Get rid of bad breath for good

Bad breath (med.: halitosis) is still a taboo subject. We find it is embarrassing for us talk about, which means that others will rarely let us know that we are suffering from this issue. In Germany, at least 20% of the population suffers from bad breath, but only very few are aware of it. It can lead to a significant deterioration in the quality of life of those affected, as well as adversely affecting both work and social life. The causes of halitosis are not to be found in the intestinal tract, as people often believe, but rather 90% of cases are due to causes to be found in the mouth.

What causes bad breath

Bad breath can be the result of multiple causes. Bacteria remain in one place for a long period of time, with patients failing to regularly remove these bacteria using toothbrushes, dental floss, or interdental brushes. This may occur in the gums or the gingival crevices (small pockets in the gums), between teeth, on the tongue, or as part of regions affected by gingivitis or periodontal disease. In rare cases, the cause for bad breath can be found in regions further down, for example in the gastro-intestinal tract. An unbalanced diet with excessive consumption of foods containing sugar, milk and acidic products can lead to halitosis. Where this condition persists for a long period of time, dentists refer to “chronic halitosis”.

Causes of bad breath (halitosis) can include:

  • Bacteria and a coating on the back of the tongue 
  • Bacteria in gingival crevices (small pockets in the gums) and in the spaces between the teeth
  • Deposits on the surface of the tooth
  • Dry mouth and dry mucosa where bacteria can spread
  • Periodontal / gum disease and inflammation of the gums, in other words, gingivitis
  • Periodontal / gum disease with necrotic ulcerative regions of gum
  • Oral thrush (possibly due to initial infection by the herpes viruses)
  • Smoking
  • Mouth breathing, snoring
  • Stress
  • Fasting / diet
  • Infections or abscesses in the mouth
  • Unbalanced diet
  • Tonsillitis

 

"In order to stop small problems from becoming big problems, it helps when patients come in for regular dental check-ups and for professional tooth cleaning appointments. This helps us to make sure that any possible halitosis (bad breath) is not the symptom of a more serious underlying disease, such as periodontal disease."

 

Dr. Eva Murmann, Dentist at the Dr. Hager Dental Practice

Recognising halitosis

Most of those affected do not notice the smell themselves. Normally family members or friends are the ones that alert the affected person of their unpleasant smelling breath. If the affected person doesn’t take sufficient measures to improve their oral hygiene, including regular tooth cleaning, using dental floss and tongue cleaners, then only a visit to the dentist or a professional tooth cleaning appointment can help (also known as dental hygienist appointments). This allows dentists to pick up on halitosis during treatment appointments. Generally, a dental hygienist appointment is recommended. Part of this appointment involves giving advice on how to correctly look after your teeth on a regular, daily basis, ensuring that poor oral hygiene becomes a thing of the past.

A bacteria test and a questionnaire may also be used in some cases to help eliminate the bad mouth odour. Bad breath is generally due to causes to be found in the mouth, but this only applies in 90% of cases. Causes of bad breath may also be due to causes in other areas, such as the upper respiratory tract, gastrointestinal tract or the nasal sinuses.

In these cases, dentists usually refer patients to a GP or ENT doctor.

Treating halitosis (bad breath)

If we as dentists identify a case of halitosis in one of our patients during a simple intra-oral examination, we are able to recommend a comprehensive treatment, personally adapted to each case. It is also extremely important for other diseases that may be causing the halitosis to be ruled out. This includes diseases which cause inflammation of the structures supporting the teeth and gums, which can have an adverse effect on breath. This inflammation is called periodontal disease. People often (erroneously) refer to this as paradontosis. In this case, a special treatment specifically for periodontal disease must be carried out.

If the only causes of the bad breath are a tongue coating or incorrect tooth cleaning techniques, e.g. poor tooth-brushing techniques, then an immediate treatment can be provided with specialist professional tooth cleaning. Following a specific treatment program, bacteria are removed from the gingival crevices (small pockets in the gums), spaces between the teeth and from the tongue. Additional bacteria that cannot be removed during manual cleaning are also removed using an antibacterial preparation (e.g. chlorhexidine). For long-term treatment, we can use a questionnaire to identify the exact causes of the halitosis and recommend you a personalised treatment approach to definitely cure you of bad breath.

Regular check-ups and professional dental hygiene appointments are important, combined with daily oral hygiene care carried out by you at home using our cleaning kit with tongue cleaner.

Also called a tongue scraper, this tool can be used to gently remove any coating on the tongue. Antibacterial toothpastes, dental floss, or better still, interdental brushes all help to keep the teeth and gums free of bacteria and using the tongue scraper can help to round off your tooth cleaning routine to ensure good oral hygiene with healthy gums.

The use of mouthwashes is a hotly debated subject. We see advertising on a daily basis that suggests patients should remove bacteria from the tongue, teeth, gums and the rest of the mouth using mouthwash to avoid bad breath. In truth, the good bacteria in the mouth tend to be the bigger victims when using mouthwash. The “bad” bacteria are normally more resistant to mouthwashes and remain in place. In order to ensure long-term treatment success, the root causes of the halitosis must be definitively remedied (e.g. this might be an inflammatory disease such as periodontal disease). This can be done in professional tooth cleaning appointments, with help from the dentist, or by patients themselves through dental care techniques at home using tongue cleaner and other tools.

This pays dividends with fresh, healthy breath and improved self-confidence, allowing you to enjoy a new-found sense of well-being.

Frequently asked questions

Why do I have bad breath?

Bad breath can have many causes. If the mouth is not thoroughly cleaned, then bacteria can spread and even cause an increased risk of suffering from periodontal disease. Using several different mouth cleaning tools can usually help. This may include: cleaning the tongue with a tongue cleaner; brushing teeth correctly; having regular dental hygienist appointments; and eating a balanced diet.

How can I tell if I am suffering from bad breath?

Normally it is a friend or family member that will mention it to you. Unfortunately, most people hold back and avoid having to say something. And it’s generally not possible for people to smell their own bad breath. For this reason, it is important for patients to attend regular appointments with the dental hygienist, and to follow the advice given on how to correctly care for your teeth. Often only a few adjustments need to be made to ensure your breath is smelling fresh again.

Can parodontitis / periodontal disease lead to bad breath?

Yes, absolutely. The bacteria that are at work in cases of parodontitis create waste products as a result of their metabolism. These products are what cause bad breath. 

Do tongue cleaners / tongue scrapers actually help?

Poor tongue cleaning is often the main cause of halitosis (bad breath). Milk products in particular leave a coating behind on the tongue which can be effectively removed using a tongue scraper. If this is not successful in treating the bad breath, then other causes may be responsible. The best thing to do in this case is to ask your dentist about this during your next check-up or dental hygienist appointment, e.g. to rule out any parodontitis / periodontal disease.