How to get rid of bad breath

What causes bad breath?

It's a common misconception that bad breath originates in the stomach. Not so, says Dr Katz - one of the world's leading experts on bad breath.

"It's actually caused by anaerobic sulphur-producing bacteria that breed beneath the surface of the tongue and in the throat and tonsils. These bacteria produce nasty smelling chemicals called volatile sulphur compounds, some of which are known as hydrogen sulphide (the rotten egg smell chemical), and other chemicals known as putrescine and cadaverine (the odours found in rotting foods and dead bodies).

"In the mouth, bad breath is more prevalent when the mouth is dry. This is because nature's way of keeping one's breath fresh is saliva, which contains several natural 'anti-halitosis' compounds one of which is oxygen. The bacteria that lead to bad breath are classified as 'anaerobes', which means that they cannot survive in the presence of oxygen, so people who have plenty of saliva always have fresh breath - that's why babies always smell so great - they have plenty of saliva."

Saliva shortages

The bad news? As we get older we produce less of this all-important saliva, which is why staying hydrated is so important.

"After the age of 25 we produce lesser amounts of saliva, which means everyone has less natural protection," points out Dr Katz. "That is why daily use of an oxygenating mouthwash and toothpaste to replace lost oxygenation from a dry mouth is so crucial. Studies show that older people also have a higher incidence of gum disease and tooth decay because of the fact there's less saliva present."

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The medication minefield

If you've recently started taking a new type of medication, this could well be the cause of your bad breath. "People taking medication - especially multiple types of medication - are more prone to bad breath," says Dr Katz.

"75% of prescription medications list a dry mouth as a possible side effect. Also, those who have undergone head and neck radiation treatment tend to have bad breath because the salivary glands become destroyed by the radiation."

Tonsil trouble

While you've probably never examined your tonsils in great detail, they could well be the cause of your bad breath.

"Besides a dry mouth, there are physical conditions to consider such as large tonsils, which have the ability to trap bacteria and mucus as it drains down the throat," explains Dr Katz. "Someone who has this combination of problems ends up with something called 'tonsil stones' or tonsiloliths. These are extremely odorous 'globs' of material that become stuck deep in the tonsils. They're very common."

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Tongue twisters

Our tongues contain a huge amount of bacteria, which is why it's so important to regularly clean your tongue - if you don't have a tongue scraper, simply give it a good going over with a separate toothbrush.

"People who have a rougher tongue will usually find that more bacteria gets trapped below the tongue's surface," says Dr Katz. "People who have this condition can have what's called a 'furrowed tongue' or even a condition known as 'black hairy tongue' where the papillae (the fibres that make up the tongue) are very long and become discoloured - often due to an overuse of antibiotics."

And, let's face it, having a black hairy tongue will never, ever be a good look.

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Get your gums checked

If your bad breath is enough to clear whole rooms, there's a good chance you've got gum disease, which means you need to make an appointment with your dentist - pronto.

"Gum disease can cause terrible bad breath," admits Dr Katz. "The bacteria that cause bad breath are related to the bacteria that cause gum disease. In fact, once gums start to bleed, bad breath bacteria take the proteins in red blood cells and use them as a fuel source to create stronger odours."

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The protein problem

Diet plays a huge part when it comes to bad breath - and we're not just talking about super spicy curries, either.

"The mechanism by which the bacteria creates odours is the breakdown of certain proteins and the extraction of sulphur from specific amino acids," says Dr Katz. "The favoured proteins are dairy proteins. Some foods already contain odorous sulphur compounds: onions, garlic and curry. Sugar feeds all types of bacteria and should ideally be avoided. We also tell patients to avoid dairy foods as much as possible. We have also found that many body builders tend to have bad breath because the 'bulking' products they use are full of dairy compounds."

Mouthwash or mouth tosh?

Although mouthwashes will never be a match for serious cases of bad breath, they can certainly help prevent it, although it's worth checking the ingredients list to find the right mouthwash for your needs.

"Most modern mouthwashes and toothpastes have similar ingredients," points out dental hygienist Henriette Brown, of London-based Open Dental Care, who was recently voted 'Best Dental Care Professional in London' at the National Dentistry Awards.

"One basic ingredient to look for is Triclosan, which is antibacterial and combats bad breath. Mouthwashes and toothpastes containing fluoride reduce and slow down dental decay and resulting odours. Xylitol is great for reducing the bacteria that causes decay, and can be used as a mouth rinse or in chewing gum. Flavours to go for are mint, cinnamon or lemon - all of which linger longer than fruity flavours like bubblegum or strawberry."

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The bad breath test

Honesty isn't always the best policy, so don't rely on your nearest and dearest to tell you that your breath smells less than perfect.

"A simple blow into your capped hand and a quick sniff test can help identify problems, or you can check with your hygienist," says Henriette Brown. "Most dentists will be able to do a bacterial test during your check-up, which can show if there are very high amounts of odour-causing bacteria. If you have persistent bad breath, ask your GP for a blood sugar test as you may have diabetes."

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Cigarettes and alcohol

While it's not going to come as a surprise that alcohol, cigarettes and coffee can all contribute to bad breath, the reasons are somewhat more surprising. "Cigarettes or anything one smokes can cause bad breath because they make the mouth dry," says Dr Katz.

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"Alcoholic beverages can also contribute to bad breath for the same reason - because they makes the mouth dry. Coffee can cause bad breath because of its acidic nature - tea is a much better alternative as it's pH neutral."

Armed with the facts about bad breath, it's easier than you think to eradicate the problem and make a good impression.

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