Bad Breath

Bad Breath Basics

It's been said that normal, healthy breath is sweet smelling, with an aroma similar to the scent of blooming chestnuts! If you or someone you care about suffers from bad breath I can help. Make an appointment to determine and discuss the best treatment for your mouth.

Although oral malodor (bad breath) has multiple origins, the most common is degradation of cause is decaying teeth and gum diseases. This is why offensive breath treatment must start with optimum dental health.

4 Steps to Fresh Breath

  1. Eliminate all areas of active bacterial infection, decayed teeth and inflamed gums
  2. Eliminate tartar, stain and irritants
  3. Eliminate deteriorating, corroding and defective dental work
  4. Institute proper cleaning procedures and home care products

While everybody experiences bad breath occasionally, persistent malodor effects at least 50% of the population and half of these people suffer from a severe, chronic problem that creates personal discomfort.

Getting to the Roots of Bad Breath

The most common cause of malodor is dental disease such as decay and deteriorating dental work. The odours come from the same bacteria that causes decay and gum disease.

Bacteria that reside on the teeth and tongue that break down proteins are also very common sources of malodor even in healthy mouths. Stress may also sufficiently alter the body systems to produce a disagreeable breath odour.

Morning Breath

Morning breath is caused by a decrease in the flow of saliva during sleep combined with reduced activity of the tongue and cheek muscles. The resulting build-up of various compounds creates bad breath.

Brushing your teeth, the roof of your mouth and the tongue as vigorously and as far back as possible best eliminates morning breath. After brushing and flossing you should thoroughly rinse with plain water. It's best to avoid high alcohol content mouth rinses that dry and damage cells lining the mouth and could contribute to the resurgence of bad breath a few hours later.

If you suffer from one of many allergy-related diseases such as sinus problems, skin rashes, hay fever, bronchitis and seasonal allergies, you're at much greater risk of having persistent malodor.

The Rinsing Reality

There's a growing number of fresh breath centres throughout the country that promote one or two specific products they claim can cure bad breath. Most of these treatments aren't proven effective over time because the products don't have sufficiently strong antibacterial actions. Usually, these products have a short-term effect or partially mask the real problems.

Effectiveness of Rinses

  • Water: Usually effective for 15 minutes.
  • Essential Phenolic Oils (Listerine & Cool Mint Listerine): More effective than water. Measurably lower bacterial counts.
  • Zinc chloride (Prevention Periodontal Mouth Rinse): Mark reduction of volatile sulphur compounds over time with substantially reduced odour for 10 hours.
  • Chlorhexidine (Periogaurd, Peridex Prescription only): Substantial antiseptic with highly effective, lasting results. Prolonged use may cause staining easily removed with polishing or bitter taste.
  • Chlorine dioxide: Unproven effective and some caution from a report by the Canadian Cancer Research.
  • Cetylpyridinium chloride (Scope-16.6% alcohol, Cepacol): Effective odour reduction for 3 hours.
  • Lactoperoxidase, Lysozyme, Lactoferrin (Salivary enzymes): Good for improving dry mouth.

The Rinse That's Right for You

It's time for a new mouthwash.

No mouthwash or rinse replaces the need for brushing and flossing. The bacterium in plaque forms a tenacious, sticky film that can only be removed by physically scraping it with toothbrush bristles or floss. Rinses are only effective after brushing and flossing. Rinses clear away the microbes and can delay new plaque formation, which usually begins to grow again within several hours.

Cancer & Alcohol Content

Listerine may be the only non-prescription mouth rinse to carry the ADA Seal but it also has the highest alcohol content at 26.9 percent. Cool Mint Listerine is 21.6% alcohol. Plax is 7.2% alcohol. This information is not available on the label. The National Cancer Institute has reported that regular users of mouth rinses containing 25% or more alcohol could have a higher risk for oral cancer.

