Bad breath: what helps when it becomes chronic

Everyone knows that bad breath after getting out of bed or eating garlic pasta. Even if it's not pleasant, this bad breath generally disappears on its own and is nothing to worry about.

That said, the situation becomes more difficult when it sets in. In medical jargon, this is known as chronic halitosis. When colleagues turn away from you in whispers or your partner keeps his distance, bad breath generates great suffering. "Those affected are caught in a terrible psychological spiral," explains Professor Andreas Filippi, a specialist in oral surgery and head of the consultation on bad breath at the University Centre for Dentistry in Basel UZB. "When employers threaten redundancy or marriages break up: these are not isolated cases, a frightening number of people are affected."

Concretely, in Switzerland, around one in four people suffer at least temporarily from clearly perceptible bad breath and around six per cent of people suffer from it permanently. Professor Filippi explains what the causes may be, how to know if you are affected by this problem and what can help in a lasting way if you are.

Bad breath: the different causes

Bad breath develops in 90 per cent of cases in the oral cavity. The most common cause is the enormous biofilm on the surface of the tongue: there are up to 1,000 different species of bacteria, which are an important part of a healthy oral flora, but are often also the culprits behind bad breath, because : "they break down organic substances into volatile sulphur compounds and thus cause bad breath", explains Professor Filippi.

Dry mouth is also often the cause of bad breath. For example, every morning when we get up: "We produce little saliva when we sleep and the rinsing effect of the biofilm on the tongue and teeth is therefore lacking", the expert tells us.

The problem is that the mouth is often dry.

Every 20 minutes or so, the bacteria in your mouth doubles. If you lack saliva or don't drink enough, these bacteria continue to multiply freely and bad breath has a field day. While dry mouth at night is completely normal and bad breath generally disappears after the first glass of water or brushing of the teeth, dry mouth is persistent in others: "some people don't produce enough saliva. For example, because of regular medication, smoking, age or illness, or after cancer treatment."

Halitosis can have up to 200 different causes. These include piercings in the mouth, cavities or general medical problems such as inflammation of the sinuses, tonsils or gastric mucosa. Although more serious illnesses are rarely involved, a medical examination is recommended.

Suspicion of bad breath: how to test yourself

It's a terrible idea to be warned by other people about your own bad breath. There's a difference between occasional bad breath and chronic bad breath. The former is quickly resolved: next time, you simply won't eat an onion kebab for lunch at the office. It's a different story when those around you decide, after weeks or months, to tell you about your bad breath...

"There is no time limit for the word chronic," explains the expert. "We talk about chronic bad breath when it can only be masked, but not controlled. What's also insidious is that the people affected don't notice their bad breath themselves for a very long time. As it forms slowly, the nose has enough time to get used to the new odour molecules.

A simple way to detect bad breath in yourself is the airbag method. Professor Filippi explains how to proceed: "you take a plastic bag that must be larger than the volume of your own lungs, i.e. more than seven litres. Breathe into it, but in such a way as not to inflate it: inhale normally through your nose and breathe the exhaled air into the bag. "Then you have to breathe in fresh air for a few seconds or, failing that, smell ground coffee to neutralise the olfactory receptors in the nose.

By then letting the air out slowly in front of your nose, you can determine whether you are still suffering from halitosis (for example after therapy). The method (along with other useful information for those affected) is described in detail in the UZB's Halitosis app.

Halitosis treatment: here's what you can do yourself about bad breath

If bad breath is proving to be a recurring issue, you can initially tackle it yourself. In practical terms, you can optimise your oral hygiene and adapt your diet. Professor Filippi explains what's important:

1. Cleaning the tongue

As bad breath generally originates in the oral cavity, oral hygiene is an important lever in the treatment of halitosis. "The question is not so much whether your oral hygiene is intense, but whether you have the right technique," says the expert. When you brush your teeth, use the right toothbrush and change it regularly. If bad breath is stubborn, the expert recommends brushing at least twice a day, but three times a day is preferable, and rinsing your mouth regularly and properly.

In addition, you should start no later than now with the daily tongue cleaning: there are specific grattoirs and special pastes for this. What's more, now is the time to floss every day, because plaque degrades: plaque settles in the interdental spaces, promoting the onset of bad breath.

2. Diet

The number one tip against bad breath is to drink plenty and regularly in order to rinse off the biofilm on the tongue and teeth. Water is the best way to do this, but teas have also proved useful: thanks to its antimicrobial effect, green tea in particular helps to combat bad breath, not only in the short term, but also in the long term. The ginger has a similar effect.

Tea

Twinings Tea bags Green Tea Earl Grey 25x 1.6 g

40 g

3

Tea

Pukka Three Inwer Tea

36 g

7

Tea

Yogi Tea Green Tea Ginger Lemon

30.60 g

8

When it comes to meals, you should favour fibre-rich foods. In addition, you should cut back on sausages, steaks and the like for a while, as "people who eat meat have stronger breath than those who eat mostly plants", says the expert. He explains: "Meat is mainly made up of proteins and peptides. It has to be chewed for a long time before being swallowed, which releases amino acids that are in turn broken down by bacteria in the mouth and cause bad breath."

When nothing else works: fighting bad breath professionally

If bad breath cannot be controlled either by optimising oral hygiene or by changing eating habits, professional help is needed. In particular to determine whether it really is halitosis or just halitophobia: the fear of having bad breath.

"These people are convinced they have bad breath. But it doesn't show up in measurements," explains the specialist. "This is a real crisis: the suicide rate is frighteningly high in this group. These patients need to see a psychiatrist or psychologist."

But if the measurements of your exhaled air clearly indicate halitosis, it's important to seek help from a professional. The best thing is to go directly to a specialist centre.

The exact cause of the bad breath is determined there: are the triggers in the oral cavity, in the nasal sinus, on the tonsils or elsewhere? "Further treatment then depends on where the cause of the bad breath lies."

If the bad breath develops in the oral cavity, a professional cleaning is carried out: the tongue, the surface of the teeth and the gum pockets (especially if they are particularly deep and cannot be cleaned at home). Afterwards, and by following professional advice on oral hygiene and diet, halitosis can be completely cured, reassures the specialist.

Look to the future: probiotics for bad breath?

In recent years, probiotic research has focused on halitosis. Indeed: on the intestinal flora, probiotics, viable micro-organisms, work wonders. They can be just as valuable for the oral flora, at least in theory. Administered in the form of suckable lozenges, long-lasting probiotic bacteria are supposed to conquer vital space in the mouth and gradually crowd out the bacteria responsible for bad breath.

"In clinical reality, it still doesn't really work very well," says Professor Filippi, who has himself done research with probiotic preparations. "There are three major problems: you have to take these expensive preparations for the rest of your life; the effect is negligible (at least at present); and finally, there is a certain risk of side effects from ingesting bacteria that are foreign to the body for years on end, which no one has yet really been able to assess."

So you'll have to wait a little longer before you can beat chronic bad breath with a sucking tablet. And follow the advice above.