Mouthwash use and risk of diabetes: a new concern
A recent study monitored overweight and obese adults over a three-year period (which included periodontal and oral hygiene assessments) concluded that those using mouthwash twice daily or more at baseline had an approximately 50% increased risk of developing prediabetes/diabetes combined, compared to those who used mouthwash less than twice daily or not at all.

The proposed mechanism to explain this is that mouthwash has antibacterial effects in the oral cavity, yet oral bacteria play an important role in the salivary nitrate-nitrite-nitric oxide pathway, and reduced levels of nitric oxide are associated with insulin resistance as well as adverse cardiovascular effects such as hypertension and impaired vascular function.

In this article, published in the British Dental Journal, the important role of oral bacteria in the production of nitric oxide is discussed, and the findings of the above study are considered in detail. It is important that dental professionals are aware of emerging research on this topic as patients frequently ask for advice on use of mouthwash as part of their oral hygiene regime.

The following are the key takeaways from this article:-

• With respect to mouthwash use, the author opines (in the context of periodontal diseases), for the vast majority of patients, mouthwash use won't achieve a clinically relevant benefit over and above that achieved by effective mechanical plaque control (that is, brushing and interproximal cleaning), and certainly should not be regarded as a substitute for ineffective mechanical plaque control.

• While at present there are insufficient firm data to advise patients to stop using mouthwash because of risk of adverse general health effects, the emerging evidence on the role of oral bacteria in the nitrate-nitrite-nitric oxide pathway and potential impacts of antibacterial mouthwash on the oral microbiome raises concerns given that a large proportion of the population use mouthwash on a regular basis.

• A further factor to consider is that we often recommend mouthwash use not only as an adjunct in the management of periodontal diseases (for example, antibacterial mouthwash in the management of gingivitis), but also for caries prevention using fluoride-containing mouthwash.

• As with any prescription or recommendation of a therapy, we must evaluate the potential risks as well as the benefits in each individual case. Therefore, as a profession, we need to be alert to further research developments on this topic so that we can inform patients appropriately.

Read the complete article in detail here:
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