The standard “brush, floss, mouthwash, dental cleaning” advice is mostly right, but one specific habit silently sabotages cardiovascular and athletic performance: antibacterial mouthwash.
This page covers why mouthwash kills the wrong bacteria, the beetroot-juice nitric-oxide pipeline that depends on those bacteria, and what to use instead — including specific water-flosser brand picks.
The beetroot-juice nitric-oxide pipeline
Endurance athletes who drink beetroot juice do so for performance. The mechanism:
- Intake: beetroot is dense in dietary nitrates (NO₃⁻).
- Saliva loop: the body absorbs nitrates, then secretes them back into the saliva through the salivary glands.
- Crucial conversion step: specific bacteria on the back of the tongue convert nitrates (NO₃⁻) into nitrites (NO₂⁻). Human cells cannot perform this conversion. The body outsources it entirely to the oral microbiome.
- The payoff: the nitrite-rich saliva is swallowed; gastric acid and downstream enzymes convert it to nitric oxide (NO), which:
- Relaxes blood vessels (lower blood pressure)
- Improves oxygen delivery during exercise
- Improves running and cycling economy by 1–3% in trained athletes
- Reduces cardiovascular event risk over the long term
The bacteria responsible are normal oral commensals — Veillonella, Actinomyces, Rothia, and others — living on the rough surface of the tongue’s posterior third.
The mouthwash paradox
Standard commercial mouthwashes (Listerine, Corsodyl, anything with chlorhexidine or strong alcohol or cetylpyridinium chloride) are designed to nuke bacteria. They are not selective — they kill the cardiovascular-protective bacteria along with the harmful ones.
The measurable result, from multiple human trials:
- Within 1 day of antibacterial mouthwash use, oral nitrate-converting capacity drops sharply
- Within 1 week, systolic blood pressure rises by 2–3 mmHg on average
- For a beetroot-juice drinker, the performance benefit goes to zero — the body excretes the unconverted nitrates in urine
The irony: a person buying premium beetroot juice for performance and then using Listerine is undoing the supplement immediately.
What to do instead
Drop the antibacterial mouthwash
If a mouthwash is needed at all (fresh-breath habit, recovery from gingivitis), the right kind is:
- Alcohol-free
- Fluoride-only for cavity prevention (e.g., ACT Fluoride rinse) — does not heavily disrupt the microbiome
- Xylitol-based (Spry, Epic) — actually selectively helps against caries-causing bacteria without nuking the good ones
- Saltwater rinse — old-school, no microbiome disruption
Specifically avoid:
- Listerine (any colour) — high alcohol, kills the good bacteria
- Corsodyl, Peridex — chlorhexidine, the most aggressive option
- Crest Pro-Health, Scope — contain cetylpyridinium chloride
Brush properly twice daily
- Soft-bristled brush (electric brushes are better — Sonicare or Oral-B at the mid-tier are fine)
- 2 minutes per session
- Cover all tooth surfaces, gum line, and the back of the tongue lightly (don’t scrub — gentle pressure preserves the good bacteria)
Floss daily
String floss reaches between teeth where the brush cannot. Bleeding gums when you start flossing means you have early gingivitis — keep flossing daily and the bleeding stops within 1–2 weeks. Bleeding is not “you flossed too hard.”
Water flosser as the replacement for mouthwash
A water flosser (Waterpik or equivalent) is the right tool to replace mouthwash for the “deep clean” feeling.
How it works: a small motor sends a pulsating, pressurised jet of water through a narrow nozzle. The jet physically dislodges food, soft plaque, and bacteria from places brushing and floss can’t reach (especially below the gum line).
Key advantage over mouthwash: mechanical, not chemical. It physically flushes the bad stuff without indiscriminately nuking the microbiome.
Dental cleanings every 6 months
Even with perfect daily hygiene, saliva mineralises any missed plaque into tartar (calculus) — like barnacles on a ship. Once formed, tartar can’t be brushed off; only a dental hygienist can scrape it off.
Tartar at the gum line drives chronic low-grade inflammation, which is causally linked to:
- Cardiovascular disease (bacteria from gum pockets enter the bloodstream and lodge in arterial plaques)
- Alzheimer’s (specific gum-disease bacteria found in brain tissue of late-stage patients)
- Diabetes worsening (systemic inflammation impairs insulin sensitivity)
Skipping dental cleanings is silently expensive. Every 6 months at minimum; every 3–4 months if any gum disease history.
Water flosser selection — the Waterpik lineup
Most water flossers are made by Waterpik (the dominant brand) or its competitors (Panasonic, Philips Sonicare). Cordless vs countertop is the main fork.
Countertop models — better for daily home use
Waterpik WP-670K / Aquarius (Ultra Professional) — the winner
- Plugs into wall outlet; consistent maximum pressure (no battery-driven dip)
- 10 pressure settings — start at 2–3 with sensitive gums and build to 7–8 over weeks
- Water reservoir holds ~90 seconds of continuous use (one fill cleans the whole mouth)
- Has a dedicated massage mode that pulsates to stimulate gum tissue (further reduces inflammation)
- Recommended pick if budget allows
Waterpik WP-70K / Classic — older model
- Same idea as the 670K but bulkier
- Pressure slider on the handle (less ergonomic) instead of on the base
- No massage mode
- Only worth choosing if the price gap from 670K is significant (it usually isn’t)
Cordless models — only if you travel
Waterpik WP-450K / Cordless Plus
- Battery-operated; water tank is built into the handle
- Tank holds ~45 seconds of water — you’ll run out mid-mouth and have to refill
- Heavier and clunkier to hold (motor + battery + water all in hand)
- Only worth it if you travel constantly or your bathroom has no power outlet near the sink
How to use it
- Fill the tank with warm water (not cold — cold shocks sensitive teeth)
- Lean over the sink
- Aim the nozzle at the gum line, keep lips slightly closed to prevent splashing
- Let water dribble out of your mouth into the sink
- Work systematically — outside surfaces, inside surfaces, between every tooth
- Total time: 60–90 seconds for full mouth
It feels strange the first two times. By day three it’s the most refreshing part of the routine.
Specific items to keep
A working oral routine for this phenotype:
- Sonicare or Oral-B electric toothbrush (mid-tier)
- Fluoride toothpaste (any reputable brand)
- String floss daily
- Waterpik WP-670K at home
- 6-monthly dental cleaning appointments
- Optional: alcohol-free xylitol rinse if a rinse is preferred
- Beetroot juice or equivalent dietary nitrate source (spinach, arugula, celery)
Pair beetroot juice with a workout for the performance benefit. Pair the longevity dietary-nitrate intake with everyday meals (leafy greens with lunch and dinner).