The Mouth-Brain Connection: The Hidden Inflammation Tax on Performance

Karla, my five-year-old, lost her first tooth this week. Not the way it's supposed to happen.

Last summer, I was deep in a business call when the power went out at our vacation home. While juggling to reconnect on my phone, I heard a crash followed by screaming. Seconds later, Karla stumbled into my room, blood streaming from her mouth. I swear I’m not making this up.

She'd fallen down the stairs, cutting her chin, splitting her lip, and nearly knocking out her upper right incisor. Nothing tests your sympathetic nervous system quite like seeing your child covered in blood.

That tooth hung on for months, but it died quickly. This week, the dentist finally extracted it—a procedure so quick you'd miss it if you glanced at your phone. For Karla, though, this wasn't traumatic but triumphant: her first encounter with the tooth fairy, something she'd watched her siblings experience with envy.

As adults, we have a completely different relationship with dental health. Children celebrate losing teeth, while we spend thousands keeping ours.

But most high performers miss this: your mouth isn't just about keeping teeth or avoiding dental bills. It's a critical control point for your brain function, energy levels, and long-term health.

Most people think oral health stops at brushing twice daily and occasional flossing (usually the night before a dental appointment). They're wrong.

The Cognitive Pandemic No One's Talking About

Periodontal disease affects a staggering 1 billion people worldwide. It's silently eroding cognitive function in executives everywhere. Yet, almost no one connects these dots.

Here's the truth, backed by science: People with poor oral health have a 20-23% higher risk of cognitive decline and dementia. Not eventually. Not theoretically. Your gum health is either supporting or sabotaging your mental performance.

This isn't speculative. Specific oral bacteria, particularly P. gingivalis, can directly infiltrate your brain. Researchers have found these bacteria in the brain tissue of Alzheimer's patients. Long before dementia develops, these same pathogens and their inflammatory by-products are already impairing the brain functions you rely on daily:

• Executive decision-making
• Working memory
• Processing speed
• Mental flexibility

That afternoon brain fog, you blame on carbs or sleep? It could be your gums talking to your brain.

The research gets more alarming. Studies consistently show that clinical markers of periodontal disease—things like calculus index and attachment loss—directly correlate with lower scores on executive function tests. The worse your gum health, the worse your high-level thinking.

Take a moment to consider this: You optimize your diet, track your sleep, and invest in productivity tools to squeeze out marginal cognitive gains. Yet you might be ignoring the biological equivalent of running your laptop with multiple background processes draining your RAM (to my colleagues, does this sound familiar?).

Your Mouth: The Gateway to Inflammation

Inflammation is the common enemy of high performers. It drains energy, slows recovery, and accelerates aging. And your mouth is inflammation's front door.

The ulcerated lining of infected gum pockets creates a direct pathway for bacteria to enter your bloodstream. These pathogens and their toxins trigger a system-wide inflammatory response.

This isn't just theoretical. It's measurable. People with periodontal disease consistently show elevated levels of inflammatory markers like CRP, IL-6, and TNF-alpha—the same markers longevity-focused executives pay thousands to measure and minimize.

This systemic inflammation creates a vicious cycle:

1. Oral bacteria trigger an inflammatory response
2. Inflammation increases cortisol, which weakens immune function
3. Weakened immunity allows more bacterial proliferation
4. Bacterial toxins enter circulation, creating more inflammation

The result? Chronic fatigue that no amount of sleep seems to fix, persistent brain fog despite your perfect diet, and stretched recovery times despite your optimized fitness routine.

This hidden tax is especially devastating for professionals who pride themselves on mental acuity and sustained energy.

The Microbiome Revolution Nobody Told You About

Everyone talks about gut health. Few realize that the oral microbiome is equally critical and possibly more immediately impactful on daily performance.

Your mouth harbors over 700 species of bacteria in a delicate ecosystem. When balanced, they provide remarkable benefits:

• Converting dietary nitrates into nitrites, essential for nitric oxide production (see my newsletter on breathing)
• Regulating immune responses
• Protecting against pathogen colonization

But here's where most people get it catastrophically wrong: they think all oral bacteria are enemies to be eliminated. This couldn't be further from the truth.

