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This might surprise you but a heart surgeon says he avoids mouthwash because it can negatively affect blood pressure.

A world-renowned heart doctor has revealed he avoids mouthwash because of the impact it has on blood pressure. Dr Jeremy London is a board-certified cardiovascular surgeon and regularly gives health advice on social media and in interviews.

His previous hard-hitting pieces of health advice include labelling one drink popular all over the world as "liquid death" (hint: it's not alcohol ) and his five habits that speed up ageing. And he issued one particularly surprising piece of advice on his social media channels.

Dr London often names things he avoids for his own health. Predictably, he put smoking and vaping, alcohol, soft drinks and ultra-processed foods on the list. But more surprising was his inclusion on the list of alcohol-based mouthwash. In a video titled "stop using mouthwash", he said: "This is one thing I absolutely avoid as a cardiac surgeon. Two reasons. Number one: just like the remainder of your gastrointestinal tract your mouth has healthy bacteria and by killing that bacteria you injure the environment in your mouth.

"Number two, and this I find really interesting, there's a chemical reaction with that healthy bacteria which helps control your blood pressure and by destroying that healthy bacteria in your mouth you can actually cause high blood pressure. High blood pressure is a risk factor for both strokes and heart attacks."

In an interview with the NBC network's Today programme, Dr London elaborated further, explaining that good bacteria in the mouth help the body produce nitric oxide, which is involved in dilating blood vessels and keeping blood pressure in check. But because antibacterial mouthwash also kills the beneficial bacteria, it interrupts that process.

Dr London said: "You can actually increase your blood pressure simply by killing the bacteria in the mouth. And if you have a propensity to having high blood pressure, that can even be worse."

A study published in the Blood Pressure journal showed a link between mouthwash use and high blood pressure. After a study involving more than 1,000 people, researchers said: "In this study, frequent regular use of over-the-counter mouthwash was associated with increased risk of hypertension, independent of major risk factors for hypertension and several other potential confounders."

In another study published in Science Direct, researchers wrote that there is "unequivocal evidence" that the disruption of bacteria in the mouth from the use of mouthwash "will suppress nitric oxide production... and negatively impact blood pressure".

Dr London is not the only expert warning of the impact. Dentist Kami Hoss says oral health in the general population is relatively poor, with people either neglecting their mouth or going to the other extreme by sterilising it to such a degree that they disrupt the balance of the oral microbiome. Dr Hoss says our tactic of using strong mouthwash to kill most bacteria leaves only "the baddest, toughest, roughest little microbes around" and compares our use of mouthwash to gardening: "If there was a weed growing in your garden, you wouldn’t just throw acid and weed killer all over and kill everything, the way we do it in our mouth. [But] we take antiseptic mouthwash that kills everything. What we do in the mouth is a disaster right now."

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