Over-the-counter mouthwash use and risk of pre-diabetes/diabetes.
Level 3 - non-randomized controlled study
Prospective longitudinal cohort study with 3-year follow-up
PubMed 28939409 · doi:10.1016/j.niox.2017.09.004
What was done
In the San Juan Overweight Adults Longitudinal Study (SOALS), researchers followed 945 overweight or obese adults aged 40–65 who were free of diabetes and major cardiovascular disease at baseline. The study evaluated the association between baseline self-reported over-the-counter mouthwash use and the 3-year incidence of pre-diabetes or diabetes. Poisson regression models adjusted for age, sex, smoking, physical activity, waist circumference, alcohol consumption, and hypertension status, with additional sensitivity models adjusting for oral hygiene, diet, medications, baseline glycometabolic parameters, and inflammatory markers.
What was found
At baseline, 43% of participants used mouthwash at least once daily and 22% at least twice daily. Compared with less frequent users, those using mouthwash twice daily or more had a 55% higher risk of developing pre-diabetes/diabetes (multivariate IRR = 1.55, 95% CI: 1.21–1.99). Compared with non-users, the incidence risk ratio was 1.49 (95% CI: 1.13–1.95). Using mouthwash less than twice daily showed no significant association. Associations remained statistically significant among never-smokers and obese individuals.
Why it matters
Frequent use of antibacterial mouthwash may disrupt oral microbiota responsible for generating nitric oxide precursors, potentially impairing metabolic regulation. These findings highlight the need to investigate systemic metabolic consequences of routine oral antiseptic use.
Limits
The study is observational and cannot establish causality. The sample was restricted to overweight and obese adults aged 40–65 in Puerto Rico, limiting generalizability to normal-weight individuals or broader populations. The abstract does not specify the active chemical ingredients of the mouthwashes used, track changes in mouthwash habits over the 3-year follow-up, or directly measure oral microbial communities or nitric oxide bioactivity.
Cited by
- context A study published in the journal Nitric Oxide found that frequent mouthwash users have a 50% increased risk of developing type 2 diabetes.