Mouthwash Increasing Risk for Diabetes?

View the study here

A Response from Dr. V Kim Kutsch

This is an interesting study. Certainly we have established the relationship between oral bacteria and systemic diseases. We have also established certain systemic conditions as risk factors for oral diseases. As dentists we often get focused on the mouth, but it is still connected to the rest of the body. In this study they found a correlation between obesity and mouthwash use as a risk factor for developing Type II Diabetes.

The implication is the more frequent reduction of the oral bacteria may result in an increased risk for this disease. They tried to rule out some confounding factors such as income, education, oral hygiene, oral conditions, sleep breathing disorders, diet (processed meat, fruit, and vegetable intake), medications, HOMA-IR, fasting glucose, 2hr post load glucose or CRP to the multivariate models. They attempted to draw a link between nitric oxide production by oral bacteria as a beneficial component of body metabolism, and the indiscriminate killing of oral bacteria may result in a reduction of nitric oxide production.

I’m not sure of this pathway link hypothesis, and it’s difficult to prove causation in any human study. But we do also know that diabetes is a risk factor for Periodontal Disease, and it may be that patients in the trial with the greatest risk for Diabetes also unwittingly self-treated their increased symptoms for PDD with more frequent use of mouthwash. In any event, unless a patient actively needs bacterial load reduction in their mouth for short term therapy for either PDD or dental caries, the daily use of a bactericidal, antiseptic or alcohol containing mouthwash is really not indicated anyway.

Studies indicate short term, limited or intermittent use of antimicrobial rinse containing sodium hypochlorite is effective self-care for patients with PDD.^1,2,3 Patients might be better served with improved oral hygiene consisting of plaque removal by effective tooth brushing, flossing, and tongue scraping.⁴ Daily use of a non-bactericidal rinse with fluoride would reduce their risk for dental caries.^5,6 The study confirms that there is a relationship between oral bacteria and systemic health, and dental professionals play an important role in overall wellness.

Dr. V Kim Kutsch received his undergraduate degree from Westminster College in Utah and then completed his DMD at University of Oregon School of Dentistry in 1979. He is an inventor holding numerous patents in dentistry, product consultant, internationally recognized speaker, is past president of the Academy of Laser Dentistry, and the World Congress of Minimally Invasive Dentistry. He also has served on the board of directors for the World Clinical Laser Institute and the American Academy of Cosmetic Dentistry. As an author, Dr. Kutsch has published over 90 articles and abstracts on minimally invasive dentistry, caries risk assessment, digital radiography and other technologies in both dental and medical journals and contributed chapters to several textbooks. He acts as a reviewer for several journals including the Journal of the American Dental Association and Compendium. Dr. Kutsch also serves as CEO of Dental Alliance Holdings LLC. As a clinician he is a Graduate, Mentor and Scientific Advisor of Dental Caries at the prestigious Kois Center. Dr. Kutsch maintains a private practice in Albany Oregon. 

References

1. Jorgensen MG, Aalam A, Slots J. Periodontal antimicrobials—finding the right solutions. Int Dent J February 2005. 55(1):3-12.
2. Galván M, Gonzalez S, Cohen CL, Alonaizan FA, Chen CT, Rich SK, Slots J. Periodontal effects of 0.25% sodium hypochlorite twice-weekly oral rinse. A pilot study. J Periodontal Res. 2013 Dec 14
3. Rich SK, Slots J. Sodium hypochlorite (dilute chlorine bleach) oral rinse in patient self-care. J West Soc Periodontol Periodontal Abstr. 2015;63(4):99-104.
4. Maltz M, Alves LS, Zenkner JEDA. Biofilm Control and Oral Hygiene Practices. Monogr Oral Sci. 2017;26:76-82. doi: 10.1159/000479348. Epub 2017 Oct 19.
5. Marinho VC1, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2016 Jul 29;7:CD002284. doi: 10.1002/14651858.CD002284.pub2.
6. Matsuyama Y, Aida J, Taura K, Kimoto K, Ando Y, et al. School-Based Fluoride Mouth-Rinse Program Dissemination Associated With Decreasing Dental Caries Inequalities Between Japanese Prefectures: An Ecological Study. J Epidemiol. 2016 Nov 5;26(11):563-571. Epub 2016 Apr 23.