Bad breath, or halitosis, is something that apparently even our best friends would find too embarrassing to tell us about. Unfortunately, it’s also a problem that’s difficult to spot yourself. That’s why bad breath affects 8 out of 10 people at some time in their life and can become a long-term health problem.

What causes halitosis?

Although bad breath is popularly believed to result from stomach or bowel problems, this is rare and accounts for less than one in a hundred cases. Similarly, breath odours due to eating onions and garlic are a dietary side effect and not true halitosis, and are easily masked by peppermint sprays or chewing sugar-free gum.

True halitosis is caused by a build-up of bacterial plaque in the mouth, trapped within the gum pockets surrounding your teeth, and between your teeth, and by bacteria coating the tongue. These bacteria produce around 300 different gases and volatile chemicals of which over 100 smell – and not of roses, either.

You can remove some plaque build up between your teeth with the careful use of dental tools available for home use. Using plaque disclosing tablets will make build-ups of tartar easier to target.

People with gum disease are almost certain to have some degree of bad breath as the bacteria that contribute to gum inflammation also produce odours. If you have redness or swelling of the gums round your teeth, or if your gums bleed when brushing, you may well have gingivitis (infected and inflamed gums). Don’t ignore this as, in addition to making your breath smell progressively worse, it can spread to involve the jawbone round your teeth (periodontitis) and your gums will start to recede. The condition is so common, there’s even a saying about becoming long in the tooth. Ignore periodontitis and you could eventually lose your teeth altogether.

Other causes of halitosis include:

• dry mouth due to lack of saliva
• mouth breathing – which also contributes to unpleasant tastes when waking with ‘morning mouth’
• nasal problems (previous fracture, post-nasal drip, nasal surgery)
• sinusitis and blocked sinuses filled with pus
• Long-term lung infection.

Check your tongue

Bad breath can occur when a build-up of mouth bacteria causes a furred-up, coated tongue. This may reflect a lack of saliva if your mouth also feels dry. Use a tongue scraper each morning (you can buy specially designed ones, but in an emergency you can also use an upside down teaspoon. Follow this with a mouthwash designed to trap and remove bacteria such as the Dentyl range, which kills up to 99.9% of oral bacteria in laboratory tests. You’ll be amazed at the visible clumps of bacteria and plaque this can remove!

Health consequences of bad breath

As well as loosening your teeth, mouth infections and poor oral hygiene have been linked with heart attacks, strokes, pneumonia and even premature low birth weight babies due to bacteria entering the blood stream from infected, inflamed gums.

Unfortunately, twice daily cleaning of teeth is not usually enough to solve bad breath and gum disease, and mouthwashes will only solve the problem temporarily.

How to overcome bad breath

Firstly, it’s important to drink sufficient water to maintain good hydration – usually around 2 litres per day in addition to the fluid naturally present in foods.

It’s also a good to drink green tea, as this contains antioxidant polyphenols which have a natural deodorizing effect to suppress the unpleasant odours produced by mouth bacteria.

As well moistening the mouth themselves, fluids help to promote secretion of saliva.

Stimulate saliva

Saliva plays an important role in keeping your gums healthy. Saliva washes your mouth clean, contains antibodies and other substances that reduce bacterial infection, and provides enzymes that help to break down food trapped between the teeth. Saliva also contains minerals that help to neutralise the acids produced by bacteria within dental plaque.

As you get older, saliva production tends to fall and dry mouth becomes more common. Scientists have also discovered that people with diabetes have salivary glands that work less efficiently than usual. This is because one of the protein ‘pores’ that transport glucose into body cells also acts as a water channel in the salivary glands. When this channel fails to work properly in diabetes, more water than usual is reabsorbed and less remains available for saliva production.

As well as causing bad breath, lack of saliva is associated with reduced acid neutralisation and increased loss of dental enamel at the base of the teeth. In people with very dry mouths – a condition known as xerostomia – this can even lead to tooth fractures.

You can relieve dryness temporarily by spraying the inside of the mouth regularly with artificial saliva, or using saliva replacement gel. You can also suck special pastilles or chew sugarless lozenges or gum which, as well as stimulating saliva production, also contain xylitol – an artificial sweetener that helps to protect against dental decay.

