Bad Breath: Why You’ve Got It & How to Get Rid of It

open mouthHear “bad breath” and chances are you can instantly think of a person or two with this problem – maybe even yourself.

It’s a common issue, after all. One new review of the science in Clinical Oral Investigations found that it afflicted more than 30% of participants – nearly one in three people. What’s more, those numbers seem to be on the rise.

Our results demonstrated that the estimated prevalence of halitosis was 31.8%, with high heterogeneity between studies. The results suggest a worldwide trend towards a rise in halitosis prevalence.

Why so much halitosis (the clinical term for bad breath)? It’s not just from eating stinky foods such as garlic, onions, and strong spices. In fact, most cases spring from oral conditions.

Although halitosis has multifactorial origins, the source of 90% cases is [issues in the] oral cavity such as poor oral hygiene, periodontal disease, tongue coat, food impaction, unclean dentures, faulty restorations, oral carcinomas, and throat infections.

The mouth provides ideal conditions for the growth of harmful bacteria. It’s dark, moist, and contains hard-to-reach, low-oxygen areas such as periodontal pockets in which these pathogens can thrive.

There are hundreds of bacterial species that live in even the cleanest mouth. Many are helpful. Some are harmful. And according to the paper quoted above,

most of them are capable to produce odorous compounds which can cause halitosis.

The answer, of course, starts with better hygiene: brushing (including your tongue), flossing, rinsing, and thoroughly cleaning any appliances or prosthetics you wear.

Essential oils such as cinnamon and lemongrass can be quite helpful in controlling oral bacteria, yeasts, and other pathogens (“bad bugs”). Such oils can be found in many natural mouthwashes, but you can also make your own at home quickly and easily.

That said, there are some cases in which bad breath is a sign of more significant issues that should be addressed by a dentist or physician. These include oral infections, respiratory problems, GI disease, metabolic conditions, and more.

If ramped up hygiene isn’t enough to help your breath, do talk with your healthcare providers.

More tips for taming bad breath

Image by Allsha Vargas

When Technology Tackles Teeth

triple-headed toothbrushesA new toothbrush doesn’t guarantee better brushing habits or even that you’ll get a better cleaning. Technique matters. But what if you have movement challenges, say, that make it hard for you to brush effectively?

One technology developed for such folks is the triple-headed toothbrush. The idea is that the three heads together maintain contact with all surfaces of each tooth at the proper angle. So you also see it marketed for children who have trouble with proper brushing, as well.

Marketers insist that a triple-headed brush will get the job done faster, easier, and better than a standard brush. But recent research in the International Journal of Dental Hygiene suggests that may only be the case when caregivers are doing the brushing.

Evaluating 15 clinical trials including 18 relevant comparisons, the authors found that

Of the 14 comparisons with self-performed brushing by the participants, the majority showed no difference between triple-headed and single-headed toothbrushes, with a few favouring the triple-headed. In the comparisons in which a caregiver performed the brushing, three of the four showed that the triple-headed toothbrush performed significantly better on the reduction in plaque scores.

Less is known about the efficacy of some new toothbrush designs for the general public, most of which aim to make brushing so quick and effortless, it becomes a cinch to do it regularly.

As if two minutes each morning and night – the duration and frequency we recommend for toothbrushing – were such a terrible sacrifice to make for supporting your oral and overall health.

But we digress.

The latest entry in the speed-brushing category is Amabrush, which has raised over $2.3 million through its highly publicized Kickstarter campaign. The device fits in your mouth and automatically brushes all the surfaces of your teeth with tiny silicon bristles in just 10 seconds.

But speed doesn’t come cheap. Not only do you pay a bit over $90 for the unit and charger but $7 every three to six months for a replacement mouthpiece and roughly $3.50 a month for the special toothpaste the device requires.

BlizzidentIt seems a lot like an automated version of the Blizzident device that came onto the market a while back. The makers of that device claim it cleans all tooth surfaces in just six seconds as you bite on the bristled mouthpiece. They also say it flosses your teeth and cleans your tongue – all for an investment of a few hundred dollars every year.

