Embarrassing Health Problems (Series 3) - Bad breath

Most people worry about having bad breath, which also known as halitosis, as shown by the huge sales of breath fresheners. However, it is not easy to tell whether you have it or not. There is actually a psychological condition called delusion of halitosis or halitophobia, in which people have an unshakeable belief that their breath smells, although in fact it does not. Their lives are totally dominated by their 'bad breath' and they are not amenable to reason.

Causes of bad breath

‘Morning breath’

Almost everyone has bad breath first thing in the morning. During the day, movement of the tongue and cheeks dislodges food debris and dead cells, and these are washed away by saliva. While we are asleep our tongue and cheeks do not move much, and the flow of saliva is reduced. The food residues stagnate in the mouth, and mouth bacteria rapidly break them down, releasing an unpleasant stale smell. Breathing through the mouth when sleeping tends to make this worse. Fortunately, morning breath normally disappears after breakfast, cleaning the teeth or rinsing the mouth with water. Get your saliva going with a drink of water and lemon.

Temporary bad breath

Temporary bad breath is the lingering effect of cigarettes or something you have eaten or drunk in the past 24–48 hours. Alcohol, onions, cabbage, broccoli, radish, durian, garlic, curries and other highly spiced foods, cured foods such as salamis, and smoked foods such as kippers are particularly likely to remain on the breath. The problem isn-t simply that the smells stay in the mouth. These foods are digested and then broken down in the body, and the breakdown products of some, particularly alcohol, onions and garlic, are expelled in the breath for hours or days afterwards (this is the basis of the breathalyser test for alcohol).

 

Smoking also reduces the flow of saliva, which makes its smell linger even longer.

 

Traditional remedies such as eating parsley help, and mouth fresheners disguise the smell. Clean your mouth by rinsing it thoroughly with warm water, giving it a good brushing with toothpaste and then rinsing thoroughly again.

 

Bad breath can even result from not eating. When no food is available, the body starts breaking down fat. Waste products from fat breakdown, called ketones, are expelled in the breath, and smell like stale apples.

Persistent bad breath

Gum disease, according to dentists, is the usual cause of persistent bad breath. You will probably be unaware you have the problem because gum disease is not necessarily painful. The gum is likely to bleed when you brush your teeth. It will look very red, but goes pale for a moment if you press on it, and will be slightly swollen where it meets the teeth. Gum disease is caused by plaque, the sticky film of bacteria that naturally forms on the teeth of everyone every day. These bacteria tend to lodge between the teeth and where the teeth meet the gum. The waste products of the bacteria have a foul, stale smell. Apart from bad breath, gum disease can eventually cause loosening of the teeth.

 

Poor oral hygiene is an obvious cause. If you don't clean your teeth, you will soon develop bad breath.

 

Postnasal drip can cause bad breath. This is mucus that trickles down the back of the throat. The reason is inflammation in the air passages behind the nose because of allergies or a sinus infection. It often causes a ticklish cough, particularly when lying flat at night. This type of bad breath is worst when the person is speaking.

 

Bacteria on the back of the tongue are one of the commonest causes of bad breath. Food particles, postnasal drip and stagnant saliva build up in the 'fur' at the back of the tongue, providing a breeding ground for bacteria. These bacteria produce many nasty-smelling chemicals.

 

Anything that dries the mouth makes bad breath worse, because saliva cleanses the mouth. Tricyclic antidepressant drugs (such as amitriptyline) reduce saliva. Alcohol, alcohol-containing mouthwashes, heavy exercise and fasting can all result in a dry mouth and worsen a bad breath problem.

 

Isosorbide dinitrate, a drug for angina, sometimes produces an objectionable smell in the mouth.

 

Gut problems used to be blamed, and enemas and laxatives were often given as cures, but in fact these have very little to do with bad breath. Your stomach is shut off from your throat and mouth by a tight ring of muscle at the base of the foodpipe, so it is normally a closed tube. Therefore no odour escapes from the stomach, except if you belch, or regurgitate food (vomit).

 

Chest problems, such as obstructive airways disease (chronic bronchitis), can cause bad breath.

 

Bad breath in a small child may mean that the child has inserted a small object (e.g. a seed or small toy) into the nose, where it has stuck and caused an infection. For this reason, small children with bad breath should be seen by a doctor.

What to do about bad breath

A dental check-up is the first priority. The Nigeria 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 5 kobo coin.
• Use only a pea-sized blob of toothpaste. Toothpaste is abrasive and too much can cause wear of the teeth.
• The Nigeria 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 scrape 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 saliva flowing.

 

Eat plenty of fruit. Chewing fruit keeps the mouth moist, and dislodges dead cells and bacteria. Pineapple is especially good, because it contains an enzyme that helps to clean the mouth.

 

Drink black tea, that is tea without milk. Researchers  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 mouthrinses also contain antibacterial chemicals so, in theory, they should improve gum disease and mouth odour. There are many different types on pharmacy shelves, so you will need to check the label to see what they contain. Before bedtime is the most effective time to use these mouthrinses. Gargle with the mouthrinse, sticking your tongue out at the same time, and then spit the mouthwash out.

• There is some scientific evidence that mouthrinses containing chlorhexidine, cetylpyridinium chloride, chlorine dioxide or zinc lactate can reduce bad breath somewhat. Although chlorhexidine is one of the most effective antibacterial mouthrinse ingredients, it tastes nasty and darkens teeth slightly for a few days. Also, look at the label to check if the mouthwash contains alcohol. Alcohol can dry the mouth and make the problem worse.
• You can make your own mouthrinse by dissolving half a teaspoon of bicarbonate of soda (baking soda) in half a cup of warm water.

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.