The Mouth Is Not Separate From the Body

Something hurts? Fix the tooth.
Gums bleed? Buy better toothpaste.
Bad breath? Find a stronger mouthwash.
Missing tooth? Replace it.

We have somehow managed to turn dentistry into a form of plumbing.

Then you are sent home to carry on pretending that the mouth has nothing to do with the rest of you.

Which is odd, because the mouth is the front door to your body.

It is where food enters, where digestion begins, where millions of microorganisms live and where inflammation can quietly persist for years.

Perhaps we should stop treating it as a separate room.

Take bleeding gums. We have become remarkably relaxed about them. A little pink foam in the basin is often regarded as an unfortunate consequence of brushing too hard.

It may be the beginning of something more serious, and isn’t something to ignore.

Persistent bleeding can be a sign of gum inflammation, and advanced periodontal disease is a genuine inflammatory disease rather than simply a cosmetic inconvenience. The tissues around the teeth can become chronically inflamed, and bacteria and inflammatory products can enter the blood circulation.

That doesn’t mean your bleeding gums are about to give you a heart attack. Anyone making that leap is selling you a frighteningly simple story.

But the relationship between oral health and cardiovascular disease is sufficiently interesting that scientists have spent years investigating it.

The same applies to diabetes.

There is a two-way relationship between diabetes and periodontal disease. High blood glucose can increase the risk of gum disease, while significant periodontal inflammation can make glucose control more difficult.

In other words, the mouth isn’t merely reporting what is happening elsewhere.

Sometimes it may be participating.

And then there is the gut microbiome – the fashionable celebrity of modern health.

Everyone now talks about their gut bacteria. Almost nobody talks about the fact that the journey begins in the mouth.

The oral cavity contains hundreds of microbial species. You swallow them all day long. That’s normal. Your mouth isn’t supposed to resemble a surgical theatre.

The objective isn’t to kill everything.

Which brings us to mouthwash.

Some modern mouthwashes are essentially chemical warfare in a bottle: antiseptic ingredients designed to reduce or kill bacteria, often accompanied by alcohol, flavourings and other compounds designed to leave your mouth feeling aggressively clean.

But clean isn’t necessarily the same as healthy.

The mouth contains a complex microbial ecosystem, and indiscriminately reducing bacteria may also alter organisms that are not causing you any harm. Research has even explored whether frequent use of certain antiseptic mouthwashes can affect oral bacteria involved in nitrate metabolism, which is connected with nitric-oxide production and blood-pressure regulation.

That doesn’t mean mouthwash is dangerous, or that everyone should throw their bottle in the bin. Certain mouthwashes have legitimate clinical uses, particularly when recommended by a dental professional.

The Chinese used mouthwash as long ago as 2700 BC. Ayurvedic medicine prescribes mouthwash as a treatment for gum disease. The Romans rinsed their mouths as well as brushing their teeth, using vinegar and Alum (a sulphur-rich salt).  

Across the Ionian Sea, the Greeks preferred olive tree leaves, oil, milk, and wine, as well as peelings from pomegranates, gallnuts, and vinegar. 

North American Indians used mouth rinses derived from plants such as Coptis Trifolia (Threeleaf goldthread or Savoyane). 18th century Europe found a use for a urine-based mouthwash because of the ammonia content.   

If your mouth is in a healthy state, by far the best mouthwash to use is your own saliva. Swallowing it boosts your immune system! 

For those of you who are in the habit of using mouthwash every morning or before a date night, the idea that the mouth needs to be chemically sterilised deserves a little scrutiny. It’s worth bearing in mind that some chemical mouthwashes have been linked to cancer.

You wouldn’t routinely sterilise your garden because it contained bacteria. Why assume your mouth should be different?

A healthy mouth isn’t a sterile mouth.

It’s an ecosystem.

And ecosystems can be disrupted.

The internet has turned medicine into a Wild West with Wi-Fi. AI chatbots invent treatment plans with the serene confidence of a consultant. TikTok gurus diagnose dental problems between dance routines. Influencers recommend supplements they couldn’t identify if you tipped the contents of the bottle onto a chemistry bench. Everyone is suddenly an expert. Nobody appears to have attended medical school.

And the really worrying thing is that people are listening.

But here’s the important bit: interesting isn’t the same as proven.

Some associations are strong. Some mechanisms are plausible. Some findings are preliminary. And some are simply nonsense dressed up in scientific vocabulary.

We should be able to hold two thoughts simultaneously:

The mouth matters enormously.

And we don’t yet know everything about why.

Perhaps the real mistake is thinking of dentistry as something separate from medicine.

Your dentist isn’t merely looking at your teeth.

They’re looking at one of the few parts of your body that gives you a daily, visible record of inflammation, infection, wear, diet, saliva, bacteria and behaviour.

The mouth isn’t outside the body.

It’s the beginning of it.