Amabrush stops short of the flossing claim. And the company’s founder and CEO offers an important caveat:

“It’s really hard to compare it to regular toothbrushes, manual or electric, because a toothbrush is just a tool, and tools are only as good as the people using them,” he said. “If a person already uses his regular toothbrush in a professional way, then Amabrush will definitely be no better than a regular toothbrush.

And you still need to floss – the part of hygiene that most people are most irregular about. We’ve yet to see any gizmo addressing that.

Previously

A Look Back at…A More Comprehensive Approach to Prevention

Updated from the original post for October 9, 2014

young girl smilingA 2014 report from the Centers for Disease Control shows that less than half of all children in the US are getting “preventive dental services” – particularly older teens and the very young. “In 2009,” reported Dr. Bicuspid,

more than half (56%) of children and adolescents did not visit the dentist in the past year, and nearly 9 of 10 (86%) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.

Dental visits, fluoride and sealants? That’s a pretty narrow definition of “prevention.”

Fluoride’s benefit is arguable, especially in light of its risks and, where there’s fluoridation, the ease with which you can overdo it.

Sure, regular dental visits are important, but getting your child’s teeth professionally checked and scrubbed once every 6 months isn’t enough to override poor diet, oral hygiene and other factors.

Absolutely, sealants can be helpful in preventing cavities in deep grooves and crevices, but they, too, are only a partial solution.

Effective prevention happens mostly outside the dental office. As one physician put it in his keynote address at the 2014 Oral Health Conference in Alabama,

“Prevention is the word….” [A]nd it shouldn’t fall to just the dentists and dental hygienists. Other health care professionals, including nurses, physician assistants and pediatricians, can be part of prevention interventions; so too can daycare workers, teachers and Head Start personnel.

But most of it happens with you. At home. Above all, it takes a daily commitment to making healthful choices.

There’s so much you can do to prevent cavities and other oral health problems – for yourself and by teaching your children healthy habits.. Here’s a quick list:

  • Eat well. It’s no secret that eating too many sugars and refined carbohydrates – the stuff that so many hyper-processed foods is made of – raises your risk of cavities and periodontal disease. The World Health Organization recommends that no more than 10% of your daily calories – about 50 grams – come from sugar. But to prevent tooth decay, new research suggests a 3% max.
  • Brush and floss regularly, making sure you clean every surface.
  • Relax. Stress makes us more prone to disease and dysfunction of all kinds. Make sure you take some time to relax each day, whether it’s doing yoga, writing in a journal, or chilling to your favorite music.
  • Avoid drugs – all kinds, including tobacco. Tobacco has an especially pernicious effect on the mouth, contributing to gum disease and, ultimately, tooth loss.
  • Get enough sleep. Sleep rejuvenates your body and replenishes your energy levels. Without enough sleep, your body can’t do everything that it needs to do to keep you healthy.
  • Exercise. Just as a car won’t run well if it’s not used, so, too, your body. We were designed to move! (And yes, we’ve seen those headlines insisting that exercise is bad for your teeth, but the vast majority of people don’t exercise enough to experience the problems that some elite athletes do.)

All these suggestions should sound familiar. They’re the stuff that promotes a healthy mind, spirit, body and mouth. (The mouth is connected to the rest of you, after all!) Whenever you take these steps, you are committing to yourself. Your body will reward your for smart choices.

Image by suzi quiban

Theobromine Toothpaste May Encourage Tooth Remineralization

toothpaste in tubeOkay, so you don’t really neeeeed toothpaste.

Yes, you read that right. In fact, in many cases, you’re better off without it – especially if your only “option” is the average toothpaste you find in your average big box or drug store.

In our opinion, that option’s no option, due to the potentially toxic ingredients conventional toothpastes typically contain.

Take sodium fluoride, for instance – a drug under the jurisdiction of the FDA. It’s the ingredient that merits the poison warning you see on every box.

