It’s a morning routine familiar for many of us: Get that mouth clean immediately after breakfast by using a harsh toothpaste applied by an abrasive toothbrush, followed by a rinse with a mouthwash so strong it makes you wince.
Dr. Kami Hoss winces, too, when he hears patients describe these habits.
They’re some of the reasons why so many people have poor oral health, which in turn affects all other aspects of their health, from physical to mental, the dentist writes in his book, “If Your Mouth Could Talk: An In-Depth Guide to Oral Health and Its Impact on Your Entire Life.”
“Statistically, our mouths are incredibly unhealthy right now as a society. With all these advancements in science and technology and medicine, you would think at this point dentists wouldn’t have anything to do,” Hoss, who is the co-founder of The Super Dentists in San Diego, California, tells TODAY.com.
“But oral health hasn’t gotten any better in the last 30 years… the majority of our population has oral diseases, so that means that what we’re currently doing is not working.”
Dental caries, also known as tooth decay, is the most common noncommunicable disease on the planet, according to the World Health Organization.
In the U.S., about half of adults have some form of gum disease, with that number rising to 70% for Americans who are over 65, the Centers for Disease Control and Prevention noted.
Poor oral health, suboptimal dental visits or infrequent flossing were associated with increased all-cause mortality, a 2024 study published in The Journal of the American Dental Association found.
The biggest problem is that people either neglect their mouth or go to the other extreme by disinfecting and sterilizing it to such a degree that they disrupt the balance of the oral microbiome, Hoss says.
Just like our gut, the mouth contains good and bad bacteria — billions of microbes in all. Disrupt this delicate balance — by using a product that kills all the bacteria in your mouth, for example — and problems can arise, he notes.
What is good oral health?
Hoss defines it as having a balanced oral microbiome as well as the right growth and development of the mouth, which leads to correct airways, a correct bite and a balanced-looking face. A healthy mouth can increase life expectancy by up to 10 years, he notes in his book.
But if something goes wrong, resulting in an unhealthy mouth, it can impact everything about a person’s well-being, including mental health. It’s “mind-boggling” how many diseases are linked to periodontal disease, including diabetes, cardiovascular and Alzheimer’s disease, Hoss writes.
Mouth health connects to overall body health, yet dentists are still mostly trained to just fill cavities or straighten teeth, rather than prevent bigger problems, he notes.
What are the biggest oral health mistakes people make?
They include using harsh oral care products that contain alcohol and other ingredients that can change the oral microbiome, which took millions of years to evolve, Hoss says.
He is especially horrified by antiseptic mouthwash, which kills 99% of everything, as advertised, and leaves behind “the baddest, toughest, roughest little microbes around — poised to recolonize that entire mouth, totally unchecked by the organisms that used to hold them at bay,” he writes in his book.
Hoss urges consumers to think of the mouth as a garden, with the many helpful oral microbes inside it as flowers and plants, and the bad bugs as weeds.
“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,” he says. “What we do in the mouth is a disaster right now.”
Some of the beneficial microbes that perish after harsh mouthwash use are designed to help the body form nitric oxide, a chemical linked to blood flow that also plays an important role in regulating endothelial function, blood pressure and insulin sensitivity, researchers previously told TODAY.
The healthy oral care routine
Hoss recommended the following steps:
- Start your morning oral care routine before breakfast, not after, because whenever you eat, the mouth becomes acidic and you can damage your enamel if you brush right away — “the biggest mistake I see is people brush their teeth after breakfast or after meals,” he notes. This is when the enamel is most vulnerable to damage so you need to wait at least 30 to 60 minutes after meals and drinks before brushing, he says.
- After waking up, use an alkaline mouthwash to restore the pH of the mouth, and loosen any plaque and particles that built up overnight. Rinsing this way reaches areas of the mouth that the toothbrush can’t.
- Floss to remove plaque between your teeth. Any floss is better than no floss, but regular string floss is the best because you use a clean surface every time, Hoss said. Flossers with a handle would be his second choice, followed by water flossers.
- Clean your tongue with a scraper or brush “because that’s another area that people ignore and it’s a big source of a bacteria that cause bad breath,” Hoss said.
- Brush with a safe and effective toothpaste using a toothbrush with soft bristles.
- Repeat this routine before bedtime, but reverse the order, so that the last oral care product you use before bed is the alkaline mouthwash, Hoss recommended.
- In the 16 hours between morning and evening, he was a fan of using mouth spray with xylitol or chewing xylitol gum to balance the acidity of the mouth throughout the day.
“It’s not really complicated: Brush and floss routinely using the right oral care products. Visit your dentist regularly,” Hoss said. “Your oral health impacts every part of your life.”
