Oral Health Optimization: Evidence-Based Practices for a Healthier Mouth (and Why It Matters for Your Body)
- Samuel Falkson MD
- 3 days ago
- 11 min read
Updated: 2 days ago
Why Oral Health Matters: A Perspective from the Operating Room
During my training in anesthesiology, I spent a lot of time examining patients’ airways. That meant looking closely inside thousands of mouths.
Over time, a pattern became hard to ignore.
In general, patients with healthy teeth and gums often appeared healthier overall. Those with clear signs of poor oral care, inflamed gums, plaque buildup, or missing teeth more often carried a higher burden of chronic disease.
The mouth is one of the few internal areas of the body we can easily and directly examine. As living tissue that is continuously exposed to the external environment, it offers a unique window into overall health.
Although physicians receive relatively limited formal education on oral health during medical training, we do learn how to critically evaluate scientific literature. Given my observations in anesthesiology regarding the relationship between oral health and systemic health, this became a topic of particular interest to me. Because oral health falls heavily within the domain of dentistry, I also asked my sister-in-law and dentist, Dr. Tia Falkson, DMD, to review and edit this article to help ensure the accuracy of the information presented.
For anyone focused on improving health and performance, oral health is not optional. It is a visible, modifiable part of your physiology that deserves attention.
If you’re interested in an introduction to the scientific literature and practical strategies that may support a healthier mouth, keep reading to learn how to build and maintain better health in your mouth!
The Science Linking Oral Health to Systemic Disease
The link between oral health and overall health is well supported in the literature.
At the center of this connection is the oral microbiome. When oral health declines, the balance of bacteria shifts toward a more pathogenic state. This is not confined to the mouth. Oral bacteria and inflammatory signals can enter the bloodstream and contribute to systemic inflammation (1).
Periodontal disease is a key example. Chronic gum inflammation is associated with elevated inflammatory markers like CRP and cytokines, which are also involved in many chronic diseases (1).
As a result, poor oral health has been linked to conditions such as cardiovascular disease, diabetes, and respiratory illness. In some cases, these relationships are bidirectional, with each condition worsening the other (1).
The key takeaway is simple.
Oral health is not isolated. It both reflects and influences the state of the body as a whole.
The Oral Health Fundamentals That Matter Most
Before discussing some of the more nuanced strategies to optimize oral health, it is important to start with the fundamentals, because this is where the majority of benefit comes from.
The highest-yield habits are simple: brush thoroughly yet gently twice per day using a soft-bristled toothbrush and floss at least once daily to clean between the teeth where brushing cannot reach. Mechanical plaque removal remains the foundation of oral health, and studies consistently show that regular brushing reduces plaque buildup and gingival inflammation, particularly when performed thoroughly and consistently (2). Because toothbrushes do not effectively clean between teeth, interdental cleaning with floss can provide additional benefit as well (2).
In addition to the teeth themselves, it may also be beneficial to gently clean the tongue and other soft tissues of the mouth, including the inside of the cheeks and roof of the mouth, since these surfaces can also harbor bacteria involved in bad breath and plaque formation. The emphasis should be on light, gentle attention rather than aggressive scrubbing, as the oral mucosa is delicate and can become irritated with excessive brushing. It is also important to replace your toothbrush regularly, generally every three to four months or sooner if the bristles become visibly worn.
More than anything, oral health is driven by consistency. You do not need a complicated routine to make meaningful progress. In most cases, these foundational habits provide the greatest return and create the base upon which everything else builds.
Fluoride vs. Hydroxyapatite Toothpaste: Safety, Effectiveness, and What to Choose
Fluoride has long been the standard in oral care, with decades of evidence supporting its role in strengthening enamel and reducing cavity risk. It remains one of the most studied and widely recommended ingredients in dentistry.
That said, discussions around fluoride safety do exist, particularly regarding higher levels of exposure and exposure during childhood development. For example, a meta-analysis by Choi et al. found an association between high fluoride exposure and lower IQ scores, though importantly, the studies analyzed largely involved fluoride exposures substantially higher than those typically encountered in the United States (3). As with many areas of health, dose and context matter.
In light of this, alternative approaches have gained attention. One of the most promising is hydroxyapatite, which is actually the primary mineral component of human enamel. Rather than primarily strengthening existing enamel through fluoride-mediated remineralization, hydroxyapatite works in a more biomimetic way by directly supplying calcium and phosphate that may help rebuild and repair the tooth surface (4).
