Eating leafy greens could be better for oral health than using mouthwash

More than half of adults in the UK and US suffer from gum disease. Typical treatment includes mouthwash and, in severe cases, antibiotics. These treatments have side effects, such as dry mouth, development of antimicrobial resistance, and increased blood pressure.

But research shows that a molecule called nitrate present in leafy green vegetables has fewer side effects and greater benefits for oral health. It can be used as a natural alternative to treat oral diseases.

Inadequate brushing and flossing can cause plaque (a sticky layer of bacteria) to build up on the surface of your teeth and gums. Plaque causes tooth decay and gum disease. Sugary and acidic foods, dry mouth, and smoking can also lead to bad breath, tooth decay, and gum infections.

The two main types of gum disease are gingivitis and periodontitis. Gingivitis causes the gums to become red, swollen, and bleed. Periodontitis is a more serious form of gum disease that causes damage to the soft tissue and bone that support the teeth.

Therefore, periodontal disease can lead to tooth loss, and when oral bacteria enter the bloodstream, it can also lead to the development of systemic diseases such as cardiovascular disease, dementia, diabetes, and rheumatoid arthritis.

Leafy greens may be the secret

Leafy greens and root vegetables are rich in vitamins, minerals, and antioxidants—and a diet containing these vegetables is known to be essential for maintaining a healthy weight, strengthening the immune system, and preventing heart disease, cancer, and diabetes. The many health benefits of leafy green vegetables are partly due to the fact that spinach, lettuce and beetroot are rich in nitrates, which can be reduced to nitric oxide by nitrate-reducing bacteria in the mouth.

Popeye knows a thing or two about the health benefits of eating leafy greens. Boomerang Official, 2017.

Nitric oxide is known to lower blood pressure and improve exercise performance. However, in the mouth, it helps prevent the overgrowth of harmful bacteria and reduces oral acidity, both of which can lead to gum disease and tooth decay.

As part of a study of nitrates and oral health, we studied competitive athletes. Athletes are susceptible to gum disease due to dry mouth caused by high carbohydrate intake (which can cause inflammation of the gum tissue), stress, and difficulty breathing during training.

Our research shows that beetroot juice (containing approximately 12 millimoles of nitrate) protects their teeth from the effects of acidic sports drinks and carbohydrate gels during exercise, suggesting that nitrates could be used by athletes as a prebiotic , to reduce the risk of tooth decay.

Nitrates hold great promise as oral health prebiotics. Good oral hygiene and a nitrate-rich diet may be the key to good health, a bright smile, and disease-free gums. This is good news for those most at risk of deteriorating oral health, such as pregnant women and the elderly.

In the UK, antibacterial mouthwashes containing chlorhexidine are commonly used to treat plaque and gum disease. Unfortunately, these mouthwashes are a bad idea for oral health because they indiscriminately remove good and bad bacteria and increase acidity in the mouth, which can lead to disease.

Worryingly, early research also suggests chlorhexidine may contribute to antimicrobial resistance. Resistance develops when bacteria and fungi survive the effects of one or more antibacterial drugs due to repeated exposure to these treatments. Antibiotic resistance is a global health problem that is expected to cause 10 million deaths annually by 2050.

Two clear bottles with white screw caps and illegible labels. One of the bottles is half filled with a red liquid and the other is filled with a light blue liquid. Between the bottles is a blue toothbrush and a clear mouthwash cup filled with red liquid.
Mouthwash may not be the best choice for maintaining oral health.
BSIP/UIG via Getty Images

In comparison, dietary nitrates are more targeted. Nitrates eliminate disease-associated bacteria, reduce oral acidity and create a balanced oral microbiome. The oral microbiome refers to all the microorganisms in the mouth. Nitrates have exciting potential as oral health prebiotics that can be used to prevent disease onset or limit disease progression.

How many leafy green vegetables do you need for pearly whites?

So how much should we consume every day? As a rule of thumb, eating spinach, kale or beetroot in large amounts with meals contains about 6-10 mmol of nitrates, which can provide immediate health benefits.

Work we have done with collaborators shows that treating plaque samples from patients with periodontal disease with 6.5 mmol of nitrate increases levels of healthy bacteria and reduces acidity.

For example, consuming lettuce juice for two weeks can reduce gum inflammation and increase levels of healthy bacteria in people with gum disease.

There is growing evidence that nitrates are a cornerstone of oral health. Chewing some vegetables during meals can help prevent or treat oral diseases and keep your mouth fresh and healthy.

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