Bad breath? You could be talk­ing too much!

With one in four af­fected by hal­i­to­sis, ex­perts give their VERY sur­pris­ing ad­vice

Daily Mail - - Good Health - By HELEN FOSTER

THOUGH it’s not a sub­ject most of us want to dis­cuss, the fact is that bad breath is a prob­lem that af­fects one in four peo­ple.

It’s typ­i­cally caused by sul­phuremit­ting sub­stances in the mouth, which trig­ger the odour. Th­ese oc­cur when cells start to die and de­cay as part of the nat­u­ral process of cell re­newal or they can also be pro­duced by cer­tain bac­te­ria that live in the mouth.

How much breath smells de­pends on the level of odour- caus­ing bac­te­ria or de­cay­ing cells in the mouth.

This re­flects how well you clean your teeth and the state of your oral health.

Gum dis­ease is the most com­mon cause of chronic bad breath: it leads to in­flam­ma­tion of the gums, which makes them swell and sep­a­rate from the teeth, cre­at­ing gaps, called pock­ets, that trap bac­te­ria and de­cay­ing cells and in­creases the rate at which cells die.

‘The poorer your den­tal hy­giene or the more crowded/crossed and hard to clean be­tween your teeth are, the more likely it is that you’ll suf­fer prob­lems,’ says Dr Mervyn Druian, a den­tist and hal­i­to­sis spe­cial­ist at the London Cen­tre for Cos­metic Den­tistry. How­ever, you don’t have to have gum dis­ease — or poor den­tal hy­giene — to have bad breath . . .

YOU’RE NOT BRUSHING YOUR TONGUE DAILY

THe most com­mon oral cause of bad breath aside from gum dis­ease is an over­growth of odour-caus­ing bac­te­ria on the tongue. It’s not clear if this is re­lated to diet, smok­ing or other is­sues, but the most com­mon area for the bac­te­ria to build up is right at the back of the tongue.

It’s an area most of us don’t in­clude in our daily tooth clean­ing reg­i­men, ac­cord­ing to Pro­fes­sor Robert Al­laker and Dr Abish Stephen, oral mi­cro­bi­ol­o­gists at the In­sti­tute of Den­tistry at Queen Mary Univer­sity London, and two of the UK’s lead­ing re­searchers into breath odour.

‘Clean­ing the tongue gen­tly with a tooth­brush can help re­duce odour,’ says Pro­fes­sor Al­laker.

‘Tongue scrap­ers can be used, but there’s no ev­i­dence they are any more ben­e­fi­cial than brushing gen­tly. Mouth­wash also helps as part of a daily rou­tine as it in­hibits the growth of bac­te­ria that cause odour and neu­tralises bad smelling com­pounds.’

An­other po­ten­tial treat­ment is oral pro­bi­otics — gum or sup­ple­ments that in­tro­duce ben­e­fi­cial bac­te­ria to the mouth.

They crowd out odour-form­ing bugs, but Dr Stephen says: ‘Th­ese show promis­ing re­sults, but we don’t know if there are any longterm ben­e­fits of chang­ing the bac­te­ria this way.’

ARE YOU TALK­ING TOO MUCH?

Any­THInG that de­hy­drates the mouth will in­crease the risk of bad breath as saliva helps wash away odour-caus­ing bac­te­ria or cells.

This is why odour is worse in the morn­ing when saliva flow is re­duced and is also more com­mon in peo­ple who breathe mostly through the mouth.

‘Talk­ing a lot is an­other fac­tor as it ex­poses the mouth to air — dry­ing out saliva,’ says Dr Druian.

‘So those in vo­cal pro­fes­sions, such as teach­ers, lawyers and peo­ple work­ing in call cen­tres, are par­tic­u­larly prone.

‘The so­lu­tion is quite sim­ple — sip wa­ter through­out the day to keep the mouth moist.’

Re­duced saliva flow is also more com­mon as we get older and as such bad breath tends to worsen with age.

Again, keep­ing the mouth moist

will help. ‘your doc­tor can of­fer sprays or lozenges to pro­mote saliva flow,’ says Dr Druian.

JUST BLAME THE STRESS OF WORK

STReSS af­fects saliva flow, which dries the mouth. new re­search from the Med­i­cal Univer­sity of Sofia in Bul­garia has found stress hor­mones cause bac­te­ria in­volved with bad breath to colonise the mouth at a faster rate.

So, clean­ing, floss­ing and us­ing mouth­wash are im­por­tant if you are un­der pres­sure.

YOU HAVE BEEN SKIP­PING MEALS

Be­CAUSe it stim­u­lates saliva pro­duc­tion and moves food and bac­te­ria out of the mouth, the sim­ple act of eat­ing helps re­duce bad breath.

Stud­ies by the Den­tal Clinic of the Univer­sity of Bern in Switzer­land found breath odour was re­duced for an av­er­age of 2½ hours af­ter eat­ing — longer if the meal con­tained fi­bre, which acts al­most like a tooth­brush.

So not eat­ing reg­u­larly could lead to odour. ‘Fast­ing plans or high-pro­tein/low- carb di­ets that switch the body into a state called ke­to­sis where it burns fat for fuel

can trig­ger bad breath,’ says Dr Druian.

