How to Freshen Your Breath and Improve Your Oral Health

Up to 60% of the global population experiences bad breath, or halitosis, at some point in their lives, causing self-doubt, communication difficulties, and signaling oral cavity diseases. To eliminate bad breath, it’s important to understand its source and take action if it originates in the mouth.

What is Halitosis?

“Halitosis” originates from “halitus,” meaning breath. It is not a separate illness but a sign of underlying health problems. The term “halitosis” is not listed in the International Classification of Diseases. Some believe that halitosis was created in 1920 as part of a marketing campaign for Listerine mouthwash. Today, people are more critical of bad breath, whereas in the past it may not have been seen as a problem.

Several factors can cause halitosis, including dry mouth, poor dental hygiene, consumption of foods like onions, garlic, and spices, smoking, certain medications, oral cavity diseases, surgical interventions, and non-dental diseases.

Dry mouth, or xerostomia, can result from decreased or stopped saliva secretion, leading to an unpleasant odor. Poor dental hygiene, such as neglecting to clean teeth and visit the dentist regularly, can allow plaque to settle and bacteria to secrete volatile sulfurous excretions that cause bad breath.

Foods high in allyl methyl sulfide, like onions, garlic, and spices, can cause bad breath after being ingested and digested. Tobacco smoke leaves traces in the throat, lungs, and mouth that mix with saliva and cause unpleasant odor when exhaled. Some medications can cause dry mouth, which can lead to halitosis.

Oral cavity diseases, such as wounds after tooth extractions, gum diseases, or mouth ulcers, can cause an unpleasant odor when inflammation is present. Halitosis can also be a symptom of non-dental diseases, such as chronic inflammation in the nose or throat, certain cancers, metabolic disorders, or gastroesophageal reflux disease.

Why dental problems are the most common cause of halitosis

The main cause of halitosis is reduced salivary secretion during the night and the subsequent imbalance of the microflora in the oral cavity. Most of the bacteria that cause gingivitis and periodontitis are anaerobic, and they thrive in periodontal pockets. They are involved in the metabolism of amino acids, such as cysteine, methionine, tryptophan, arginine, and lysine, producing volatile sulfur compounds that cause unpleasant smells, similar to garlic, rotten cabbage, sulfur, gasoline, and feces.

The oral cavity is home to 700-1000 species of microorganisms. They form diverse communities on different surfaces in the oral cavity, including the biofilm on soft tissues and the “tooth biofilm” on teeth. The biofilm on the oral cavity mucosa is refreshed faster, but the tooth plaque must be removed mechanically and regularly to prevent excessive accumulation of bacteria and decomposition of food remains. Poor oral hygiene, gum diseases, poor quality prosthetics, and orthodontic structures, and active caries and its complications can all lead to excessive bacteria in the oral cavity and cause halitosis.

Detecting Bad Breath on Your Own

Surrounding people may be shy to mention bad breath, making it difficult for some individuals to recognize the problem. Here are a few methods for self-diagnosing bad breath:

1. Check the interdental spaces using floss or a special scraper. If there is plaque buildup, an unpleasant odor may be present.
2. Breathe into a glass, cover it with your hand, and smell it. It is best to perform this procedure in the morning on an empty stomach.
3. Brush the buildup off the back of your tongue with a dry brush and assess the odor.

To determine the effectiveness of your teeth cleaning habits, which is crucial in preventing halitosis due to poor hygiene, you can compare your technique with a demonstration video or ask a dentist for an assessment. During a controlled cleaning, a hygienist will observe your brushing technique and suggest improvements. This procedure can also be conducted using a plaque staining test, where after a demonstration cleaning, the dentist applies a special solution that highlights poorly cleaned areas with a bright color. You can also perform this test at home by purchasing plaque coloring tablets or powders from a pharmacy or oral hygiene store.

How to clean teeth to have fresh breath

The “gold standard” for personal hygiene is achieved by cleaning teeth, interdental spaces, and the tongue. To monitor your own oral hygiene, use the sensation of smoothness of your teeth, which occurs after a professional cleaning.

Dental plaque can be either visible, such as “colored” plaque and dental stones, or invisible, such as biofilm. Biofilm plays a significant role in the development of dental diseases. Poor oral hygiene leads to plaque buildup, a change in its properties to a pathological state, mineralization, and the formation of dental stones.

Poor oral hygiene includes cleaning teeth for less than two minutes, applying excessive or insufficient pressure, lacking interdental hygiene, using an inappropriate toothbrush, and not replacing the toothbrush regularly. It’s important to note that an irrigator cannot remove biofilm, making it ineffective in fighting plaque.

