12/23/2009 - Articles

Tooth Brushing, Flossing, AND a Mouthwash Can Help Prevent Stroke

By: Robert W. Griffith, MD


A study has shown that adding the right mouthrinse to your regular toothbrush- and flossing-routine can lower your risk of having a stroke.

Tooth Brushing, Flossing, AND a Mouthwash Can Help Prevent Stroke

Summarized by Robert W. Griffith, MD
July 29, 2004

The association between periodontitis and stroke

It's been generally accepted for some time that gingivitis and periodontitis (infection of the gums around the teeth) are a strong risk factor for cardiovascular diseases. A recent study reported in the journal Stroke throws new light on the association between this evidence of chronic inflammation in the body and the risk of ischemic stroke (the type due to blockage in a brain artery).1

In this study, 303 patients who had been hospitalized with stroke had a complete clinical and radiological dental exam 7 days later. The 'pockets' at the base of suspicious teeth were probed, and a depth of over 6 mm was considered to be evidence of severe periodontitis.

The findings from the stroke patients were compared with the results of similar dental exams in 300 people from the general population and 168 hospital patients who had non-vascular and non-inflammatory neurological diseases. It was found that the worse the periodontitis, the greater the risk of stroke. Severe periodontitis increased the likelihood of a stroke 4.3 times. The risk was clear-cut in men, particularly those below 60 years of age, but not in women. Importantly, missing teeth, the amount of plaque, and caries were not related to the risk of stroke.

What can be done?

Tooth brushing and flossing have been advocated by the American Dental Association for many years - almost a century, in fact. In spite of these 'mechanical' approaches, however, caries, plaque, and periodontitis are far too common in the community. Gingivitis, for instance, was found to be present in 63% of the adult US population in 1991.

An article in the Journal of the American Dental Association describes a study to see if adding a mouthrinse containing an essential oil would decrease the frequency of gingivitis and periodontitis. Patients with gingivitis were randomly assigned to one of three treatment groups:

  • Brushing and rinsing with a control (i.e. an 'inactive') mouthrinse - BC
  • Brushing, flossing, and rinsing with a control mouthrinse - BFC
  • Brushing, flossing, and rinsing with an essential oil-containing mouthrinse - BFEO


At baseline examination all participants had a full dental exam; the presence of gingivitis, gingival bleeding, and the amount of plaque were assessed using recognized scoring systems. After a complete dental hygiene cleansing, they were instructed to brush twice daily, floss daily, and rinse twice daily with their allocated mouthrinse.

The control mouthrinse contained 5% hydroalcohol. The essential oil-containing (EO) mouthrinse was, in fact, Listerine®. In previous studies, twice-daily use of Listerine had been shown to be as effective as daily flossing in reducing gingival inflammation.

The participants returned each month to check that they were complying with their allocated regime. Full dental exams were carried out after 3 and 6 months.

Out of the 246 people who started the study, 237 returned for the 6-month evaluation. This shows that the regimes were not too difficult to follow. Those in the BFEO group (i.e. those brushing and flossing AND rinsing with Listerine) had a significant additional benefit in reducing plaque and gingivitis (and hence the likelihood of periodontitis), as shown in the table below.

Percent Reduction in Scores, Compared with Brushing and Placebo Rinse
  Gingivitis Index Plaque Index
Brush, floss, and placebo rinse -11.2% -9.3%
Brush, floss and Listerine® rinse -21.0% -51.9%

What this means

Periodontitis (which develops from excess plaque and gingivitis) is linked to a 4-fold increased risk of having a stroke. You can guard against this by visiting your dentist, having a good clean, and following her/his advice. Brush twice a day, floss once a day, and rinse with Listerine (or another ADA-approved mouthrinse) twice a day. It's worth the effort!


  • Adjunctive benefit of an essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly. N. Sharma, CH. Charles, MC. Lynch,  et al., JADA, 2004, vol. 135, pp. 496--504


1. Periodontal disease as a risk factor for ischemic stroke. AJ. Grau, H. Becher, CM. Ziegler,  et al., Stroke, 2004, pp. 496--501

Related Links
Tip of the Month #2: Looking After Your Teeth and Gums
Brush Up on Oral Health
A New Prescription for Healthy Teeth: Brush, Floss, and Get Enough Calcium

Created on: 07/26/2004
Reviewed on: 12/23/2009

No votes yet