01:09.120 | That's not what you want.

00:01:09.960 | That's not what I want.

00:01:10.800 | That's not what anyone wants.

00:01:12.160 | But I think it's important to realize

00:01:14.200 | that these alcohol-based mouthwashes are not good for us.

00:01:18.580 | In addition, there are antiseptic mouthwashes,

00:01:20.920 | some of which contain alcohol, some of which don't,

00:01:23.600 | which sometimes are prescribed

00:01:25.440 | for very serious bacterial overgrowth

00:01:27.720 | and infections of the oral cavity.

00:01:29.800 | If your dentist or physician or periodontist

00:01:32.600 | prescribes those, I certainly am not going to try

00:01:34.880 | and get in the way of that prescription.

00:01:36.720 | That's between you and your healthcare professional.

00:01:38.460 | But you would be wise to ask them whether or not

00:01:41.600 | these chlorhexidine-type mouthwashes, et cetera,

00:01:44.720 | are potentially bad for other components of oral health

00:01:48.600 | or microbiota in the gut generally.

00:01:51.840 | Because in some cases, they have been shown

00:01:53.640 | to be not good for us.

00:01:55.160 | At the same time, we don't want overproliferation

00:01:57.680 | of really bad bacteria in the mouth,

00:01:59.520 | so we don't want infections to run wild either.

00:02:02.160 | Most people, however, are using mouthwashes

00:02:04.280 | to freshen their breath and to kill off additional bacteria

00:02:08.000 | in the mouth that they might believe they couldn't get

00:02:09.880 | with brushing or flossing.

00:02:11.600 | If you are somebody who really wants to use a mouthwash

00:02:14.360 | for that reason, I encourage you to try

00:02:16.400 | and find a mouthwash that is not alcohol-based

00:02:20.680 | and that is not a strong antiseptic,

00:02:23.840 | or that if it is an antiseptic,

00:02:25.600 | that it's not alcohol-based, okay?

00:02:27.480 | And such mouthwashes exist out there.

00:02:30.060 | They're a little bit hard to find.

00:02:31.320 | I'll provide a link to at least a couple of them

00:02:33.640 | in the "Show Note" captions.

00:02:35.160 | Here, I have to say I have not tried those mouthwashes yet.

00:02:38.100 | They do come from sources in which they were developed

00:02:40.480 | by licensed dental healthcare professionals,

00:02:43.060 | but this is always the case

00:02:44.600 | when somebody's selling something,

00:02:46.320 | it's worthwhile to do diligence.

00:02:48.800 | Now, as we talk about toothpaste and mints and gums

00:02:51.640 | and mouthwashes, I think it's worth taking a step back

00:02:55.040 | and also asking the question,

00:02:56.840 | are there any zero or very, very low cost

00:02:59.440 | or even cost-saving alternatives to any of this?

00:03:02.000 | And the great answer is yes.

00:03:04.100 | There are actually a number of things that you can do

00:03:06.080 | with basic over-the-counter stuff from the grocery store

00:03:09.720 | that all the dentists I spoke to said,

00:03:12.120 | yeah, that's a pretty good option.

00:03:13.560 | It's not the best option available perhaps,

00:03:15.680 | but it's a pretty good option.

00:03:16.920 | And in many cases, it's better

00:03:18.540 | than the typical commercially available toothpaste

00:03:21.240 | or mouthwash.

00:03:22.080 | For instance, I would imagine,

00:03:25.440 | based on everything I now know about the structure of teeth,

00:03:28.940 | that using something like baking soda to brush the teeth

00:03:31.960 | would indeed scrape off the biofilm,

00:03:34.280 | perhaps even whiten the teeth a little bit,

00:03:35.840 | although as we talked about earlier,

00:03:36.960 | you're not really whitening the teeth,

00:03:38.120 | you're actually just changing the reflectiveness

00:03:41.800 | and some of the composition of that enamel,

00:03:44.160 | which is translucent so that you can see

00:03:45.900 | the underlying components better.

00:03:48.480 | Well, I talked to several dentists

00:03:50.760 | and they told me that baking soda actually is fairly low

00:03:54.320 | on the abrasiveness rating scale.

00:03:56.320 | They have a specific rating scale for this

00:03:57.840 | that we don't have to go into,

00:03:59.040 | but it's actually considered quite safe

00:04:00.800 | for the enamel of the teeth,

00:04:01.820 | especially if you're brushing with a soft toothbrush

00:04:03.960 | and you're not like really grinding the stuff

00:04:05.720 | against your teeth at maximum intensity

00:04:08.000 | or even near maximum intensity.

00:04:09.900 | So it turns out that baking soda and water

00:04:11.560 | is actually a pretty good toothpaste

00:04:13.740 | if you're not going to go buy a toothpaste.

00:04:16.160 | So that's good news.

00:04:17.220 | Now, you may have heard that you can make

00:04:18.800 | a sort of mouthwash or mouth rinse with baking soda,

00:04:22.560 | water, and a little bit of hydrogen peroxide.

00:04:25.640 | I want to emphasize a little bit,

00:04:27.480 | but I'm also going to emphasize,

00:04:28.920 | I don't think this is a good idea at all.