From an effectiveness standpoint, emerging evidence suggests that hydroxyapatite may perform similarly to fluoride for enamel remineralization and cavity prevention. In a randomized clinical study, hydroxyapatite toothpaste was found to be non-inferior to fluoride in preventing demineralization and supporting remineralization of early caries (5).
At this point, both fluoride and hydroxyapatite appear to be reasonable options. Fluoride has a much longer track record and stronger long-term evidence base, while hydroxyapatite is newer but biologically appealing and increasingly supported by emerging research. Personally, I use hydroxyapatite toothpaste because it appears to provide similar benefits while avoiding some of the questions surrounding higher fluoride exposure. However, I think either approach can fit within a thoughtful, evidence-based oral health routine.
Tongue Scraping Benefits: A Simple Addition to Improve Oral Health
So far, we have focused on the fundamentals like brushing, flossing, and toothpaste. These are essential, but are there additional practices that can further improve oral health?
One often overlooked practice is tongue scraping. The tongue carries a significant bacterial load and contributes to both bad breath and overall oral microbial balance. A systematic review showed that mechanical tongue cleaning, including scraping or brushing, reduces markers of oral malodor (bad breath) and tongue coating when added to routine brushing (6).
Beyond supporting better-smelling breath, there is evidence that tongue cleaning may also improve broader oral health. A clinical trial by Winnier et al showed that adding tongue scraping to standard oral hygiene practices (tooth brushing) significantly reduced plaque levels compared to brushing alone (7).
Practically, this is a low-risk, quick addition to your oral hygiene routine. It can be done twice daily, right after brushing, and takes only seconds. To perform it, place the scraper gently toward the back of the tongue, apply light pressure, and pull it forward toward the tip, rinsing the scraper between passes and repeating a few times.
Tongue scrapers are inexpensive and widely available, and can be purchased on Amazon for under ten dollars. They are typically simple, U-shaped metal or plastic tools designed to gently conform to the surface of the tongue for effective cleaning.
Oil Pulling with Coconut Oil: Benefits, Evidence, and How to Do It
Oil pulling is an additional adjunct practice that may help support oral health. Oil pulling is a traditional Ayurvedic practice that involves swishing oil in the mouth as part of an oral hygiene routine (commonly coconut or sesame oil). It is often used as an alternative to conventional over-the-counter mouthwashes, with proposed mechanisms including mechanical removal of bacteria, disruption of plaque adhesion, and antimicrobial and anti-inflammatory effects. These effects may be particularly relevant to coconut oil, which is rich in lauric acid, a compound associated with antimicrobial activity.
There is evidence suggesting benefits. In a small interventional study, coconut oil pulling was associated with significant reductions in plaque and improvements in gingival health (8). A systematic review of randomized trials also found reductions in plaque and bacterial counts, supporting a potential role in improving oral hygiene (9). While the results of this research are promising, most studies conducted so far are relatively small and short, so the overall strength of the evidence is still limited.
Oil pulling may also serve as an alternative to the routine use of conventional mouthwashes. Emerging evidence suggests that frequent use of strong antibacterial mouthwashes can disrupt the oral microbiome and reduce nitric oxide–producing bacteria, which play a role in blood pressure regulation, with some studies showing an association between frequent use and increased risk of developing high blood pressure (10). In addition, some alcohol-containing mouthwashes have been associated with side effects such as oral dryness, burning, and mucosal irritation, and there has also been discussion in the literature about potential links between alcohol-containing mouthwashes and oral cancer risk, although the evidence remains mixed and somewhat controversial (11). Studies suggest that alcohol-free mouthwashes may provide similar effectiveness for plaque and gingival control while potentially being gentler on the oral tissues (12). For individuals who still prefer to use mouthwash, an alcohol-free formulation is likely the more reasonable choice.
Oil pulling is not a replacement for brushing and flossing, but rather a practice that can be added to these staples of oral health maintenance. Given that oil pulling appears to be very low risk and may provide additional benefit, it’s a routine I personally do every day. Practically, this can be done once daily by swishing a tablespoon of coconut oil in the mouth for 10 to 15 minutes before spitting it out. It is generally recommended to discard the oil into a trash can or outside rather than into a drain, since oil does not dissolve in water and may contribute to clogging over time.
Nasal Breathing vs Mouth Breathing: Why It Matters for Oral Health
Oral health is not just shaped by the routines you perform a few times a day. The habits you carry throughout the day and night also matter, and breathing is a great example.
