What should I do if I have bad breath?

To many, halitosis, bad breath , is unpleasant and embarrassing. Many people don't realize that they have bad breath, but everyone has it every once in a while, especially in the morning.

There are many reasons why some people have bad breath, but for healthy people, the major reason is because of microbial deposits on the tongue, especially on the back. Some studies show that just brushing the tongue reduces bad breath by 70 percent.

 What may cause bad breath?

What can I do to prevent bad breath?

Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush. Floss daily to remove food debris and plaque from in between the teeth and under the gumline. Brush or use a tongue scraper to clean the tongue and reach the back areas. Replace your toothbrush every 2 to 3 months. If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning. See your dentist regularly – Get a check-up and cleaning at least twice a year. If you have or have had periodontal disease, your dentist will recommend more frequent visits. Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit. Drink water frequently – Water will help keep your mouth moist and wash away bacteria. Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor. Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem. In most cases, your dentist can treat the cause of bad breath. If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

How often should I brush and floss?

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums. The bacteria in plaque convert certain food particles into acids that cause tooth decay. Also, if plaque is not removed, it turns into calculus (tartar). If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums. Brush the outer, inner, and biting surfaces of each tooth. Use the tip of the brush head to clean the inside front teeth. Brush your tongue to remove bacteria and freshen your breath. Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands. Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion. Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth. Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush. If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Are amalgam (silver) fillings safe?

Over the years there has been some concern as to the safety of amalgam (silver) fillings. An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury. Dentists have used this blended metal to fill teeth for more than 100 years. The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth. The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe. Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective. The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling. The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels. For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them. However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.

There are numerous options to silver fillings, including composite (tooth-colored), porcelain, and gold fillings. We encourage you to discuss these options with your dentist so you can determine which is the best option for you.

How often should I have a dental exam and cleaning?

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for cavities. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health. These include:

Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your over all health and also your dental health. Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss-rays also help determine tooth and root positions. Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any sings of oral cancer. Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease. Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments. Examination of existing restorations: Check current fillings, crowns, etc. Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface. Calculus forms above and below the gum line, and can only be removed with special dental instruments. Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (poisons) that inflame the gums. This inflammation is the start of periodontal disease! Teeth polishing: Removes stain and plaque that is not otherwise removed during tooth brushing and scaling. Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.). Review dietary habits: Your eating habits play a very important role in your dental health. As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth. We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

How can I tell if I have gingivitis or periodontitis (gum disease)?

Recent studies have shown that four out of five people have periodontal disease and don't know it. The unawareness is because the disease usually is painless in its early stages. Having regular check ups and periodontal examinations are very important and it will help detect if you have periodontal problems.

The disease starts when plaque is left on the teeth and gums. The bacteria produce acids that inflame gums and slowly destroy the bone. Brushing and flossing on a regular basis will ensure that plaque will not be left behind to do any damage.

There are many other factors which may increase the risk of getting periodontal disease:

Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth. Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria. Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives. Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums. Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins. Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc. Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis. Patients with a family history of tooth loss should pay particular attention to their gums.

Whatever goes inside your mouth affects the air you exhale. Certain foods, especially those containing garlic and onions strongly contribute to bad breath odor. Once food has been absorbed into the bloodstream, it is transferred to the lungs where it is expelled. Brushing, flossing, and mouthwash only temporarily mask the odor. The odor will cease once your body eliminates the food. In many cases, dieters develop unpleasant breath from infrequent eating.

If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor. Dentures that are not cleaned properly can also harbor odor-causing bacteria and food particles.

One of the warning signs of periodontal (gum) disease is persistent bad breath or a bad taste in the mouth. Periodontal disease is caused by plaque, the sticky, colorless film of bacteria that constantly forms on teeth. The bacteria create toxins that irritate the gums. In the advanced stage of the disease, the gums, bone and other structures that support the teeth become damaged. With regular dental checkups, your dentist can detect and treat periodontal disease early.

Bad breath is also caused by dry mouth (xerostomia), which occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth. If you suffer from dry mouth, your dentist may prescribe an artificial saliva, or suggest using sugarless candy and increasing your fluid intake.

Bad breath may be the sign of a medical disorder, such as a local infection in the respiratory tract (nose throat, windpipe, lungs), chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment. If your dentist determines that your mouth is healthy, you may be referred to your family doctor or a specialist to determine the cause of bad breath.

Eliminating periodontal disease and maintaining good oral health is essential to reducing bad breath. Schedule regular dental visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of the foods you eat and make a list of medications you take. Some medications may play a role in creating mouth odors. Let your dentist know if you've had any surgery or illness since your last appointment.

Brush twice a day with a fluoride toothpaste to remove food debris and plaque. Brush your tongue, too. Once a day, use floss or an interdental cleaner to clean between teeth. If you wear removable dentures, take them out at night. Clean them thoroughly before replacing them the next morning.

Tobacco products cause bad breath, stain teeth, reduce one's ability to taste foods and irritate gum tissues. Tobacco users are more likely to suffer from periodontal disease and are at greater risk for developing oral cancer. If you use tobacco, ask your dentist for tips on kicking the habit.