The most striking evidence comes from research on ordinary antiseptic mouthwashes. Studies show that the regular use of strong antimicrobial rinses like chlorhexidine can eliminate beneficial bacteria that convert nitrates to nitrites. The consequences are immediate and measurable: reduced nitric oxide production and increased blood pressure.

One particularly alarming study found that people using antibacterial mouthwash twice daily had a 50% higher risk of developing prediabetes or diabetes within 3 years.

Think about that for a moment. Something as seemingly innocent as "killing germs" with mouthwash could be undermining your metabolic health, vascular function, and cognitive blood flow.

This is why the standard "brush, floss, rinse with whatever's on sale" approach isn't just suboptimal—it's actively harmful to high performers seeking an edge.

The Five Fundamentals Your Dentist Should Tell You

Let's get tactical. If you're serious about leveraging oral health for peak performance, here's what actually matters:

1. Tool Selection Is Non-Negotiable

The research is clear: powered toothbrushes outperform manual ones, removing approximately 11% more plaque in the short term and up to 21% more in long-term studies. This isn't marginal—it's the difference between chronic inflammation and oral health.

Both rotation-oscillation models (where the round head rotates one way, then the other, like Oral-B) and sonic technology (high-frequency vibration, like Philips Sonicare) are effective. While some studies suggest rotation-oscillation may have a slight edge in plaque removal, a 2021 Journal of Clinical Periodontology review concluded both technologies work well, with user preference being the deciding factor. Sonic brushes may offer advantages for sensitive teeth or gums due to their gentler perceived action.

The key features to demand:

• Pressure sensors that alert you when you're brushing too hard
• Built-in timers ensure a full two minutes with 30-second quadrant signals
• Multiple modes for different needs (daily cleaning, sensitive, gum care)

For interdental cleaning, the evidence points to a clear effectiveness hierarchy:

1. Interdental brushes: most effective where they fit, shown in multiple studies to remove more plaque than other methods
2. Traditional floss: essential for tight contacts where brushes can't fit
3. Water flossers: excellent adjunct, especially beneficial for implants/bridges or those with dexterity issues

The key is using the right tool for your specific anatomy. Most mouths need a combination approach: interdental brushes where space permits, floss for tight contacts, and potentially water flossers as a supplement.

2. Technique Over Frequency

Some people brush more often than necessary but with terrible technique. Quality beats quantity every time.

The optimal approach:

• 45-degree angle toward the gum line
• Gentle, short strokes (not aggressive horizontal scrubbing)
• Two full minutes, divided equally across all quadrants
• Systematic pattern ensuring all surfaces are cleaned

A critical nuance most miss: wait at least 60 minutes after consuming acidic foods or drinks (citrus fruits/juices, sodas, wine, sports drinks, even coffee) before brushing. When enamel is temporarily softened by acid, brushing can actually accelerate erosion. Rinse with water immediately after acid exposure, then delay brushing.

If done correctly, once daily is sufficient for interdental cleaning. The debate about flossing before or after brushing is settling: evidence suggests flossing first, then brushing enhances fluoride delivery to interdental spaces.

3. Timing Matters More Than You Think

Your mouth's biochemistry follows its own rhythm:

• Saliva flow decreases significantly during sleep
• Acid production peaks after meals
• Calcium and phosphate remineralization takes time

Leverage these cycles:

• Morning brush: After breakfast (waiting appropriate time if acidic)
• Interdental cleaning: Before evening brushing
• Evening brush: Last thing before bed, with no eating/drinking after (except water)

For high performers who want to optimize further, consider a quick midday brush after lunch for a cognitive refresh. Studies show that brushing can increase alertness through physical stimulation and the psychological reset it provides.

4. Mouthwash Strategy Needs a Complete Overhaul

The billion-dollar mouthwash industry is built on a fundamentally flawed premise: that annihilating all oral bacteria is desirable. It's not.

If you're using mouthwash, be strategic:

• Avoid chlorhexidine for long-term use (it is effective but disrupts beneficial bacteria and causes noticeable tooth/tongue staining)
• Skip alcohol-containing rinses (they dry the mouth, actually worsening breath long-term)
• Consider timing: using rinses immediately after brushing washes away beneficial fluoride

For specific needs:

• High caries risk: use fluoride rinse (0.05% NaF) at a different time than brushing
• Gum inflammation: essential oil rinses (e.g., Listerine) used short-term
• Fresh breath: address the cause (usually tongue bacteria) with a tongue scraper rather than masking with rinses

Some research suggests that occasional rinsing with plain salt water can provide antimicrobial benefits without disrupting the beneficial microbiome.