Whether from hygiene products, “supplements,” or fluoridated water, too much fluoride during the first eight years, while teeth are still developing, can cause dental fluorosis. In severe cases, the teeth turn brown, with rough and pitted surfaces. It’s a clear sign of too much fluoride.

If only the concerns were “just cosmetic,” right? But fluoride has also been linked with many chronic conditions. These include arthritis, neurological issues, cancer, cardiovascular disease, pineal gland problems, thyroid disease, kidney disease, and endocrine disruption – to list but a few.

And for all this, it may not even prevent decay. (It certainly doesn’t address the cause.)

Other problem ingredients include sodium lauryl sulfate, triclosan, titanium dioxide, and FD&C blue dye 1 and 2.

So if that’s what’s available, then ditching the toothpaste is a good thing. You don’t neeeeed it. After all, the main reason we use it is just to provide a little grit to help remove plaque more easily – and for the pleasant taste and clean feeling it leaves.

And for that reason, most of us probably don’t want to do without.

Fortunately, there are great nontoxic alternatives available. One of our favorites, as we’ve mentioned before, is Theodent. It’s an option you can feel good about.

cocoa Theodent’s active ingredient is theobromine, a natural compound derived from cocoa beans. Research suggests that this alkaloid may encourage tooth remineralization by restoring minerals to the tooth’s structure – all without relying on fluoride.

Even more promising research has published of late, further supporting theobromine as a safe and effective alternative to fluoride.

One study serendipitously found that theobromine causes the formation of large hydroxylapatite (HAP) crystals. Hydroxylapatite is the main mineral in tooth enamel. While small crystals were seen to increase demineralization during acid exposure, large crystals did not and were associated with less decay. Because of this – and its safety – the authors consider theobromine “a better ingredient than fluoride.”

We believe that theobromine can be used as an ingredient of dentifrices and even if swallowed accidentally, there are no adverse effects.

A second study pitted Theodent classic – in both fluoride-free and fluoridated forms – against Colgate Regular (containing fluoride) and a prescription remineralizing paste. The goal was to compare their effectiveness at decreasing tooth sensitivity. Theodent did so more quickly than the others. Colgate fared the worst. Clearly, the theobromine made a difference.

If you want to decrease sensitivity, prevent decay, freshen your breath, and avoid a whole host of toxins, Theodent is definitely worth a try. Even though you don’t really neeeed it, we think you’ll waaaant it.

Images by Adam Minter & Carsten ten Brink

The “Essentials” for a Healthy Smile?

Soon, little ghouls, witches, and werewolves will go door-to-door asking for treats – and parents will deal with the trick of managing their sugary haul. So maybe it’s appropriate that October is also National Dental Hygiene Month.

To that end, the American Dental Hygienists’ Association has put forth their four “essentials” in fighting tooth decay:

  1. Brush twice a day.
  2. Floss daily.
  3. Rinse with mouthwash.
  4. Chew sugar-free gum.

That last point might only surprise you until you learn that Wrigley – of gum fame – is a sponsor of the event. But is that enough to make chewing gum “essential” to good oral health? Will it be somehow less than it could be were you to forego the gum?

While there is some evidence that chewing sugar-free gum may remove and even kill bacteria in the mouth, even the lead author of the study demonstrating that stated that it’s still no replacement for brushing and flossing.

Similarly, while research has shown that artificial sweeteners such as xylitol and erythritol may help prevent decay, there’s been at least some suggestion that it’s the action of chewing itself that’s really responsible, in so far as it generates more saliva. Among other things, saliva helps neutralize acids, washes the teeth, clears bacteria, and aids remineralization.

Again, sugar-free gum is no replacement for the brushing and flossing and healthful eating that are the foundation for good oral health. But in most cases, it can be a fine support for it. (The one case in which we recommend no gum chewing at all: if you have “silver” amalgam fillings. All the extra chewing means extra release of mercury from those fillings.)

And it’s a great alternative to candy for Halloween trick-or-treaters.

