More people than pets have dogs' breath

October 16, 2003

http://www.thestar.co.za/index.php?fArticleId=262108

London - More than half the people living in Briton have breath that smells worse that their pet's.

And women are the worst offenders, with three out of five failing a sulphur emissions test, according to research by toothpaste manufacturer Aquafresh.

"Some mouths may be dirtier than cat litter," dentist Brian Grieveson said in a statement that accompanied the research, which was released today.

"Most people in the UK don't realise that cleaning your tongue is as important as cleaning your teeth."

Scots had the best oral hygiene, with only 10% suffering from bad breath, compared to 27% in London. Throughout Britain, 52% were rated at a level that could be worse than that of a pet.

"We are one of the last countries to understand the need to clean our tongue, with people in America and parts of Europe practising tongue-cleaning routinely," Grieveson said. - Reuters

Most of us know at least one person with bad breath, and have had the embarrassing problem of trying to find an easy way to tell them that their breath stinks. But it's only recently that we have found that bad breath comes from that moist bacterial jungle in your mouth.

Some of these mouth bacteria make truly nasty chemicals, some with disgusting names. There's "putrescine" which gives decaying meat its special fragrance, "cadaverine" which is usually given off by corpses, "skatole" and "methyl mercaptan" which smell like faeces, "isovaleric acid" which smells like sweaty feet, and "hydrogen sulphide" which smells like rotten eggs. The bacteria also emit "indole", which smells lovely at low concentrations and is used sparingly in perfumes, but strangely smells foul in large quantities.

Back in the old days, people wrongly believed that rotten food in your gut gave off bad smells which came up your oesophagus, into your mouth, and inevitably into somebody's face. But thanks to the work of Breath Scientists like Professor Mel Rosenberg, we now know better.

Mel Rosenberg is a Professor of Microbiology at Tel-Aviv University's of School of Dental Medicine (http://www.tau.ac.il/~melros/). Alice Shirrell Kaswell and Stephen Drew honoured him with their article in the Annals of Improbable Research. They write of his many university and hospital positions around the world. They also quote some of his research papers that "tell the exciting story of how one man helped a tiny field of research blossom, grow, and finally attain recognition as a distinct branch of science" - and remember, we are talking about the Science of Bad Breath.

It didn't come easy - he had to work hard to get to his present pinnacle of fame. He says, "Over the past 15 years I have had the opportunity to smell the mouths of thousands of individuals in clinics and in research studies, not to mention the hundreds I have smelled surreptitiously in supermarkets, in airplanes, and in synagogue during the fast day of Yom Kippur".

First, he had to do lots of groundwork, before he was even ready to write his first paper. Then, in the early years, after much sniffing around, he wrote Bad Breath: Diagnosis And Treatment (1990) which was then followed in 1992 by Measurement of Oral Malodor: Current Methods and Future Prospects.

After much hard word and technical achievements, he then demonstrated enough mastery in his field to be able to treat the whole patient. He began thinking deeply both about the condition and its psychological effects.

In 2001, his field of expertise blossomed. The growing International Society for Breath Odor Research (ISBOR) had some 350 delegates attending its fifth international meeting in Tokyo.

In 2002, he finally achieved his deserved recognition for having helped create a mature, free-standing branch of science with his article in the Scientific American called The Science of Bad Breath.

Mel Rosenberg says that the people who are most at risk of bad breath (once all the other causes have been excluded) are people who talk a lot. This group includes teachers, lawyers, politicians and (of course) radio announcers. He also lists the causes of bad breath. We now know that most bad breath happens in the mouth, and hardly any comes from below the tonsils.

There are a few dozen obscure causes that make up about 1% of the cases of bad breath.

An interesting and rare condition is Trimethylaminuria. It's also called "Fish-Odour Syndrome", and there are well over 200 cases on record.

Probably the first mention of it is in the Indian Mahabharata, which is one of the two major Sanskrit epics (the other is the Ramayana). They are great literary and religious works, and deal with the evolution of Hinduism between 400 BC and 200 AD. The Mahabharata is huge - about seven times longer than the Odyssey and the Iliad combined. A small part of it tells the story of a young woman, Satyavata, who stank of "rotting fish". She was expelled from society because of her smell, but a demi-god took pity on her and bestowed a miracle cure on her.

The first modern medical report on trimethylaminuria was in 1970. It's not confined to humans. A certain breed of Rhode Island Red chicken produces eggs which smell "fishy", if the diet is rich in chemicals which lead to trimethylamines (formula N(CH3)3).

