Patient leaflets from the BMJ Group
Bad breath
Bad breath is a common problem. It can be embarrassing, but there are treatments
that can help.

What happens?
Everyone gets bad-smelling breath occasionally. It’s common first thing in the morning,and after eating strong-smelling foods. It usually goes away when you clean your teeth.
This information is about bad breath that lasts through the day. It’s sometimes called
halitosis. It’s usually caused by gum disease or bacteria on your tongue.
Gum disease is caused by plaque. Plaque coats your teeth. It’s mainly made of bacteria,which can infect your gums. Early, mild gum disease is called gingivitis. Advanced gumdisease is called periodontitis.
Bacteria growing on your tongue give off bad-smelling gasses. You’re more likely to getthis if you smoke, don't brush your teeth regularly, or don't produce enough saliva. Salivahelps keep your mouth clean.
Some people worry that they have bad breath when they don't. They continue to worryeven after they've been examined and reassured. This can be very upsetting.
What are the symptoms?
People may notice an unpleasant smell when you talk or breathe out. It's possible tohave bad breath without knowing. That's because you get used to the smell of your ownbody. If you worry you may have bad breath, you could ask a trusted friend, or visit yourdentist.
You can get a rough idea of what your breath smells like. You lick your wrist, wait aminute for it to dry, then smell your wrist. That tells you how your tongue smells.
Your dentist can probably give you all the help you need with bad breath. As well astesting your breath, your dentist should check your teeth, gums and tongue. If your dentistcan’t find any problems, but agrees your breath smells bad, he or she may suggest yousee your doctor. Bad breath is sometimes caused by a problem somewhere else in yourbody.
What treatments work?
The treatment you need depends on what is causing your bad breath. This informationis about treatments for bad breath caused in the mouth. It doesn't look at treating badbreath caused by illness elsewhere in your body.
BMJ Publishing Group Limited 2007. All rights reserved.
Bad breath
Things you can do for yourself
There are several things you can do to keep your mouth clean. These can reduce thenumber of bacteria in your mouth, which may make your breath fresher. There’s no goodresearch on these things, but your dentist may suggest: Brushing your teeth at least twice a day with a fluoride toothpaste If you wear dentures, removing them at night and cleaning them thoroughly beforeputting them back in Many people try things to cure bad breath themselves. We didn’t find any good researchto show if they help. But you may want to try: Using tablets or a spray designed to fight bad breath Chewing fresh parsley, mint or fennel seeds.
Using an anti-bacterial mouthwash
Research shows your breath is likely to improve if you use an antibacterial mouthwashtwice a day. A mouthwash that doesn't kill bacteria is unlikely to help. Antibacterialmouthwash starts working straight away, but the benefits wear off. You’ll need to use itfor two to four weeks to see a lasting improvement.
You can buy lots of different brands of mouthwash from pharmacists. Look for the activeingredients. These kill the bacteria.
Some brands (with their active ingredients) are: Some types of mouthwash might make your tongue discolour. If you get a sore mouthwhile using mouthwash, you could try diluting it half and half with water.
There are other treatments meant to get rid of bad breath caused by bacteria, but there’s
no good research to say if they work. These include: tongue cleaners to scrape your
tongue, toothpastes containing zinc, and artificial saliva, which comes as a lozenge, a
spray or a gel.
BMJ Publishing Group Limited 2007. All rights reserved.
Bad breath
Treating gum disease
If you have mild gum disease (gingivitis) your dentist will advise you to clean and floss
your teeth thoroughly every day. He or she may also scrape the plaque from your teeth.
This is called scaling.
If your gum disease is more advanced (periodontitis) you may need more complicated
treatments, like scaling below the gum, root planing or flap surgery. These remove
plaque from the parts of your teeth covered by the gums. You’ll have a local anaesthetic
to numb your gums first.
Some medicines can be used to treat gum disease. They're normally used after scaling
and root planing. You may need to use a mouthwash containing chlorhexidine. It helps
to kill bacteria. Your dentist may suggest a low dose of an antibiotic called doxycycline
(brand name Vibramycin).
If you have really bad breath that doesn't improve with treatment, your dentist may
prescribe an antibiotic called metronidazole (Flagyl). You mustn’t drink alcohol when
taking metronidazole, because using the two together can make you vomit.
What will happen to me?
Most people can cure bad breath themselves by keeping their mouth clean. But if yourbreath doesn't get any better, your dentist will probably be able to help.
If your dentist can't find any sign of bad breath, he or she will reassure you that yourbreath is perfectly acceptable.
If you're still worried about having bad breath, even after you've been reassured by yourdentist, you may have a condition called halitophobia. This is a strong fear of having badbreath, even though your breath actually smells fine. As with any kind of phobia, apsychologist or psychiatrist will be able to help you.
BMJ Publishing Group Limited 2007. All rights reserved.
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content BMJ Publishing Group Limited 2007. All rights reserved.

Source: http://www.drmichaelelliott.com.au/pdf/halitosis_pt_leaflet_bmj.pdf

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