Avoid acid attack

Tooth enamel forms a thin layer over the surface of each tooth that is up to 2.5mm thick. It is the hardest substance found in the body but readily dissolves on contact with acid. In fact, enamel starts to dissolve as soon as it encounters acid substances with a pH of less than 5.5. Water, which is neutral, or non-acidic, has a pH of 7.0.

The acids present in many soft drinks, fruit juices, sport drinks and wine can chemically erode tooth enamel, as can the acetic acid found in vinegar, tomato sauce, mustard and salad dressings.

All the substances listed in the chart below have a pH that is acidic enough to soften or dissolve your tooth enamel with prolonged contact. Once tooth enamel has dissolved away, it can’t be recovered, and the softer, underlying parts of the tooth soon start to decay.

Researchers have found that someone who eats citrus fruit more than twice a day is thirty-seven times more likely to experience dental erosion than someone who eats citrus fruit less frequently. BUT you don’t want to avoid eating fruits and drinking fruit juices altogether, as they are a vital part of a healthy diet. Cranberries and their juice even contain unique substances known as type A-type proanthocyanidins, which bind to certain bacteria and prevent them from sticking to the lining of the mouth and tongue.

So, fresh breath experts recommend that if you have bad breath, you stimulate saliva flow first thing each morning by drinking a glass of citrus juice and eating fresh fruit. Then immediately follow this with a thick, unsweetened, natural yogurt – Greek yoghurt is ideal – or a piece of cheese. This is vital as the calcium present in yogurt, milk, cheese and other dairy products neutralises any remaining acid left in your mouth from drinking the fruit juice.

You can also neutralize acids in your mouth with a sugar-free, antacid tablet containing calcium. Remegel is the nicest to use as, instead of being chalky, it is chewy and pleasant to take.

Foods containing calcium and phosphate can also protect against acid erosion, and some dental experts suggest holding a piece of cheese in your mouth for a few minutes after eating a fruit salad, for example, to protect your teeth. Another good tip is to select fruit juices fortified with added calcium, as this significantly decreases their erosive potential.

If you have a tendency towards dry mouth, sip water regularly and sluice your mouth out after drinking tea, coffee, cola, sports drinks, wine and other alcohol drinks which contain tannins or other chemicals that are ‘drying’. In fact, this is another good reason (apart from responsible drinking) to have a glass of water after each alcoholic drink.

Decrease the frequency with which you consume acidic foods or drinks, and consume them quickly, rather than sipping or chewing daintily. Using a straw positioned towards the back of your mouth lessens the contact time between your teeth and the drink, compared with using a cup and may reduce the erosion caused by soft drinks.

Protect sensitive teeth

Some toothcare products designed for sensitive teeth can plug and repair minute holes in teeth to strengthen enamel against acid attack, and reduce gingivitis. You could also ask your dentist about the advisability of using fluoride containing products. Fluoride is a mineral that binds to tooth enamel and strengthens it to help prevent decay. It needs to be used under supervision, however, especially in young children, in whom excess fluoride can cause discoloured teeth (fluorosis). You may not need this if water in your area is fluoridated.

Don’t brush your teeth immediately after having acidic foods or drinks, as abrasion by a toothbrush soon afterwards may increase loss of enamel. In this case, rinsing your mouth with a glass of water is better than brushing immediately after eating.

Best tools for cleaning your teeth to reduce bad breath

While we all know we should clean our teeth twice a day, a recent survey found that as many as 40% of Brits admitted to regularly going to bed without cleaning their teeth at night!

Invest in an electric toothbrush with a rotating head that is designed to remove plaque efficiently. Sonic versions vibrate and help to break up and dislodge plaque for effectively.

Flossing and using dental tape are often advised, but you will find it easier to use interdental brushes (non-wired) to clean awkward spaces such as between your back molars. Select the correct sized brush that gently eases into a space between your teeth, without forcing.

Dip the brush into the top of a toothpaste tube to get a slight coating of paste, and gentle insert the interdental brush between your teeth where rotting food and bacterial plaque lurk. Simply move back and forth a few times and rinse under water before using again.

As well as reducing gum disease, people who floss regularly may be less likely to develop coronary heart disease by reducing gum inflammation and the amount of mouth bacteria that enter the circulation to trigger arterial disease.

Which are the best mouthwashes to reduce halitosis?