Happy National Dental Hygiene Month and Halloween (a little bit early) from Pride Dental!

jackolanterns

Choosing the Best Mouthwash

Rinsing after you brush and floss is a good idea. It washes away bacteria and other microbes you’ve just spent the last few minutes removing from your teeth. And if you use an antimicrobial rinse, you get a little extra protection from that, as well.

mouthwash on store shelvesBut not all mouthwashes are created equal.

Many mainstream brands, for instance, contain alcohol – partly for its antiseptic qualities, partly because it’s a good solvent, allowing the manufacturer to better blend the other ingredients. Yet when it comes to oral health, it may not make much of a difference according to new research in the British Dental Journal.

More than 300 people with mild to moderate gingivitis participated in the study. One group just brushed. One group brushed and rinsed with alcohol-free chlorhexidine. One group brushed and rinsed with chlorhexidine containing alcohol. Both rinse groups showed perio improvements that the brush-only group lacked. There was no significant difference between the alcohol and non-alcohol groups.

Naturally, this raises the question: If it doesn’t make a difference, why use alcohol at all?

For it does have its downsides – especially in that alcohol tends to dry out the soft periodontal tissues. If the dryness becomes chronic, it becomes more than just an annoying feeling. It becomes a real problem. Chronic dry mouth raises your risk of a whole host of oral health problems, including enamel erosion and caries (cavities), gum disease, oral infections and bad breath – all of the problems you were trying to prevent.

Plain chlorhexidine has its problems, as well. Many participants in the BDJ study reported both staining and discomfort.

A high proportion of subjects in the chlorhexidine mouthrinse groups reported TRAEs characteristic of those known to be associated with prolonged chlorhexidine use including discoloration of the tongue and oral tissues, alteration of taste sensation, burning sensation of the mouth, dry mouth, oral desquamation and loss of sensitivity to sensory stimuli in the mouth.

And as we noted before, research has suggested a number of potential negative consequences from changing the balance of oral flora (bacteria and other microbes) as dramatically as chlorhexidine can.

Fortunately, there are healthier, more natural options available – options that can be at least as effective as chlorhexidine but without its side effects. Research has shown some particular essential oils commonly used in natural dental products may be especially effective. For instance, one study in the Journal of Contemporary Dental Practice found that “cinnamon oil, lemongrass oil, cedarwood oil, clove oil and eucalyptus oil exhibit antibacterial property against S. mutans” – the major bacterium involved in tooth decay. A study in Acta BioMedica found that cinnamon oil inhibited “all the ten test bacterial species involved in dental caries.”

Powerful, effective and side-effect free? Sounds like the ideal choice to us!

Image by jchwhite

Getting to the Dentist Early May Improve Your Child’s Lifelong Health

young girl brushing teethSometimes getting kids to take care of their teeth can be a real struggle. Could a video game change that? One study recently discussed in Trials seeks to find out if this particular tech route might be effective.

Providing children with oral health education through a potentially interesting method, such as video games, might provide them with a positive media influence. In addition, parents are indeed going to be part of the intervention in this study, as they will be required to guide the child through the game. Moreover, parents might learn indirectly, as some evidence suggests that children can transmit knowledge to their parents.

Of course, there are already a lot of tech-driven products out there, aiming to make hygiene more fun for kids as they also teach them how to clean their teeth effectively (this and this, to take just a couple examples). Popular children’s media such as Sesame Street also regularly promote good hygiene in kid-friendly ways.

And of course there are plenty of websites out there like Mouth Healthy Kids and My Smile Kids that provide videos, games and other activities to help children learn about their teeth (though usually from a non-holistic perspective, unfortunately).

But not everything has to be tech- or media-driven. Incorporating games, stories, songs or other fun while your child brushes can do wonders. The key is to get children excited about and involved with their own health. No one tactic works for every kid. Try different things until you find what works.

Then make sure the fun translates into action. Modeling good habits yourself and answering your child’s questions are great steps towards ensuring your child understands.

Do keep in mind, though, that although your child can begin learning to brush on their own by the age of 3, most kids don’t develop enough coordination to do so effectively until the age of 6 or even 7 – about the same age at which they can begin learning to floss, as well. Until then, you’ll likely need to help them along, to make sure they clean all the surfaces of their teeth (and floss for them until they’re old enough to do it on their own).

