The effects of nitrate on the oral microbiome: a systematic review investigating prebiotic potential
Open accessAbstract
Background: ) has been suggested as a prebiotic for oral health. Evidence indicates dietary nitrate and nitrate supplements can increase the proportion of bacterial genera associated with positive oral health whilst reducing bacteria implicated in oral disease(s). In contrast, chlorhexidine-containing mouthwashes, which are commonly used to treat oral infections, promote dysbiosis of the natural microflora and may induce antimicrobial resistance. Methods: A systematic review of the literature was undertaken, surrounding the effects of nitrate on the oral microbiota. Results: = 5). Conclusions: More clinical trials are required to confirm the impact of nitrate on oral communities. However, these findings support the hypothesis that nitrate could be used as an oral health prebiotic. Future studies should investigate whether chlorhexidine-containing mouthwashes could be replaced or complemented by a nitrate-rich diet or nitrate supplementation.
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Antibiotics can disrupt the oral and gut microbiota responsible for reducing nitrate to nitrite, thereby impairing endogenous NO generation.
“antibiotics can disrupt the oral and gut microbiota responsible for reducing nitrate to nitrite, thereby impairing endogenous NO generation [106,252,271].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [106]
The Introduction says oral bacteria reduce nitrate along the nitrate–nitrite–NO pathway and that prolonged chlorhexidine mouthwash use can displace oral nitrate-reducing species. It does not say that antibiotics disrupt those bacteria, address disruption of gut nitrate-reducing microbiota, or directly establish impaired NO generation after antibiotic use. (LLM, conf=0.84)
Experimental — accuracy not yet measuredReduced NOS activity and bioavailability, as well as alterations to the oral microbiome, can impair nitrate metabolism; oxidative stress accelerates NO degradation.
“Reduced NOS activity and bioavailability, as well as alterations to the oral microbiome, can impair nitrate metabolism. Meanwhile, oxidative stress accelerates NO degradation [101,105,106,107].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [106]
The citation is attached to the sentence about oxidative stress accelerating NO degradation. The Introduction describes NOS-mediated NO production and oral-bacterial nitrate reduction, but the passages found for oxidative stress, reactive oxygen species, and NO degradation do not address that mechanism. (LLM, conf=0.72)
Experimental — accuracy not yet measuredThe timing of optimal intake may affect the efficiency of oral bacterial nitrate reduction.
“the timing of optimal intake may affect the efficiency of oral bacterial nitrate reduction [106,252,271,292].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [106]
The Introduction (page unavailable) explains that oral bacteria reduce dietary nitrate, but does not address whether the timing of intake affects how efficiently they do so. Searches for intake timing, time of day, and nitrate-reducing capacity found no passage in our copy that evaluates that relationship. (LLM, conf=0.74)
Experimental — accuracy not yet measuredHighly processed beetroot products may exhibit reduced nitrate stability and diminished physiological impact.
“highly processed beetroot products may exhibit reduced nitrate stability and diminished physiological impact [106,252,271,292].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [106]
The Introduction identifies beetroot as a dietary nitrate source, and the Discussion ('NO3− and secondary findings'; page unavailable) reports blood-pressure benefits from beetroot juice. Neither passage addresses whether heavy processing reduces nitrate stability or physiological effects; searches for processed beetroot and for processing, storage, and nitrate stability found no passage that does. (LLM, conf=0.75)
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- Authors
- Moran, S. P., Rosier, B. T., Henriquez, F. L., & Burleigh, M. C.
- Affiliations
- University of the West of Scotland (GB)
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (ES)
- Corresponding author
- Burleigh, Mia C.
- Venue
- Journal of Oral Microbiology
- Publisher
- Informa UK Limited
- Published
- 2024-02-27
- Volume
- 16
- Issue
- 1
- Pages
- 2322228-2322228
- ISSN
- 2000-2297 (ISSN-L)
- PMC
- PMC10901185
- OpenAlex
- W4392200614
- Cited by
- 37
- References
- 59
- Citations by year
- 2026: 21 · 2025: 13 · 2024: 3
- FWCI
- 3.00
- Type
- journal article
- Language
- en
- Update notices
- correction (2024-05-15)
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Oral Microbiology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- The UWS Academic Portal (University of the West of Scotland) (submittedVersion, cc-by-nc)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- received no external funding
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Keywords
- dietary nitrate, nitrate supplementation, oral microbiota, prebiotics, oral health, chlorhexidine mouthwash, dysbiosis, antimicrobial resistance, oral diseases, oral bacteria
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