Good oral hygiene not only helps prevent halitosis, but also reduces the risk of us having cavities, abscesses, and gum diseases and losing our teeth.
Routine oral hygiene - recommended for everyone
The main treatment of bad breath coming from within the mouth is good oral hygiene. Aim to get into a regular habit of good oral hygiene - in particular, teeth brushing and cleaning between teeth.
Brush your teeth at least twice a day. Use a soft-tufted brush and a toothpaste that contains fluoride. The head of the brush should be small enough to get into all the areas of the mouth. Spend at least two minutes brushing, covering all areas (the inside, outside and biting areas of each tooth). Pay particular attention to where the teeth meet the gum. Get a new toothbrush every 3-4 months. Studies suggest that powered toothbrushes remove plaque and debris better than manual brushes.
Ideally, brush your teeth either just before eating, or at least an hour after eating. The reason for this is to help prevent tooth erosion. Many foods contain acids. In particular, fizzy drinks (including fizzy water) and fruit juices. After your teeth are exposed to acid, the enamel is a little softened. But, the action of calcium and other mineral salts in the saliva can help to counteract and reverse this softening. Therefore, do not brush teeth immediately after eating when the enamel tends to be at its softest; in particular, after eating or drinking acidic foods and drinks. It is best to wait at least an hour after eating or drinking anything before brushing.
Cleaning between teeth
Clean between your teeth after brushing once a day, but ideally twice a day. This is to remove plaque from between teeth. Dental floss is commonly used to do this. It may be that small interdental brushes are more effective, but studies have not yet shown this convincingly. The aim is to clean the sides of the teeth where a toothbrush cannot reach. Also, to clear the spaces between teeth (the interdental spaces) of debris. Some people who have not cleaned between their teeth before are surprised as to how much extra debris and food particles can be removed by doing this in addition to brushing.
If you are not sure how to clean between your teeth then ask your dentist or dental hygienist. Briefly: normal floss looks a bit like cotton thread. Cut off about 40 cm. Wind the ends round your middle fingers of each hand. Then grab the floss between the thumbs and first finger to obtain a tight 3-4 cm section which you can pull between teeth. Gently scrape the floss against the sides of each tooth from the gum outwards. Use a fresh piece of floss each time.
Some people prefer floss tape which slides between teeth more easily than normal floss. Also, some people use disposable plastic forks with a small length of floss between the two prongs. These may be easier to hold and manipulate. However, they are expensive. Some people use sticks, or small interdental brushes to clean the space between the teeth.
The gums may bleed a little when you start to clean between your teeth. This should settle in a few days. If it persists, see a dentist, as regular bleeding may indicate gum disease.
Have regular dental checks at intervals recommended by your dentist (normally at least once a year). A dentist can detect build-up of plaque and remove tartar (calculus). Early gum disease can be detected and treated to prevent it from getting worse.
Further reading and references
Kapoor U, Sharma G, Juneja M, et al; Halitosis: Current concepts on etiology, diagnosis and management. Eur J Dent. 2016 Apr-Jun10(2):292-300. doi: 10.4103/1305-7456.178294.
Halitosis; NICE CKS, November 2014 (UK access only)
Bollen CM, Beikler T; Halitosis: the multidisciplinary approach. Int J Oral Sci. 2012 Jun4(2):55-63.
Yaacob M, Worthington HV, Deacon SA, et al; Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014 Jun 17(6):CD002281. doi: 10.1002/14651858.CD002281.pub3.
Poklepovic T, Worthington HV, Johnson TM, et al; Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev. 2013 Dec 18(12):CD009857. doi: 10.1002/14651858.CD009857.pub2.
Kuo YW, Yen M, Fetzer S, et al; Toothbrushing versus toothbrushing plus tongue cleaning in reducing halitosis and tongue coating: a systematic review and meta-analysis. Nurs Res. 2013 Nov-Dec62(6):422-9. doi: 10.1097/NNR.0b013e3182a53b3a.
Porter SR, Scully C; Oral malodour (halitosis). BMJ. 2006 Sep 23333(7569):632-5.
Fedorowicz Z, Aljufairi H, Nasser M, et al; Mouthrinses for the treatment of halitosis. Cochrane Database Syst Rev. 2008 Oct 8(4):CD006701.
Phillips IR, Shephard EA; Trimethylaminuria, University of Washington, 2007 (updated 2011)
Reidy JT, McHugh EE, Stassen LF; A review of the role of alcohol in the pathogenesis of oral cancer and the link between alcohol-containing mouthrinses and oral cancer. J Ir Dent Assoc. 2011 Aug-Sep57(4):200-2.
I'm 35 and had 5 wisdom teeth out 8 days ago (yes I had an extra one) under a general anesthetic. I never had very much pain from the actual extraction areas, just what was to be expected. But ever...michael 60452
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