Bad breath - What to do about bad breath

Bad breath

What to do about bad breath

Have a dental check-up
Clean your teeth properly
Buy a tongue cleaner
Chew sugar-free gum
Stop smoking
Use a mouthwash
Herbs

A dental check-up is the first priority. The British Dental Association suggests that you explain in advance that you will be asking for advice about bad breath. Tell the receptionist when you make an appointment, and ask that it is noted down and that the dentist is told. Ask the dentist for a thorough scale and polish, and ask if there are any defects where plaque and food debris might be building up.

Clean your teeth properly. A dental hygienist (make an appointment via your dentist) will show you how to clean your teeth properly, and how to use floss to clean between the teeth. Give your teeth a thorough cleaning for 3 minutes twice a day to remove the plaque, and use floss (see How to clean your teeth). Use disclosing tablets (which you can buy from pharmacies); these dye the plaque on your teeth, showing the areas you have not been cleaning properly. Use a toothpick after meals to remove large food particles from between the teeth and, if possible, rinse your mouth out after meals.

How to clean your teeth

Use a brush with a small head, about the size of a 20p or 5c coin.
Use only a pea-sized blob of toothpaste. Toothpaste is abrasive and too much can cause wear of the teeth.
The British Dental Association recommends the ‘gentle scrub’ method. Place the brush at the neck of the tooth where it meets the gum and use very short horizontal movements, at a 45 degree angle, to dislodge the plaque. The brush can be held in a pen-like grip to avoid excessive force.

Buy a tongue cleaner. This is a curved plastic scraper like a small garden hoe. Stick out your tongue and place the cleaner onto the tongue as far back as possible. Then pull forward while gently pressing against the tongue surface. Do not scarpe too much, because if you scratch the tongue, bacteria will get into the cracks and make the problem worse. You can buy tongue cleaners from most dentists and some pharmacies.

If you cannot obtain a tongue scraper, brushing the tongue with a soft toothbrush once a day may be helpful. The most important part to clean is the back of the tongue, if you can do this without gagging. Wet the brush with mouthwash, then stroke from the back of the tongue in an outwards motion. Do not overdo the brushing; the idea is to dislodge any bacteria and flush out stagnant saliva.

Don't skip meals (especially breakfast). You need to eat regularly to keep the salliva flowing.

Eat plenty of fruit. Pineapple is especially good, because it contains an enzyme that helps to clean the mouth.

Drink black tea, that is tea without milk. Researchers at the University of Illinois, USA, found that chemicals in tea can stop the growth of the bacteria responsible for bad breath, and may suppress the bad-smelling chemicals they produce. However, to get the most benefit, the tea must be drunk without milk.

Chewing sugar-free gum can be helpful because it stimulates the flow of saliva and involves movements of the jaw and cheeks. Both these factors help to remove food debris and cleanse the mouth.

Stopping smoking will get rid of ‘smoker’s breath’.

Mouthwashes, deodorizing mouth sprays or tablets will mask bad breath temporarily - useful after eating onion or garlic. Modern mouthwashes also contain antibacterial chemicals so, in theory, they should improve gum disease and mouth odour. Before bedtime is the most effective time to use this type. Gargle with the mouthwash, sticking your tongue out at the same time, and then spit the mouthwash out. There are several types of mouthwash.

Sarakan is a herbal mouthwash available from health shops. It contains extract of Salvadora persica, a bush grown in Africa and known locally as the ‘toothbrush tree’ because twigs from it are used to clean the teeth. Chemicals from the plant dissolve plaque. It has a pleasant taste, flavoured with oils of peppermint, clove and geranium, and does not contain alcohol. Tom’s of Maine is another non-alcohol mouthwash made from natural ingredients, but has a stronger mint flavouring.
You can make your own mouthwash by dissolving half a teaspoon of bicarbonate of soda (baking soda) in half a cup of warm water.
A two-phase mouthwash (Dentyl pH) contains three antibacterial agents - natural essential oils, triclosan and cetylpyridinium. These absorb, lift and remove bacteria, debris, food and dead cells which cause bad breath. (See the result when you spit out.) The oil phase absorbs smelly gases. The effect is said to last for 18 hours.
A mouthwash and lozenge system (Colgate Neutralize) contains compunds that neutralize the bad-smelling chemicals.
Chlorhexidine gluconate (as in Corsodyl, Colgate Chlorohex) is the most effective antibacterial wash, but tastes nasty and darkens teeth slightly for a few days.
Phenolic mouthwashes (such as Listerine) are almost as effective as chlorhexidine in reducing gum disease, but are too zingy for some people.
Cetylpyridinium chloride (as in Search, Reach, Listermint, Macleans Mouthguard) is an effective antibacterial but it does not remain in the mouth for long after rinsing.
Povidone-iodine (as in Betadine) can cause irritation, and must not be used by pregnant women or children, or for longer than 14 days.
Chlorine dioxide rinses (such as Retardex) are claimed to eliminate some of the bacteria and the sulphur chemicals which are partly responsible for the bad smell of halitosis.
Peroxide (as in Colgate Peroxyl) is also an antiplaque agent.

At present, many mouth rinses are acidic, and dentists worry that they might damage tooth enamel. There is also a possibility that the bacteria they eliminate could be replaced by more harmful types that can withstand the effects of mouthwashes. Look at the label to check if the mouthwash contains alcohol. Alcohol can dry the mouth and make the problem worse.

Herbs may help. Chamomile and myrrh are said to have anti-bacterial properties. Peppermint, rosemary, sage and cloves have a pleasant smell, which helps to mask bad breath. Pour 1 pint (500 ml) of boiling water onto 2–4 oz (75–125 g) of herb or 1 oz (30 g) of cloves. Leave to cool for 1 hour, then strain and use as a mouthwash (i.e. swish around your mouth and then spit out). Do not use herbs if you are pregnant.

If you have dentures, remove them at night and soak them in a solution of hypochlorite or chlorhexidine. A pharmacist will be able to advise you.