The odour comes from sub­stances called ke­tones, which are pro­duced when we burn fat. This breath smell, of­ten de­scribed as sweet or smelling like nail var­nish re­mover, won’t dis­ap­pear un­less you stop the diet. Drink­ing more wa­ter or pep­per­mint tea and chew­ing pars­ley can help dis­guise it.

STONES IN YOUR MOUTH

yOUR ton­sils are not smooth — they have dips and pits in them known as crypts. ‘If food or other de­bris get caught in th­ese crypts it cre­ates an en­vi­ron­ment where the bac­te­ria that causes bad breath can thrive,’ says James Tysome, an enT sur­geon at Ad­den­brooke’s in Cam­bridge and Spire Cam­bridge Lea Hos­pi­tals.

This is par­tic­u­larly likely if the de­bris hard­ens, a prob­lem known as ton­sil stones.

A 2008 Brazil­ian study found 75 per cent of peo­ple with high lev­els of sul­phur com­pounds in the breath also suf­fered ton­sil stones.

Salt gar­gles and an­tibi­otics can re­duce ton­sil stones by killing

bac­te­ria. ‘But the only cure if you de­velop them reg­u­larly is re­mov­ing the ton­sils,’ says Mr Tysome.

‘How­ever, this is only likely to be done if they are se­verely im­pact­ing on your qual­ity of life.’

IT’S THE STOM­ACH UL­CER BAC­TE­RIA

HeLICOBACTeR py­lori is bac­te­ria found in the stom­ach of 40 per cent of the pop­u­la­tion. It’s most com­monly as­so­ci­ated with

the de­vel­op­ment of stom­ach ul­cers, but it has also been linked to bad breath.

In fact, a 2015 study from the Penin­sula School of Medicine and Den­tistry in Ply­mouth found that erad­i­cat­ing helicobacter py­lori with an­tibi­otics dra­mat­i­cally re­duced hal­i­to­sis in peo­ple who had the bac­te­ria and bad breath.

‘This bac­te­ria pro­duces sul­phur com­pounds and am­mo­nia that al­ter the odour of the breath,’ says Pro­fes­sor Al­laker. But if it lives in the stom­ach, how can odour end up in the breath?

The an­swer is acid re­flux — if the re­flux con­tains helicobacter py­lori this can change the smell of the breath. If bad breath is as­so­ci­ated with heart­burn, a hoarse voice or food re­gur­gi­ta­tion, ask your doc­tor to test for this bac­te­ria.

YOUR SINUSES ARE BLOCKED

‘I GeT a lot of peo­ple com­ing to see me com­plain­ing of bad breath and upon ex­am­i­na­tion I find the prob­lem is that they have some­thing wrong with their nose,’ says Mr Tysome.

‘ They’re suf­fer­ing chronic si­nusi­tis — an in­flam­ma­tion of the sinuses, which are the air-filled cav­i­ties be­hind the cheek­bones and fore­head.’ Mu­cus, which has high lev­els of pro­teins that feed the odour-caus­ing bac­te­ria, drips down the nose into the throat. A steroid- based nasal spray re­duces in­flam­ma­tion and the symp­toms that come with it.

. . . OR IT COULD BE DI­A­BETES

BAD breath may be trig­gered by chem­i­cals in the blood. ‘We call this blood-borne hal­i­to­sis and while it’s not a com­mon cause of bad breath it should be con­sid­ered,’ says Dr Sal­iha Saad, an oral mi­cro­bi­ol­o­gist at the Univer­sity of West eng­land. It’s most com­monly re­lated to dis­eases where tox­ins build up in the blood and odours as­so­ci­ated with th­ese are ex­creted through sweat or breath. Di­a­betes gives the breath a sweet, sickly scent ( from ke­tones build­ing up in the blood), liver dis­ease causes a musty odour and kid­ney prob­lems re­sult in a fishy/ am­mo­nia-like smell.

CHECK YOUR MEDICINES

CeR­TAIn med­i­ca­tions can also be as­so­ci­ated with bad breath — most com­monly be­cause they dry the mouth. Th­ese can in­clude anti-de­pres­sants, anti-his­tamines and blood pres­sure med­i­ca­tion.

If your prob­lem started when you be­gan a new drug, ask your GP if dry mouth is a known side­ef­fect — they may pre­scribe an al­ter­na­tive med­i­ca­tion.

YOU’RE SIM­PLY IMAG­IN­ING IT

WHen re­searchers in Bel­gium an­a­lysed the cause of bad breath in 2000 pa­tients at­tend­ing a bad breath clinic, they found 16 per cent didn’t have bad breath at all — they were imag­in­ing it.

‘It is called hal­i­to­pho­bia and peo­ple with it of­ten cover their mouth when they speak, avoid get­ting close to peo­ple and are fix­ated with oral hy­giene be­cause they are so con­vinced their breath smells,’ says Pro­fes­sor Al­laker.

The first stage in di­ag­no­sis is an in­de­pen­dent as­sess­ment of breath odour (not avail­able on the nHS).

An easy DIy test is to lick your wrist, wait ten sec­onds and smell.

Pic­ture: GETTY

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