We all produce trimethylamine (which smells like bad fish) from the food we eat. Luckily, practically all of us make the enzyme that gets rid of trimethylamine. But rarely, a person has low levels of this enzyme. So these people have high levels of trimethylamine throughout their body. These molecules get picked up by the blood stream, travel into the lungs, jump into the airstream, and finally come out through the mouth - giving these poor unfortunates the persistent odour of rotting fish. The trimethylamine also comes out in the sweat and the urine (hence the name, trimethylaminuria). This condition can in extreme cases have a very severe impact on the sufferers - such as deep mental depression and rarely, attempted suicide.

So next time, I'll talk about the causes of 99% of bad breath...

Last time, I talked about Bad Breath, and how Professor Mel Rosenberg (http://www.tau.ac.il/~melros/) helped turn the study of Bad Breath from a Swamp of Ignorance into a mature, free-standing branch of Science. Thanks to his shoving his nose into the line of fire of thousands of blasts of bad breath, we now know what causes it.

The tonsils cause about 3% of bad breath.

The tonsils are actually part of your immune system. They have tiny little holes on their surface. Occasionally, bacteria live in these holes, and then get killed by your immune system. These conglomerations of dead bacteria and dead immune system cells are usually squirted out of the little holes, and then you swallow and eat them.

But sometimes, instead of being squirted out, they stay and calcify. They get turned into tonsilloliths (meaning "tonsil stones") that are about half the size of a head of a match - and smell quite nasty. They cause no other medical problems, (besides bad breath) and so many doctors and dentists have not heard of them.

In 5-10% of cases, bad breath happens in the nose - from sinusitis, or a reduced mucus flow, or rarely, a foreign body.

There was the curious case of a 28-year-old woman who went to her doctor complaining of persistent bad breath. When he looked up her nose, he found a small bead that she put up there as a young child. When he removed the foreign body, the bad breath vanished - after quarter of a century.

But in the vast majority of cases, 85-90%, bad breath is generated in the mouth - and practically all of it comes from the back of your tongue. (A small percentage of mouth-generated bad breath does come from diseased teeth or gums. A famous encyclopaedia wrongly claims that bad breath "… is due to the rotting debris in the pockets under the gum margins").

The tongue is triply famous. First, it’s the only muscle in your body that gets stronger with age. Second, it’s probably the muscle that’s the most fun to exercise. And third, the tongue is like a shag pile carpet. The bacteria responsible for bad breath live in tiny holes on the shag-pile surface of your tongue.

But how can you tell if your breath stinks?

Luckily, in 1995, Mel Rosenberg looked at (and solved) this problem when he ran an "Oral Malodor Clinic" in Tel-Aviv. He set up a study to see if people were "able to smell their own malodor". Mel worked with 52 Israeli citizens, 43 of whom claimed that they had bad breath.

He had them run through the "well-tried-and-maybe-true" techniques for inhaling and checking your own bad breath. He got them to cup their hands over their mouth and nose, and then breathe out through the mouth and in through the nose. He also got them to do the breathe-rebreathe thing under the blankets, as well as smelling their freshly-used telephone mouth piece and their freshly-used piece of dental floss. He even got them licking their wrist "in a perpendicular fashion", and then sniffing it.

He then added his own brand-new technique. They were to spit into a laboratory dish that was then closed and cooked at 37°C for 5 minutes, and finally "presented for odour assessment" to the spitter.

Of course, Dr. Rosenberg would be the impartial "odour judge". This meant that he had to sniff 52 mouths breathing upon him, 52 saliva-covered wrists, 52 telephone mouth pieces, 52 strands of dental floss, and 52 warmed-up samples of saliva in a laboratory dish. To make sure that his nose didn’t get overloaded and stop functioning normally, he would regularly sniff his control solution - "chicken-dung based fertiliser in aqueous suspension ... in an opaque sniff bottle."

He found that there is no simple way to accurately know if you have bad breath. There was absolutely no relationship between how the volunteers, and Rosenberg, rated people’s breath odour.

The only case where there was any reliability was with his special "incubated spit technique". It’s not simple, but you can monitor your own breath status. Unfortunately, you have to go to the trouble of carrying around a sealable laboratory dish, and "cooking it" in your armpit or next to your body for 5 minutes.

But Mel Rosenberg also offered seven tips for good breath in his Scientific American article of April, 2002.