Recognizing Halitosis by a Dentist

If you’re experiencing discomfort from bad breath and have ruled out hygiene problems, visit a dentist. During your first appointment, the dentist will examine your oral cavity and ask you to fill out a questionnaire about your lifestyle, diet, chronic illnesses, medication, and symptoms such as dry mouth or bleeding gums.

To evaluate the intensity of the unpleasant odor from your mouth, the dentist may use a halimeter, a device equipped with a gas analyzer. Not all clinics have access to this equipment, but if it’s available, the test is included in the cost of your visit.

During the dental examination, the dentist will also check the overall health of your oral cavity, such as the condition of your gums, the presence of cavities, and any abnormal growths on the mucous membranes. To determine the health of your teeth, the dentist may also require a radiographic examination.

Sometimes, a person may believe they have bad breath when it is not actually the case. This is known as pseudo halitosis and can be due to psychological or neurological reasons. Psychological pseudo halitosis is caused by halitophobia, an excessive concern with oral hygiene. Neurological pseudo-halitosis can result from dysgeusia, a taste disturbance caused by medication, injury, or certain illnesses. In such cases, the person will be referred to a psychotherapist.”

How to treat halitosis

To treat and correct halitosis, mechanical cleaning of teeth, tongue, and the use of antiseptic agents are the main methods.

Professional hygiene using the GBT (Guided Biofilm Therapy) protocol is the optimal start of treatment. The doctor removes biofilm and mineralized deposits, which cause cavities and gum diseases, with the help of plaque indicators and micro-abrasive powders tailored to the individual’s oral cavity condition, tooth sensitivity, presence of braces, veneers, fillings or implants, and other factors. The protocol ends with a therapy that strengthens tooth enamel by remineralizing it.

The specialist will then choose personal hygiene items and tools like a toothbrush, toothpaste, interdental cleaners, and mouthwash, and will correct the technique. Several visits may be necessary to practice and refine skills, as many people have been cleaning their teeth incorrectly for years. For example, at a consultation, they may learn they don’t need to apply too much pressure on the brush to clean their teeth better, or they use the same cleaning method with an electric and a regular toothbrush.

If the problem persists after visiting the dentist, seek a non-dental cause of halitosis. First, consult an ear, nose and throat specialist to rule out gum diseases and inflammation in the nasal sinuses and throat. Then, see a gastroenterologist to examine your gastrointestinal tract and prescribe treatment if necessary.

If the source of the unpleasant odor cannot be found, consider seeing a therapist and receiving referrals to other specialists.

Why it is not advisable to limit yourself to a mouthwash for halitosis.

Understand the cause of bad breath before buying a mouthwash to mask halitosis. While mouthwashes can temporarily eliminate bad breath, they are not a substitute for daily hygiene and are not necessary. They do not clean plaque better than plain water. Therapeutic mouthwashes with chlorhexidine and fluoride can be prescribed for gum diseases.

Effective components against bad-smelling microflora include chlorhexidine, triclosan, cetylpyridinium, chlorine dioxide, and zinc compounds. Research suggests that mouthwash with chlorhexidine and cetylpyridinium chloride can reduce the number of bacteria causing halitosis on the tongue. Mouthwash with chlorine dioxide and zinc can neutralize sulfurous odors. Chlorhexidine combined with cetylpyridinium chloride and zinc is considered the most effective.

When using mouthwash with these substances, be aware that they can have both therapeutic and adverse effects with improper use. For example, long-term use of mouthwash with chlorhexidine can lead to hypertension in healthy individuals.

Specialists also recommend using sugar-free chewing gum and breath fresheners as additional oral hygiene aids. They increase saliva secretion and may temporarily mask odors, but will not completely eliminate them.

Remember: It is important to understand the cause of bad breath before relying on a mouthwash to mask it.

Remember

• Poor oral hygiene is the leading cause of bad breath. Ensure proper care by visiting the dentist regularly, brushing your teeth twice a day for at least two minutes, and using interdental and tongue cleaners.
• If you suspect bad breath, confirm it by breathing into a glass, covering it with your hand, and smelling. If confirmed, see a dentist for treatment.
• The treatment strategy for halitosis includes professional hygiene, oral health assessment, choosing home care products, and learning proper brushing technique.
• While mouthwashes can mask unpleasant odors, they cannot eliminate the cause. Chewing gum can also help reduce bad breath, but it is just a supplementary oral hygiene method.
• If the dentist finds no problems in your mouth, seek other specialists to identify the cause of your halitosis.