What is the treatment?
Good oral hygiene
For most people, the treatment for bad breath is much the same as the measures of good oral hygiene described in the prevention section. This means regular effective teeth-brushing and cleaning between teeth.
These routine daily procedures are usually sufficient to look after your teeth and to prevent bad breath. However, if you still have bad breath coming from your mouth then the following extra measures may help cure the problem.
Consider using a mouthwash each day. Chemicals in the mouthwash aim to kill germs (bacteria) and/or neutralise any chemicals that cause bad breath. It is difficult to advise on which mouthwash is the most effective. A number of clinical trials have shown that various ingredients are good at reducing bad breath. These include chlorhexidine, cetylpyridinium chloride, chlorine dioxide, zinc chloride and triclosan. The various mouthwashes that you can buy usually contain one or more of these ingredients, plus various other ingredients.
Note: some people are reluctant to use a chlorhexidine-containing mouthwash long-term. This is because it has an unpleasant taste, can give rise to a burning sensation in the mouth if used too frequently, and can cause (reversible) staining of the teeth or occasionally some temporary darkening of the tongue. Also, some mouthwashes contain alcohol as one of their ingredients. There is some concern that long-term use of alcohol-containing mouthwashes may be a risk factor in the development of mouth cancer. Also, young children should not use a mouthwash if they may swallow it.
Consider cleaning the back of your tongue each day. Some people do this with a soft toothbrush dipped in mouthwash (not toothpaste). An easier and better way is to buy a special plastic tongue scraper from a pharmacy. You need to place it as far back as you can and then gently scrape forward to clear the tongue of any coating. Some studies suggest that tongue scrapers or cleaners are slightly more effective than toothbrushes as a means of controlling halitosis.
Some people chew sugar-free gum after each meal. It is not clear how well gum helps to reduce bad breath but chewing gum increases the flow of saliva. Saliva helps to flush the mouth to help clear any debris remaining from the meal.
Food and drink
Sugars and sugary foods in the mouth are the main foods that germs (bacteria) thrive on to make acid which can contribute to tooth decay. Acidic foods and drinks are also a main factor in tooth erosion. So, some tips:
- Limit the amount of sugary foods and drinks that you have. In particular, don't snack on sugary foods.
- Try to reduce the amount of acid in contact with your teeth. So, limit fizzy drinks (including fizzy water) and fruit juices, as these tend to be acidic. Perhaps just limit yourself to one fizzy or fruit juice drink a day. Otherwise, choose drinks that are much less acidic, such as still water, and milk, tea, or coffee (without sugar).
- Drink any acidic drinks, such as fizzy drinks and fruit juices, quickly - don't swish them around your mouth or hold them in your mouth for any period of time.
- Brush your teeth at least an hour after eating or drinking anything - especially acidic foods and drinks. (See above for reasons.)
- Likewise, do not brush your teeth within an hour of being sick (vomiting), as stomach acid will be part of the vomit.
- When giving children medicines, such as Calpol®, use the sugar-free versions wherever possible.
If you smoke, try to stop. Smoking increases the risk of developing gum disease.
If you have dentures and have bad breath
You may not be cleaning them properly. Ask your dentist for advice on cleaning dentures.
What treatment will I need if it isn't coming from my mouth?
This will naturally depend on the cause. For example, if it turns out you have nasal polyps, you might be prescribed a steroid nasal spray, or have an operation. If you have acid reflux, you may prescribed medicines such as proton pump inhibitors (PPIs) or ranitidine. You may be prescribed antibiotics if you have an infection, etc.
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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