Ideally, instilling good hygiene practices starts even earlier than that, with their first visit to the dentist. This should happen once the first tooth erupts or the child’s first birthday. Seeing your child at such a young age, we can keep better track of their dental and orofacial development, catching any problems before they become big problems. But this early visit can also help lessen childhood fear of the dentist. Too often, children aren’t taken to the dentist until something’s gone wrong. By going early and often – before there are problems – you make these visits seem common, no big deal.

As soon as your child is old enough, we’ll also talk with them about things like good hygiene and healthy eating for healthy teeth. Encourage your child to ask questions, too!

And just as for adults, 6 month return visits – for thorough cleanings and exams – are the norm, though frequency can differ depending on individual situations.

Get your child engaged in their own health early. Help them create lifelong healthy habits and avoid dental decay or discomfort. No age is too early, so why not start the conversation and the fun today?

Image by Patrick

Other than a Toothbrush

Pop quiz: What do you need in order to clean your teeth thoroughly and effectively?

 

 

If your answer included “toothpaste,” you might be a little bit wrong. Or at least not entirely right.

Believe it or don’t, but there’s actually some argument as to whether toothpaste helps clean teeth. Consider, for instance, a study published a few years back in the Indian Journal of Dental Research. Not only did its authors find that toothpaste didn’t help remove plaque but that it might actually interfere with the process. While toothpaste users reduced plaque by about 57%, non-toothpaste users reduced 9% more.

Yet toothpaste has other purposes. For one, the taste can be refreshing and actually provide a little extra incentive to brush. It can also provide a way of applying essential oils such as clove, thyme, tea tree and peppermint (to name but a few) that can keep oral pathogens – “bad” bacteria and other microbes – in check. Likewise, it can deliver compounds such as theobromine, which can help the teeth remineralize more effectively – more so than fluoride, and more safely, as well.

toothbrush and waterFor the simple sake of breaking up dental biofilm (plaque), though, it’s the mechanical action of brushing that really counts. At most, as we’ve noted before, toothpaste can provide a little extra grit to help in the process.

As for the other answers to the quiz? A toothbrush (natch), floss (or a proxy brush or oral irrigator to clean between the teeth), good technique, and making good hygiene a habit.

(And in case you’re wondering if there’s a best type of brush, see this and this.)

Image by Greg Foster

5 Tips for Staving Off Gum Disease (& 4 for Making Sure You Don’t “Forget” to Floss)

flossing teethAs we mentioned last time, a healthy mouth isn’t a 100% “germ-free” mouth – something that’s impossible to achieve anyway – but one with a healthy balance of oral flora. For most Americans, maintaining that is a bit of a struggle – to put it mildly. But hey, red, swollen gums or a little blood when you floss is no big deal, right?

Wrong. They’re signs of periodontal (gum) disease. Other symptoms include bad breath, gum recession, loose teeth and sores in your mouth. It’s been estimated that up to 75% of US adults have some degree of gum disease. It’s the 6th most prevalent health problem in the world.

And bleeding gums are just the start.

As the disease progresses, the normal space between the teeth and gums (the sulcus) gets deeper. These “pockets” become perfect little harbors for bacteria and other pathogens to proliferate: dark, wet and lacking oxygen. The immune system goes on red alert to fight the infection. Unless treated and successfully managed, the disease process ultimately breaks down connective tissue and supporting bone.

Eventually, with less structure there to support them, teeth will loosen and come out.

And that’s just the damage that happens in the mouth. Through recent years, a vast amount of research has shown links between gum disease and all manner of other inflammatory disorders, including diabetes, heart disease, stroke, Alzheimer’s, kidney disease, rheumatoid arthritis and cancer.

Fortunately, periodontal disorders are not only treatable but largely preventable. How?