Breathing through the nose plays an important role in maintaining a healthy oral environment. In contrast, mouth breathing can dry out the oral cavity, reducing the protective effects of saliva and allowing for increased bacterial growth, plaque buildup, and a higher risk of cavities and gum disease (13).
Mouth breathing has also been linked to changes in dental and facial development over time, especially when it becomes a chronic habit (13). For these reasons, it is worth being intentional about breathing through the nose as much as possible.
Given the benefits of nasal breathing, some people use mouth taping during sleep to encourage this practice. Direct evidence for this specific routine is limited, but the rationale is based on the known downsides of mouth breathing. If someone can comfortably breathe through their nose and finds it helpful, it may be a reasonable personal strategy.
Xylitol Gum for Oral Health: A Simple Adjunct with Possible Benefit
As we think about additional ways to optimize oral health, one low-effort strategy worth considering is chewing xylitol gum.
Xylitol is a sugar alcohol that oral bacteria, particularly those involved in cavity formation like Streptococcus mutans, cannot effectively use as a fuel source. This can reduce bacterial growth and acid production. At the same time, chewing gum increases saliva flow, which supports the natural remineralization of enamel.
A recent systematic review found that xylitol gum use is associated with reductions in cavity-associated bacteria and, in many studies, decreases in plaque accumulation compared to other sweeteners (14). There is also evidence suggesting a potential reduction in cavity risk over time, though results are somewhat variable across studies.
Practically, this is an easy addition. Using xylitol gum after meals can help support the oral environment throughout the day. It is not a replacement for brushing and flossing, but given its low risk and potential upside, it is a simple tool that may be worth incorporating into a comprehensive oral health optimization strategy.
Practical Oral Health Framework: The Highest-Value Habits for a Healthier Mouth
At this point, we have covered a range of strategies to support oral health, from foundational habits to more nuanced optimization practices. To simplify things, I think about oral health in tiers:
Tier 1: The Fundamentals
This is where the majority of benefit comes from.
Brush thoroughly yet gently twice daily with a soft-bristled toothbrush
Floss at least once daily
Gently clean the tongue and other soft tissues of the mouth
Replace your toothbrush every 3 to 4 months
Stay consistent
These practices form the foundation of long-term oral health.
Tier 2: High-Value Additions
Once the fundamentals are in place, these practices may provide meaningful additional benefit.
Use a well-formulated toothpaste. I personally use hydroxyapatite because it appears to provide enamel remineralization benefits comparable to fluoride while avoiding some of the concerns surrounding higher fluoride exposure discussed earlier. That said, fluoride remains a reasonable evidence-based option.
Incorporate tongue scraping
Prioritize nasal breathing over mouth breathing
Be cautious with routine use of strong antibacterial mouthwashes, as they may disrupt the oral microbiome and reduce nitric oxide–producing bacteria involved in blood pressure regulation
Tier 3: Adjunct Optimization Strategies
These approaches may provide additional benefit. The evidence for these practices is generally less robust, but they are generally low risk, physiologically reasonable, and do have some data to support their implementation.
Oil pulling (for example, with coconut oil)
Xylitol gum
Mouth taping during sleep (if nasal breathing is comfortable)
The key is not perfection. Oral health, like most aspects of health, is driven by consistency over time. Even a few simple habits performed regularly can meaningfully shift the trajectory of long-term health.
Oral Health Optimization: The Bigger Picture
Oral health is about far more than having clean teeth or fresh breath. The mouth is a dynamic part of the body that reflects and influences broader physiology, from inflammation and the microbiome to cardiovascular and metabolic health.
At the same time, optimizing oral health does not need to be overly complicated. The majority of benefit comes from consistently executing the fundamentals: brushing, flossing, and maintaining a healthy oral environment over time. From there, additional strategies like tongue scraping, hydroxyapatite toothpaste, nasal breathing, xylitol gum, and oil pulling may provide additional benefit.
The broader lesson is one that applies to many aspects of health. Small, intentional practices performed consistently tend to matter more than extreme interventions performed occasionally. Awareness, consistency, and thoughtful iteration are what ultimately drive long-term results.
For more evidence-based insights on health optimization, performance, and longevity, follow BlissElla (@BlissAndElla, Instagram) and explore the BlissElla blog for future articles and educational content.
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Disclaimer: The information on this site is for educational purposes only and is not medical advice. It does not create a physician–patient relationship with BlissElla and/or the medical providers working for this practice. Always consult your personal healthcare provider before making medical decisions. If you are experiencing an emergency, call 911.
References:
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