00:04:31.020 | Why is it not a good idea at all?

00:04:32.600 | Well, first of all, when we were kids,

00:04:34.040 | we used to take baking soda and hydrogen peroxide

00:04:36.160 | and put them together to simulate volcanoes.

00:04:38.160 | So that tells you right there,

00:04:39.960 | the kind of chemical reaction that you're going to get.

00:04:42.620 | But in addition to that,

00:04:44.040 | it's pretty clear that hydrogen peroxide,

00:04:47.320 | unless there's a specific medical recommendation to do so,

00:04:50.240 | is not something you want to introduce to the oral cavity.

00:04:52.880 | Now, this is something that I'm very familiar with

00:04:55.160 | because when I was a postdoc,

00:04:56.560 | so this is in the 2005 to 2010 stretch,

00:05:00.520 | I started to get some pretty bad canker sores.

00:05:04.480 | I don't know about you, but canker sores feel awful to me.

00:05:08.240 | I hate them.

00:05:09.120 | When you eat, they hurt.

00:05:10.520 | When you swallow, they hurt.

00:05:11.480 | When you do anything, they pretty much hurt.

00:05:13.200 | And someone gave me the recommendation

00:05:14.780 | to use a little bit of baking soda dissolved in some water

00:05:18.920 | and a little bit of hydrogen peroxide

00:05:20.400 | and to use that as a oral rinse.

00:05:22.900 | And of course, then to spit it out.

00:05:24.260 | And I did that.

00:05:25.180 | And actually what happened to me

00:05:26.500 | is I got almost quarter-sized ulcers

00:05:29.820 | on the roof of my mouth and on the sides of my mouth.

00:05:32.460 | It took those little canker sores,

00:05:34.100 | which were annoying and kind of painful,

00:05:35.760 | and turned them into full-blown ulcers.

00:05:37.500 | I know this because when I stopped using it,

00:05:39.540 | those healed up almost immediately.

00:05:41.320 | And then when I spoke to some dentists and periodontists,

00:05:43.700 | they said, "Oh yeah, yeah.

00:05:44.540 | "Hydrogen peroxide is just far too abrasive

00:05:46.760 | "for the mouth cavity."

00:05:47.740 | And the reason I raise this is because

00:05:49.580 | I don't think I'm alone in that if you kind of venture

00:05:52.680 | into some of the, let's call it,

00:05:54.500 | alternative recommendation space for oral health,

00:05:58.900 | you may hear that things like hydrogen peroxide

00:06:01.700 | can be useful for gargling with or swishing with

00:06:04.680 | if you are starting to get a little bit of a throat tickle,

00:06:06.780 | maybe an infection.

00:06:07.820 | It turns out it's a really bad idea.

00:06:11.220 | Now, if there are physicians or oral health experts

00:06:13.440 | out there that strongly believe in the use

00:06:15.580 | of hydrogen peroxide rinses or gargling with it

00:06:18.420 | to promote oral health for any reason,

00:06:20.380 | let me know in the show note captions.

00:06:21.800 | I don't wanna go against any of those recommendations,

00:06:23.700 | but this now considered kind of old school recommendation

00:06:27.560 | of creating one's own mouthwash

00:06:29.940 | with a little bit of baking soda,

00:06:31.080 | some hydrogen peroxide and water,

00:06:33.260 | does not seem like a good idea,

00:06:34.800 | not just based on my experience,

00:06:36.080 | but every one of the dental professionals that I spoke to.

00:06:38.880 | That said, it does seem that creating a high salt solution,

00:06:43.880 | so taking some salt, putting it in water, dissolving it,

00:06:46.720 | and then finding the point at which it won't quite dissolve

00:06:49.600 | because the concentration of sodium is just high enough,

00:06:52.520 | and using that as, of course, not something to swallow,

00:06:55.880 | but rather as a dental rinse,

00:06:57.240 | so putting your mouth and swishing it around,

00:06:59.080 | and then spitting it out,

00:07:00.440 | and it's gonna taste very salty,

00:07:01.800 | and then taking a swig of water, just plain water,

00:07:04.980 | and then swishing it around and then spitting it out,

00:07:07.560 | that actually provides a really nice milieu

00:07:10.740 | for the production of healthy mouth bacteria.

00:07:14.900 | It's near zero cost.

00:07:16.920 | I suppose you need a little bit of salt,

00:07:17.960 | a little water, and a glass to put it in,

00:07:19.760 | but it's basically zero cost.

00:07:22.560 | And if you think about it,

00:07:24.160 | that high saline or high salinity solution

00:07:27.480 | is a lot like the sort of brines

00:07:30.000 | and the liquid that comes from these low sugar

00:07:34.040 | probiotic foods that earlier I was suggesting,

00:07:36.660 | and in other episodes I've suggested

00:07:38.160 | could be really healthy

00:07:39.200 | for swallowing for the gut microbiota.

00:07:41.200 | But again, I wanna be very clear.

00:07:42.320 | Do not, do not swallow high salt concentration fluid.