  1. If you smoke or otherwise use tobacco, quit. Tobacco use is the number one risk factor for gum disease.
  2. Get enough good quality sleep and take steps to manage stress. Lack of sleep and chronic stress have both been shown to make you more vulnerable to perio problems.
  3. Eat a whole foods-based diet, rich in fresh produce, low in added sugars. Avoid soft drinks.
  4. Exercise – or at least stay physically active. Those who are regularly physically active are at lower risk of gum disease, even if they used to smoke.
  5. Practice optimal oral hygiene at home – brushing and flossing regularly – and have dental visits at least twice a year for exams and professional cleanings.

And yes, the flossing part really does matter. A lot. Remember: Brushing only reaches about 60% of the total surface area of your teeth. You need floss to get the rest, as well as below the gumline. And you need to floss effectively:

Here are a few tips to help you not forget – or to push past excuses for not flossing:

  1. Floss before you brush.
  2. Floss in the shower.
  3. Keep floss nearby where you usually watch TV or video so you can floss while you watch.
  4. If you really don’t like the feel of traditional floss, try using flossers. The handle makes them a little easier to maneuver well. Other alternatives include interproximal (proxy) brushes and oral irrigators. Some suggest these last two may be even more effective than traditional floss.

And if you have gum disease already? Typically, treatment includes frequent deep cleanings from a dentist or periodontist (a dentist who specializes in the health of the gums and other supporting tissues). Antibiotics – pharmaceutical, natural or homeopathic – may be used, as well. Both ozone and laser therapy can be extremely helpful for disinfection. There’s been some suggestion that these may even stimulate bone growth in the jaw.

The most important thing is to do something. Left unaddressed, gum disease never gets better, only gets worse. The earlier we spot it and help you manage it, the better – and easier and less expensive – the outcome.

Image: Patricia H. Schuette

Do 4 out of 5 Holistic Dentists Recommend Chewing Gum?

person chewing gumSugar-free chewing gum can be useful stuff. It can make your breath minty, “pop” your ears on a long flight, increase salivary flow, maybe even help your memory. (Yes, really.) But can it keep bacteria away from your teeth?

Maybe so, according to a recent study in PLoS ONE.

Comparing two types of chewing gum, the researchers found that some oral bacteria become trapped in the gum – a little over 100 per piece.

Although this number may be considered low, it shows that when gum is chewed on a daily basis, it may contribute on the long-term to reduce the bacterial load in the oral cavity, which is supported by observations that long-term studies on the use of chewing gum cause a reduction in the amount of oral biofilm.

It’s roughly the amount removed by flossing and brushing without toothpaste.

What’s more, seeing a decrease of bacteria trapped the longer the gum was chewed, the authors note that some bacteria may actually be killed by specific ingredients in the gum, such as “sweeteners like xylitol, food preservatives or flavoring agents like spearmint and peppermint, which are reported to have antimicrobial properties.” (Learn more about xylitol in our previous post.)

But before rushing out and buying a bunch of gum, know that it’s no replacement for brushing and flossing. As Dr. Bicuspid reports,

[Lead author Stefan] Wessel emphasized that brushing and flossing remain more effective in reaching many areas in the mouth, and that sugar-free chewing gum should not be seen as a replacement but as an addition to both techniques.

Nor is gum selective about which bacteria it traps. It takes good along with the bad, health-promoting microbes as well as pathogens. By the same token, that it removes bacteria gradually

is preferable to sudden ecological shifts that can change the relationship between the oral microbiome and the host as another potential cause of disease, they concluded.

A healthy mouth is not a 100% “germ-free” mouth – as if that were even possible. Rather, we understand now that it’s about maintaining an overall healthy balance of oral flora.

This was a small study – and funded by Wrigley, a company that definitely stands to gain from such results. If future research backs up the findings, we may see the development of products that can selectively remove pathogens.

Given the possible benefits, it’s hard to think of a reason not to chew sugarless gum, but some dentists still encourage caution due to habitual chewing putting extra stress on the jaws. And if you have mercury amalgam “silver” fillings, best not chew at all, as it can accelerate the release of mercury from those fillings.

Image: Amy Messere