Don't be a foul mouth - prevention of bad breath - includes related article on exercise protocols

Men's Fitness, July, 1998 by R. Daniel Foster

The latest treatments can banish bad breath forever. Sweet!

When Tom Bailey began suffering from bad breath at age 15, everybody let him know. "Girls would tell me my breath stank," says Bailey, who lives in Northern California. "I tried everything - mouthwashes, sprays, chewing gum.... I even had my tonsils removed. I'm an outspoken guy, and I was driving people away. I felt helpless, and at one point I gave up because nothing worked. I even started drinking because I felt so bad about myself."

Decades passed before Bailey found the help he needed. Then he walked into the California Breath Center, one of a dozen facilities that have sprouted up in past five years to deal with the worst cases of dragon breath. Along with dentists whose practices now include treating halitosis, they're bringing new hope to the estimated 25 million Americans who suffer from this socially toxic malady.

The clinic's co-founder, dentist Harold Katz, had Bailey breathe into a tube connected to a shoebox-size device called a halimeter, a breath-measuring machine that dentists began using about four years ago. His readout registered 169, which lies somewhere between an old dog and a dead skunk. Katz says he's had patients top the 1,800 mark, causing a fiery blast Godzilla would envy.

As Bailey learned, most bad-breath problems occur when your mouth harbors a surplus of anaerobic bacteria, which emit smelly sulfur compounds. "The bacteria feast on protein found in plaque, food debris and dead cells," says Katz. Some people are plagued with an extra dose of this bacteria, which can hide in the mouth even if you brush regularly. Bacteria commonly lurk in pockets in the gums, which is why some experts recommend gum surgery for chronic halitosis.

Trying to banish this bacterial smell with regular mouthwashes can be like using a squirt gun to put out a forest fire. While they may contain germ-killing ingredients, they can't penetrate all the hidden places where bacteria and plaque get together and party. That's why a 1992 Consumer Reports test of 15 brands found that mouthwashes masked odor for only 10 minutes to an hour. Breath mints and sprays were even more limited in their effectiveness.

Some people think they can avoid the aftereffects of a garlicky meal by swallowing "internal" breath fresheners such as BreathAsure, but many dentists are skeptical. BreathAsure's active ingredient is an old folk remedy: parsley-seed oil. Though chewing parsley can leave your mouth feeling fresh, the odor of garlic actually gets into your lungs and your bloodstream. Then it comes out in your sweat as well as your breath. (In fact, the best way to deal with eating garlic may be to make sure your partner eats it as well.)

New solutions

The oral hygiene program that changed Bailey's life is actually fairly simple. In addition to brushing and flossing, he now rinses with chlorine dioxide and scrapes his tongue every day. Chlorine dioxide, an antimicrobial agent that has been used for decades to control odor in water-treatment systems, is now recognized as a potent weapon against bad breath. While regular mouthwashes kill some germs, chlorine dioxide reportedly goes further, destroying the proteins these bacteria use to create sulfur compounds.

Most of these products, including TheraBreath, RetarDex and Oxyfresh, contain chlorine dioxide in a stabilized form, which experts say becomes active in the mouth. One of them - ProFresh, introduced in 1993 by periodontist Jon L. Richter, DMD, PhD - significantly reduced mouth odors for about 30 hours in the company's tests.

Tongue scraping is another important weapon for attacking the enemy where it lives. "We like to think of the tongue as being ground zero," says Richter, founder of a Philadelphia-based center for the treatment of breath disorders. "Anaerobic bacteria tend to gather in colonies, especially at the back of the tongue. That's where they need to be eliminated." While the tongue may appear smooth, Richter explains that it is etched with a network of miniature Grand Canyons, grooves and fissures in which bacteria hunker down and flourish.

Bailey was told to gently scrape his tongue twice each day, paying particular attention to the back third. Dentists have found that doing this with an appliance available in any drugstore is much more effective at reducing bad breath than brushing alone. In fact, researchers at the University of Toronto Halitosis Clinic found that it slashed sulfur compounds by 75 percent, while brushing reduced them by just 25 percent.

Middle Eastern cultures have used tongue scrapers for centuries, and increasing numbers of dentists here are doling them out as part of a complete oral hygiene program. "When it comes to bad breath, most people don't bother with their tongues," says dentist Julian Geller, co-founder of the Fresh Breath Clinic in Toronto. "I tell patients to watch for a thick, white coating on their tongues, and to reach far back with the scraper. Brushing the tongue is not as effective because it tends to move the mucus around instead of removing it. And you're more likely to gag on a brush."