00:07:47.320 | We're talking about a swish and then a spitting it out

00:07:50.840 | as a way to improve the overall milieu of the mouth,

00:07:54.940 | to get their pH right,

00:07:56.280 | to promote the proliferation

00:07:57.400 | of healthy microbiota components.

00:08:00.320 | Okay, so we've talked about some commercially available

00:08:02.560 | gums and mints containing xylitol.

00:08:05.000 | We've talked about some commercially available toothpaste,

00:08:08.500 | indeed some toothpaste that, you know,

00:08:10.140 | almost fall into the very boutique category

00:08:12.320 | because they have all these things that are known by dentists

00:08:14.700 | and periodontists to be great for oral health,

00:08:17.480 | but those can run some cost, right?

00:08:20.020 | And so I do think it's important that we also talked about

00:08:23.100 | the use of just baking soda with a soft toothbrush

00:08:25.540 | and some water and gently brushing the teeth

00:08:27.780 | as a great way to disrupt the biofilm and clean your teeth,

00:08:30.940 | and a high salt solution as a swish and spit,

00:08:33.780 | followed by, you know, swish and spit with clear water,

00:08:37.900 | clean water, no salt in it,

00:08:39.960 | as a essentially very low cost or zero cost mouthwash,

00:08:44.940 | far in a way different from the heavily scented

00:08:48.560 | alcohol-based antiseptic mouthwashes

00:08:50.760 | that are commercially available

00:08:51.880 | and that we know are basically not good

00:08:54.520 | for our oral microbiome.

00:08:56.200 | In addition, I'd like to point out

00:08:57.560 | that those alcohol-based mouthwashes

00:08:59.600 | that many people in the world use

00:09:01.600 | are also known to reduce the amount of nitric oxide

00:09:04.640 | that's produced in the oral cavity,

00:09:06.560 | and that's very important

00:09:08.880 | for the production of nitric oxide elsewhere in the body.

00:09:12.360 | Why is that important?

00:09:13.240 | Well, nitric oxide promotes vasodilation,

00:09:16.120 | not just within the blood vessels

00:09:19.060 | that line and feed the oral cavity,

00:09:21.080 | but also the throat, also in the nose,

00:09:23.400 | also in the brain, also in the heart.

00:09:25.280 | So what we're talking about here is a substance

00:09:27.320 | that is indeed increased when we, for instance,

00:09:31.080 | nasal breathe, we know that,

00:09:32.520 | dramatically increases nitric oxide.

00:09:35.440 | We're talking about a substance

00:09:36.520 | that when the oral microbiome is preserved

00:09:38.920 | in its healthy state, tends to increase in production.

00:09:43.040 | And we're talking about a substance

00:09:44.280 | that's really good for small capillary,

00:09:46.840 | vein, and arterial health,

00:09:48.680 | because it allows for the passage of blood,

00:09:51.400 | both for the delivery of oxygen

00:09:53.000 | and other nutrients to tissues,

00:09:54.540 | but also the removal of waste products from tissues.

00:09:57.080 | So we don't want to do anything that reduces nitric oxide

00:10:00.680 | unless there's some specific medical condition

00:10:02.880 | that leads us to want to do that.

00:10:04.880 | So for most people, increasing nitric oxide

00:10:07.200 | or keeping nitric oxide levels stable

00:10:09.560 | is the state that we want to seek.

00:10:12.320 | And these alcohol-based mouthwashes

00:10:14.480 | are known to deplete the production of nitric oxide.

00:10:17.180 | So there's yet another reason to avoid the use

00:10:19.240 | of these alcohol-based,

00:10:20.640 | more typical over-the-counter mouthwashes.

00:10:23.400 | By the way, this is not a scare tactic against mouthwashes.

00:10:27.180 | I'm sure that if you use mouthwashes,

00:10:29.100 | you're still producing some nitric oxide.

00:10:31.220 | But I think nowadays, many, hopefully all of you,

00:10:35.120 | are interested in doing whatever you can

00:10:36.920 | to improve your mental health,

00:10:38.460 | physical health, and performance.

00:10:39.880 | And if there are things that you are doing

00:10:41.200 | that are inhibiting those in any way,

00:10:43.020 | that you'd potentially want to at least think about those,

00:10:45.720 | maybe remove them from your protocols,

00:10:47.360 | especially if there's a cost to them that you can remove.

00:10:49.840 | In other words, you can save on costs.

00:10:52.400 | So again, lots of reasons to move away

00:10:54.320 | from the alcohol-based standard antiseptic mouthwashes.

00:10:57.560 | Aside from the improvement in your breath,

00:11:00.060 | that by the way, can be better achieved

00:11:01.920 | by supporting the oral microbiome

00:11:03.420 | other ways that we've discussed,

00:11:05.160 | there's really no clear advantage

00:11:06.960 | as to why one would use one.

00:11:08.580 | And there apparently are a number of disadvantages.

00:11:11.620 | [upbeat music]

00:11:15.040 | [upbeat music]

00:11:17.620 | (upbeat music)

Is Alcohol-Based Mouthwash Bad for Oral Health? | Dr. Andrew Huberman

Chapters