Oral microbiota dysbiosis, concomitant with decreased abundance of nitrate (NO₃⁻)-reducing bacteria, oral net nitrite (NO₂⁻) production, and reduced nitric oxide (·NO) bioactivity, is associated with the development of cardiometabolic disorders. Therefore, restoring the oral microbiome to a health-associated state is suggested as a therapeutic approach to potentiate the NO₃⁻–NO₂⁻–·NO pathway and provide a backup resource for insufficient NO production in conditions including cardiovascular disease and type 2 diabetes mellitus (T2DM). The current review discusses how inorganic NO₃⁻ can improve the oral microbial community in patients with T2DM and act as a prebiotic. Both animal and human experiments indicated that inorganic NO₃⁻ modulates the oral microbiome by increasing the abundance of health-associated NO₃⁻-reducing bacteria (e.g., Neisseria and Rothia) and decreasing the plenty of species Prevotella and Veillonella, leading to oral NO₂⁻ accumulation and improved systemic ·NO availability. Supplementation with NO₃⁻ reduces caries- and periodontitis-associated bacteria and the pathogenic genus related to insulin resistance and glucose intolerance. In addition, inorganic NO₃⁻ may provide a more optimal environment for NO₃⁻ reductase activity in the oral cavity, as it increases salivary flow rate and prevents decreased pH by inhibiting acid-producing bacteria.

口腔微生物群失调，伴随着硝酸盐 (NO ₃ ^- ) 还原菌、口腔净亚硝酸盐 (NO ₂ ^- ) 产生和一氧化氮 (·NO) 生物活性降低，与心脏代谢疾病的发展有关。因此，建议将口腔微生物组恢复到与健康相关的状态作为一种治疗方法，以增强 NO ₃ ^- -NO ₂ ^- -·NO 途径，并为心血管疾病和 2 型糖尿病等疾病中 NO 产生不足提供备用资源糖尿病（T2DM）。目前的审查讨论如何无机 NO ₃ ^-可以改善 T2DM 患者的口腔微生物群落并充当益生元。动物和人体实验均表明，无机 NO ₃ ^-通过增加与健康相关的 NO ₃ ^-还原细菌（例如，奈瑟菌和罗氏菌）的丰度和减少普雷沃氏菌和韦荣氏菌的数量来调节口腔微生物群，从而导致口腔 NO ₂ ^-积累和改善的系统性 ·NO 可用性。补充 NO ₃ ^-减少与龋齿和牙周炎相关的细菌以及与胰岛素抵抗和葡萄糖耐受不良相关的致病菌。此外，无机 NO ₃ ^-可以为口腔中的NO ₃ ^-还原酶活性提供更理想的环境，因为它可以增加唾液流速并通过抑制产酸细菌来防止 pH 值降低。