Mouthwashes are generally cosmetic and do not have a long-lasting effect on bad breath. If you must constantly use a breath freshener to hide unpleasant mouth odor, see your dentist. If you need extra help in controlling plaque, your dentist may recommend using a special antimicrobial mouth rinse. A fluoride mouth rinse, used along with brushing and flossing, can help prevent tooth decay.

Look for products that carry the American Dental Association Seal of Acceptance. Products that display the seal have undergone strict testing for safety and effectiveness.

What can I do about bad breath?

Regular checkups will allow your dentist to detect any problems such as periodontal (gum) disease, a dry mouth or other disorders that may be the cause. Maintaining good oral hygiene, eliminating periodontal (gum) disease and scheduling regular professional cleanings are essential to reducing bad breath.

Regardless of what may be the cause, good oral hygiene is essential. Brush twice a day and clean between your teeth daily with floss or interdental cleaners. Brush your tongue, too. If you wear dentures, be sure to remove them at night and clean them thoroughly before replacing them the next morning. If you don't already have a dentist, see Manage Your Oral Health: You & Your Dentist.

How do I find a dentist who treats bad breath?

Dentists are taught in dental school about the oral causes of bad breath (halitosis). If you have bad breath, you may want to start by talking to your general dentist about treatment options. You can also contact your state dental association to see what resources are available in your area of the country.

What is the treatment for bad breath?

If your dentist determines that your mouth is healthy and that the odor is not of oral origin, you may be referred to your family physician or to a specialist to determine the cause of the odor and for treatment. Of course, if the odor is of oral origin, as it is in the majority of cases, your dentist can treat the cause of the problem.

If the odor is due to periodontal (gum) disease, your general dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Periodontal (gum) disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate. Sometimes more extensive treatment is necessary.

If you have extensive build-up of plaque, an invisible layer of bacteria, your dentist may recommend using a special antimicrobial mouth rinse. Your dentist may also recommend that when you brush your teeth, you also brush your tongue to remove excess plaque.

Where can I get products that will be useful in treating bad breath?

After determining the cause of your halitosis, your dentist will be able to prescribe or recommend those products that can be helpful for you. See Products with the ADA Seal of Acceptance. 

What is the effectiveness of "halitosis kits" and other products that claim to treat bad breath?

The American Dental Association does not vouch for the claims the manufacturers of halitosis kits make. However, if you are concerned about the safety and effectiveness, ask your dentist if the kits will be any use to you.

Most antiseptic mouth rinse products have been accepted from the ADA for their therapeutic benefits which reduce plaque and gingivitis with their breath freshening properties. These products kill germs that cause bad breath instead of just masking breath odor.

But it is possible to transfer the bacteria by kissing. Most people have bad breath and do not realize it. If you do not have a bad breath problem, you are unlikely to catch one by kissing a person with bad breath.

My floss smells, is this bad breath?

Bad Breath bacteria live all through the mouth, tongue, teeth and gums, throat and nasal areas. Therefore people that floss infrequently will have a buildup of these smelly anaerobic bacteria and their sulphur compounds trapped in the biofilm below the gums. But this amount of gum bacteria is not enough to cause bad breath, but rather a bad taste. Bad breath needs to come from a larger source of bacteria (that collected on the back of the tongue and throat). When you exhale, you blow out the sulphur compounds that have collected in the throat and tongue area. The exception to this, would be if you have bleeding gums when you floss your teeth as well as floss smells. This combination would indicate a change of mouth bacteria that would cause bad breath.

Bad Breath - are there any home remedies?

I don't know of any home products that can rid you of bad breath. What is known is that people that are fit and healthy suffer less from bad breath. This could be that their metabolism is in balance and does not allow the anaerobic bacteria to get out of hand. People that are mobile and active have less problems. People that do not go on high protein fad diets, or protein shakes have less bad breath problems. People that do not need to take medicines are better off as they do not get dry mouth.

Why don't "over the counter" mouthwash stop bad breath?

Mouthwash to stop bad breath is intrinsically different to those marketable for fresh breath. Bad breath mouthwash needs to be manufactured at neutral pH and with out alcohol (ethanol). This is an expensive manufacturing process, so is not often tackled by the major companies. Also eliminating bad breath, takes more than just a mouthwash. It takes a system that can remove biofilms from many areas such as teeth, gums, tongue, throat and nose. The big companies do not see this as profitable, when it is easier to churn out another mouthwash. Treating bad breath is a lot about education, so that each person can identify their own causes and treatments.  Bad Breath smell is of fecal odor - do I have a bowel problem Bacteria that live in the bowels and produce fecal smells, have cousins that have similar metabolic pathways, that live in the mouth. So mouth bacteria can cause fecal smells. It is just the method of metabolism. It is the same principle why mouth bacteria can make a "rotten egg gas" smell. It doesn't mean you ate eggs for lunch. It is the bacterial breakdown method.

Is a tongue coating normal?

Tongue coating is an individual thing. Tongue coating is a combination of saliva, bacteria, and by product. You should clean your tongue everyday for hygiene purposes. For bad breath sufferers, the bacteria in the tongue coating is an accumulation of anaerobic bacteria and sulfur compounds that cause bad breath. For bad breath patients, tongue coating is not good. For people with fresh breath, they have a different accumulation of bacteria that isn't as bad.