A few mouthwashes are designed to neutralise rather than just mask odours. Both the UltraDex and the TheraBreath range of dental products oxidize sulphur molecules to eliminate bad breath instantly and have a prolonged action throughout the day.

Irrigate your gums

While you can just swish your chosen mouthwash to-and-fro then spit, you will get the best effect by applying it via a water irrigator that pumps the mouthwash between your teeth. The Philips Sonicare AirFLoss Rechargeable Electric Flosser is easy to use – just hold the ‘spout’ in front of each gap between your teeth and press the button – you can select whether you want one, two or three ‘squirts’ per go. It remove up to five times more plaque from between teeth than manual toothbrushes, and you can put mouth wash or water into the reservoir. You will be amazed at how fresh your mouth feels afterwards – I wouldn’t be without mine and is ideal for daily use.

Other irrigators with larger tanks are also available that you fill with water for a really deep clean.

Activated charcoal and hyaluronan products

Strange but true – brushing your teeth with black charcoal products is super effective at removing stains like coffee, tea, wine and plaque, and aid teeth whitening. But activated charcoal is also effective at absorbing and neutralising odours so, while it may seem weird to rinse your mouth with a black mouthwash, it will help if you have bad breath.

Gengigel mouthwash and gel contain hyaluronan, a natural healing agent found within the body which can attract up to 1000 times its own weight in water, to help plump up tissues and improve receding gums. It has been clinically shown to significantly reduce inflammation and to restore and maintain healthy gums, even helping receding gum tissue to regenerate in some cases.

Have you pulled today?

Oil pulling is traditionally used in Asia to cleanse the mouth. Known as ‘gandusha’ it involves gargling with oil to ‘pull’ toxins from the body. To do this, hold a tablespoon of oil in your mouth and swish it around for between two to twenty minutes – such as when you are in the shower. Don’t swallow the oil, but spit it out and clean your teeth thoroughly afterwards.

While sesame or sunflower oil were traditional used for oil pulling, coconut oil tastes nicer and have useful antibacterial properties. Cocofina has launched single serve 10ml sachets of cold pressed, virgin and organic raw coconut oil to make this easy – each sachet is filled in a nitrogen atmosphere to stop the oil from oxidising. Roll the sachet in the palm of your hand so the oil warms and liquefies.

A new Swish To Go range has been launched in the UK whose sachets contain a quick dissolving powder. These are designed for when you want a quick mouth freshen up without cleaning your teeth with a traditional brush. Tear open the sachet, pour the powder onto your tongue and, when it liquifies, swish it around your mouth vigorously for ten seconds to neutralise mouth acidity. This can be swallowed if you wish.

Supplements that can reduce bad breath

While the supplements mentioned below won’t act as magic treatments on their own, they can support other measures such as regular visits to a dental hygienist to have gum pockets cleaned and the hard build-up of bacterial plaque (scale) removed.

• Co-enzyme Q10 supplements, combined with professional dental hygiene treatment, can help to reverse receding gums. Diseased gum tissue has a significantly lower level of Co-enzyme Q10 compared with healthy gum tissue in the same person. AS co-enzyme Q10 is needed for oxygen processing in cells, it is vital for cell regeneration and renewal. A trial involving 49 patients with periodontal disease found that, compared with placebo, combining periodontal hygiene treatments with 60mg Co-enzyme Q10 daily for 12 weeks produced significant reductions in the depth of periodontal pockets. Co-enzyme Q10 also helped to reverse periodontal gum disease and even saved teeth that were scheduled for surgical removal. For information on the best co-enzyme Q10 supplements, click here.
• A multivitamin and mineral supplement protects against nutritional deficiency and have been shown to improve gum health within two months of starting to take them daily. My tips for chosing the best multivitamin supplements can be found here.
• Calcium is not just important for strong, healthy bones – it is also needed to prevent calcium from being leached from the teeth if there is too little in the diet. Calcium supplements improve the protective benefits of saliva, and may help to reduce bone thinning in the jaw which contributes to loosening teeth.
• Vitamin C is needed for production of collagen in healthy gums.

And, of course, regular dental check-ups are key.

If you do all of the above, I can almost guarantee your breath will be fresh and sweet. In practice, however, just one or two approaches are probably all that’s needed! Which products have worked best for you?

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