There's a growing body of studies that appear to confirm that Listerine and chlorhexidine mouth rinses are effective at reducing bacteria through pre-rinsing for 30 seconds. Chlorhexidine rinses (Periogaurd, Gingigaurd and Peridex) in a concentration as little as 0.12% disrupt bacterial cells by damaging their membranes or cell walls.

But one of the problems with all mouthwashes is that they're liquid and quickly washed away. Gels are a more effective way to deliver some formulations where they're needed.

For maturing adults the problems of gum recession resulting in root exposures leads to sensitivities and even root surface decay. Fluoride has again become more important as prevention. Many of my patients now require occasional or long-term fluoride rinses.

As you get older, your saliva changes in many ways as well, leaving you more susceptible to oral diseases. Your saliva becomes a less efficient buffering agent, decreases in flow rates and becomes thicker. I can prescribe excellent supplemental rinses to help you combat these problems.

Chlorhexidine

Chlorhexidine is the most effective mouth rinse currently available.

It's excellent for reducing gum inflammation and bleeding between treatment appointments as part of a professional periodontal therapeutic program. I usually prescribe it to be used daily for one week on and then one week off. Sometimes I recommend that on the 'off' weeks you use a fluoride rinse. It's safe in even pregnant and nursing mothers since it's not swallowed and has been proven safe when even large amounts have been ingested.

One of the precautions of using chlorhexidine rinses is that your gums may become so healthy that underlying periodontal disease of the supporting bone can be masked even though it also needs treatment. This is one reason why it must be prescribed and used as part of a comprehensive periodontal program.

The rinse also has a tendency to stain un-removed plaque a light, tan brown colour that's easily removed with conventional, professional polishing procedures. A small percentage of patients will also experience a temporary change in taste perception. In most cases, you'll regain your normal taste perception even without stopping the use of the chlorhexidine.

The Recommended Rinse

I recommend that when I prescribe chlorhexidine rinses that you start its use directly after having your teeth cleaned and polished. You should rinse with 15ml for 30 seconds in the morning and evening after cleaning your teeth.

After rinsing for 30 seconds you spit the rinse out and then avoid rinsing, eating or drinking for 30 minutes. I most often recommend that you use chlorhexidine rinse for one week 'on' and one week 'off' for approximately 3 months. At that time, it's important that your gums and tissues are re-evaluated and any accumulated stain removed.

If you find that your gums bleed occasionally or are concerned with offensive breath, ask us about chlorhexidine rinses at your next appointment.

Stick Out Your Tongue at Bad Breath

Proper oral hygiene includes brushing your teeth, your gums and yes, your tongue! Regular tongue brushing for adults with healthy gums can greatly improve breath quality.

The tongue, which occupies one-third of your mouth, provides a warm, moist breeding ground for bacteria. Bacteria counts increase tenfold after only one week of not brushing your tongue.

If you already have healthy teeth and gums, tongue brushing can go a long way to improve your mouth odour. But if you have another notorious cause of bad breath—gum disease—you need to come in and see me.

Tongue Scraping Statistics

In one study involving 30 adults with healthy teeth and gums, the group was divided into two, each employing a different tongue-cleansing method.

The first group used a toothbrush, and the second group used a tongue scraper - a thin plastic strip that can be bent into a U-shape. Those who used tongue scrapers enjoyed the greatest improvement in breath, although tongue brushers also had significantly better breath.

The second study involved adults suffering from gum disease. It concluded that tongue brushing or scraping alone didn't reduce bad breath. Mouth odour caused by gum disease won't go away with brushing but rather must be treated by caring for the gum disease first. Next time you come in for a visit ask one of my hygienists about a tongue scraper.

At Dentistry Asleep®,Dr. Kevin Dann offers dental hygiene services, routine dental care for adults and children, periodontal and endodontic therapy,  cosmetic dental procedures and dental implants. Dr. Dann is one of the few Certified Specialists in Dental Anaesthesia, giving complete, comfortable care to all his valued patients. Enjoy experienced, anxiety-free dental healthcare!  Make your appointment now!