How do I ditch bad breath?

I feel like I have bad breath sometimes, but it’s hard to know if it’s in my head or not. I asked my roommate and he said he’d noticed it. I’m so embarrassed! What do I do? — Kate, Toronto I have a simple rule: You’re not a real friend if you won’t tell me I have chia seeds or spinach stuck in my teeth. I respect people who tell the truth, even if it’s not pretty. It demonstrates their confidence in you: proof they know you can handle a moment of embarrassment in the name of growth.

But of course, the overarching caveat is that any tough news should be broken with kindness and compassion — quietly, quickly and preferably with a little reassuring wink. And there is a difference between noticing and nitpicking.

So before we get any further, let’s make something clear: “The cause and the perception of bad breath are completely different,” explains Dr. Jim Hyland, dentist and president of OralVital — a Canadian company that specializes in products used to treat oral infections — and a founding member of the American Academy for Oral Systemic Health. “Bad breath is caused by bacteria that are naturally found in our mouths. They break down protein and produce sulphur compounds, which is what people can smell. The perception of that, however, is that you’re somehow unclean or not taking care of yourself, which of course is not true, and which is what creates a great deal of insecurity in people who suffer from it.”

With that said, it’s not surprising your roommate is noticing something you simply aren’t able to: “You can’t smell your own breath technically,” he says. “In other words, you can’t just put your hand in front of your mouth and exhale because the volatile sulphur compounds that are produced affect your sense of smell and taste buds, so you become immune to it a little bit.” A more trustworthy indicator is to stick your tongue out as far as you can and lick your wrist, let the saliva dry for a few seconds and then sniff that.

While we all know that eating a garlicky lunch will leave us with potent breath, not drinking enough water is a lesser-known culprit, as is skipping meals, eating a high-protein diet, exhaustion, stress and chewing sugary gum. All of these common habits create a breeding ground for the bacteria that cause bad breath.

Managing those microorganisms is a top priority for people who suffer from bad breath — as well as those who suffer from gum disease, which is also caused by bacteria, and affects some 80 per cent of people. Microbes get trapped in the mouth — often around the gum line and between teeth — in a gluey substance called biofilm. “If all you’re doing is brushing your teeth, you’re cleaning the wrong place. That’s like cleaning the wall to remove dirt from a baseboard. You need to clean the junction between your gums and your teeth.”

Instead of swearing that you’ll one day start flossing religiously, try Hyland’s favourite tool: a soft pick, which you pass gently through your teeth once a day before brushing. I have to say, since speaking with him, I’ve been using the picks, which are kind of like tiny little plastic spooled brushes, and I am addicted. “When you use the pick at first, your gums may bleed — that’s because they’re infected. Healthy gums would never bleed. They may hurt — that’s because they’re inflamed. You must persist; you have to suck it up. It’s not the instrument causing the problem, because if you use that instrument on healthy skin, it doesn’t hurt. You are cleansing a wound, even if it’s one you can’t see, and by the third day or so, the bleeding should go away.”

You also might notice your gums start to shrink a little after a few days, which is not the same as receding. “They will shrink because they were swollen and they’re going from beer belly gums to six pack abs!” says Hyland with a laugh.

After using a pick, it’s time to brush. With a very small amount of toothpaste and a light touch, hold your brush at a 45-degree angle and use circular motions to clean around each tooth, whether you have a manual or electric brush. “Imagine what you’re trying to accomplish, which is the same motion as cleaning under your fingernails — and get each tooth, like a bee pollinating flowers.” And here’s an important note: if, after three months of use, your toothbrush doesn’t look like it did when it came out of the package, you’re pushing too hard.

“Going to the dentist regularly to get cleanings is really important to get rid of the scale that provides a rough surface for bacteria to cling to, but it doesn’t prevent gum disease,” he notes. “There’s not a single study published that shows scaling teeth prevents gum disease — it’s treatment, not prevention. And this is a vital public health message because so many people have gum disease, despite the care that we provide, and these bacteria are associated with strokes and heart attacks, with syphilis and Lyme disease, with Alzheimer’s, dementia and rheumatoid arthritis.”

The take-home is that we can’t rely on biannual dentist visits to do all the work: We need to care for our gums daily. Hyland suggests asking your dentist to “disclose” your teeth at the beginning of your visit, which essentially means using a dye to reveal where biofilm has been building up — and shows the areas you’ve been missing while brushing and picking. Ask your dentist to measure your gums, as well.

Hyland suggests those with persistent bad breath should consider a probiotic supplement and an over-the-counter mouthwash that targets the specific bacteria that causes the problem, with ingredients like chlorine dioxide and zinc — rather than a bleach-based product that eliminates all bacteria, including the useful strains. If those at-home strategies don’t work, or if gum bleeding persists, you should consider talking to your dentist about an antibiotic mouthwash.

“I just want people to know one thing: Your gums should not bleed,” says Hyland as we say our goodbyes. “I am trying to make a difference in the world: Gum disease is the most prevalent disease — more prevalent than the common cold — and it’s completely preventable.”