The Quest for Sweet Breath
For: Getting the Most from Mouthwash, October 2003
Bacteria do useful work, but cause their share of grief, too, including bad breath, also known as halitosis. Bad breath almost always originates in the mouth, produced by bacteria that live mostly at the back of the tongue. They are not the same species that live in the plaque on your teeth, which cause cavities. Scientists have only recently identified many of these mouth-dwelling bacteria—some 85 of them so far. The microbes find places to hide in the back of the mouth, where they process debris from food, saliva, postnasal drip, periodontal disease, cells from the tongue, and so forth, turning these into rank substances with unlovely names such as cadaverine (because that’s what it smells like), putrescene (rotten meat), and others that may as well go unmentioned.
If you don’t brush and floss, or if your mouth is dry, or you have periodontal disease, or you take certain mouth-drying medications or use tobacco, the situation goes from bad to worse. A dry mouth means that saliva is not there to wash away the smelly products, and tobacco use not only dries the mouth, but also adds its own residue and smell. Tobacco use practically guarantees bad breath. And many foods perfume the breath in unpleasant ways—raw garlic and onions being the most notorious. Alcoholic beverages, also drying, can make your breath smell bad, or at least like alcohol.
Halitosis is not a joke—it can undermine self-confidence and limit one’s romantic, social, and professional life. It’s hard to check your own breath, because you cannot really smell it. A bad taste in your mouth does not inevitably signal bad breath. Sometimes you can detect your own bad breath by sniffing a toothpick or tissue that you’ve moistened with saliva, or blowing into your cupped hands. There are tests that a dentist can perform, too. The best way to check your breath is to ask somebody. There’s a rare psychological condition called "delusional halitosis," characterized by compulsive mint-chewing and teeth-brushing, and even avoidance of social contact. This usually requires psychiatric treatment. Such people, though, are vastly outnumbered by those who have no clue they have bad breath. If you can do it tactfully, it is probably a kindness to tell a friend or family member when you notice his/her bad breath.
How to prevent (and combat) bad breath
• What tops the list, not surprisingly, is regular brushing and flossing. Floss thoroughly once a day, or twice if you know your breath is bad. Try a toothpaste that reduces bacteria, such as Colgate’s Total, which contains triclosan, an antibacterial agent. If you tend to have bad breath, try to clean your teeth and mouth after each meal. Rinse frequently with water or a mouthwash.
• Scrape and brush your tongue, particularly the back of it, as part of your oral hygiene routine. You can get a plastic tongue cleaner at the drugstore. Be gentle—don’t damage your tongue. The gag reflex will usually subside over time.
• Get regular dental check-ups. If your bad breath is chronic, see your dentist to rule out tooth or gum disease, and to get treatment, if needed. If the dentist cannot pinpoint the cause, see a physician. You may have some underlying disorder that is causing bad breath.
• In conjunction with proper brushing and flossing, antiseptic mouthwashes can help reduce bacteria, particularly Listerine and its generics, which carry the seal of the American Dental Association. Products with chlorhexidine, cetylpyridium chloride, and chlorine dioxide may also help reduce smelly sulfur compounds or the bacteria that produce these compounds. Billions are spent on mouthwashes, but by themselves they seldom accomplish much. (An upcoming article will discuss mouthwashes in detail.)
• Billions more are spent on breath mints, most of which simply mask the bad smell for a few minutes, even those "curiously strong" ones that burn your tongue. (Peppermint oil, even in its purest form, does not kill mouth bacteria.) Mints containing sugar may actually compound the problem. It’s true, though, that sucking on a mint can promote saliva flow, and if candy is all that’s at hand, no one can blame you for trying. Two new products claim to kill mouth bacteria and sweeten breath: Cool-mint Listerine PocketPaks and Arm & Hammer Advance Breath Care mints (the latter contain zinc salts and bicarbonate). You might give them a try.
• Keeping your mouth moist is good for your breath as well as your teeth. Morning bad breath can usually be banished by a glass of water. Chewing sugarless gum is also a good way to stimulate saliva flow, especially when you can’t brush and floss. If you have chronic dry mouth, talk to your dentist or doctor.
• Don’t use tobacco. And, of course, avoid such things as raw garlic and onions, especially if you’re around people who haven’t partaken of these seasonings.
UC Berkeley Wellness Letter, November 2002