5. Diet Is Your Defense System

Nutrition affects your mouth before it impacts anywhere else. Three critical factors:

Sugar frequency matters more than quantity.

Each sugar exposure triggers approximately 20-30 minutes of acid production. Five small sweets throughout the day cause more damage than the same amount consumed in one sitting.

Protective foods actively shield your teeth.

• Cheese and dairy products deliver calcium and phosphate while raising the pH
• Green tea contains catechins that inhibit bacterial growth
• Fibrous vegetables stimulate saliva and physically clean teeth
• Vitamin D, K2, and magnesium optimize calcium utilization in teeth and bones

Hydration is non-negotiable.

Saliva is your mouth's primary defense system. Even a 1-2% dehydration dramatically reduces salivary flow and protection. This is especially relevant for executives who talk frequently, take certain medications, or travel often.

The Executive's Dental Cheat Sheet

DAILY ESSENTIALS:

• Brush twice daily (2 minutes each) with fluoride toothpaste and electric brush
• Clean between teeth once daily (interdental brushes or floss)
• DON'T rinse after brushing — spit only to maximize fluoride protection
• Wait 60 minutes after acidic foods/drinks before brushing
• Clean tongue daily with dedicated scraper
• Stay hydrated to maintain protective saliva flow

MAINTENANCE SCHEDULE:

• Toothbrush/electric head: Every 3-4 months or when bristles fray
• Dental check-ups: Every 6-12 months (3-6 months for high-risk individuals)
• X-rays: Every 24-36 months for low-risk, 12-18 months for cavity-prone

STRATEGIC ADDITIONS:

• Xylitol gum after meals stimulates saliva and fights cavity-causing bacteria
• Professional cleaning at least annually (2-4× yearly with periodontal concerns)
• Water flossers as a supplement, especially for implants/orthodontics
• Use mouthwash strategically — alcohol-free, at a different time than brushing for recovery and performance.

Beyond The Brush: The Invisible Edge

The most successful executives I work with understand that proper optimization isn't about adding more supplements or hacks—it's about eliminating hidden drains on performance. Your mouth might be the biggest leak in your system.

Years ago, I won the costume award at an annual Halloween party. My winning ensemble? The tooth fairy (again, I’m not making this up; witnesses can be called). Picture this: 185cm (6'1"), 90kg (200 pounds), the frame of a wrestler, dressed in pink tights, a pink tutu, a matching top, and wings. I believe I even had a shiny tiara on my head.

Little Karla would have been even more thrilled to know what the real tooth fairy looks like.

But unlike my daughter's simple exchange of a tooth for a small gift, the adult version is more complex. Our deal with our oral health has much higher stakes: invest in it properly, and it returns decades of better cognition, energy, and longevity.

That's a performance edge worth smiling about.

Stay healthy.

Andre

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A note for new readers:

I'm a trained reconstructive facial surgeon, medical doctor, and dentist. Before launching this newsletter, I had a varied career: competitive freestyle wrestler, management consultant (McKinsey), entrepreneur (Zocdoc, Thermondo, and docdre ventures), and corporate executive (Sandoz). Today, I'm a Managing Director and Partner at BCG.

Husband of one. Father of three. Split between Berlin's urban pulse and our Baltic Sea retreat. I'd rather be moving than sitting. Not just hobbies. Research. My body is my primary laboratory; I've been conducting experiments for decades.

If this is your first time here, welcome. I'm excited to share what I've learned—and will continue to learn—with you.

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Let’s get one thing straight: None of this—whether text, graphics, images, or anything else—is medical or health advice. This newsletter is here to inform, educate, and (hopefully) entertain you, not to diagnose or treat you.

Yes, I’m a trained medical doctor and dentist. No, I’m not your doctor. The content here isn’t a replacement for professional medical advice, diagnosis, or treatment.

If you have questions about your health, talk to your physician or a qualified health professional. Don’t ignore their advice or delay getting care because of something you read in Health, Redefined. Be smart. Do your research. And, as always, take care of yourself.