1. Clean the back of your tongue with a scraper or a toothbrush;
2. Eat breakfast - it gets the saliva flowing and cleans the mouth;
3. Stop your mouth from drying out by chewing gum or drinking water;
4. Rinse and gargle with a mouthwash just before sleep. This slows the growth of bacteria overnight;
5. Clean your mouth after you eat/drink smelly foods/drinks such as garlic, curry or coffee. If you eat or drink foods high in proteins, clean between your teeth;
6. Of course, always floss and brush;

The most reliable way to check for bad breath is ask a family member to smell you.

That, or any of the above, is vastly preferable to spending the day anxiously spitting in a dish, or licking your wrist.

Monday, May 21, 2001

Bad Breath
Before you open your mouth, read this

By Stephanie Allmon
Cox News Service

http://www.reporternews.com/2001/features/breath0522.html

Someone alert the Environmental Protection Agency — 60 million Americans are emitting pungent fumes from their mouths.

Better call in Ann and Abby, Dr. Ruth and the labor department, too, because public opinion surveys show people with malodorous mouths suffer impaired social, sexual and occupational interactions. Wouldn’t hurt to let Alan Greenspan know that Americans spend $10 billion a year to disguise their stinky exhales with minty flavors.

Trouble is, no matter how close your upper lip is to your nose’s tip, you’re still “olfactorarily” impaired when it comes to smelling your own breath.

“You get immune to your own fragrance, so of course you don’t know you have bad breath,” said Janna Beatty, a Waco image consultant and owner of Image Enhancers.

Beatty, who has actually been called by businesses to help with odorous oral situations, said your inability to smell your own breath is like the inability to smell your overdoused perfume. You may not know you offend, but you’d better believe your co-workers do.

Before you sniff around for a solution, you should know what causes chronic bad breath — what experts call halitosis. Contrary to some beliefs, the problem doesn’t start in your stomach, on the roof of your mouth or on the top of the tongue.

Jon Richter, founding director of the Pennsylvania Center for Breath Disorders, said most bad breath originates in certain bacteria deposits at the back of the tongue, where it starts to plunge into the throat. Some people have more of it than other people, so their breath smells worse, he said. Bad breath-producing bacteria contain sulfur compounds many people associate with a “rotten egg smell,” the American Breath Specialists report.

To further complicate things, Richter says, bad-breath-producing bacteria hide under heaps of other types of bacteria, so mouthwashes, gum and mints can’t touch it.

“(Gum and mints) will mask odor for a period of time with another odor,” said Richter, a practicing dentist who started whiffing bad breath as a hobby. “They will also give the user a sense of confidence because they feel a strong, minty, tingly feel in their mouth.”

So-called “morning breath” is particularly pungent because when the mouth is closed, and there’s no saliva flow while you sleep, there’s less oxygen in the mouth.

“Bacteria that produce bad breath do better in those kinds of environments,” Richter said.

To “cure” yourself of bad breath, Richter said, you have to have to kill the bacteria, and you have to fight in their turf — the back of the tongue.

Some people use a spoon to manually scrape bacteria from their tongues. Richter developed his own system, called ProFresh, which he sells on the Internet. His system uses a tongue scraper to scratch off top layers of bacteria and a chlorine dioxide rinse to kill the underneath bacteria.

Before you wage an all-out battle with the little tongue-dwellers, consider another cause of bad breath — your gums.

Steven Little, a general dentist, said a dirty mouth leads to plaque development, which leads to tartar, which cakes on teeth, which deteriorates gums and leads to infection, odor and disease. This calls for not only daily brushing and flossing, he said, but a regular, thorough periodontal cleaning of teeth and gums by qualified dentists.

Just because you have bad breath in the past doesn’t mean you have bad health now, Richter said. But there are more serious health problems that contribute to bad breath, according to his Web site, ProFresh.com.

In “systematic disorders,” such as diabetes or liver disease, sulfur chemicals build up in the bloodstream and get exhaled through the lungs, the site says. If the onset of the breath odor has been sudden, is growing noticeably worse or has been accompanied by fever, cough or other symptoms, you should consult a health provider, he advises.

If, by now, you think you need a breath diagnosis, some dentists have machines called Halimeters, which measure gasses coming from bacteria in the mouth. The American Breath Specialists also recommend trying the following self-evaluation methods: smelling a piece of unwaxed, unflavored floss 45 seconds after you floss your upper and lower back molars; rubbing your tongue with a wash cloth and smelling it; licking and smelling your own wrist. But to get the best breath analysis, swallow your pride and ask a trusted friend, colleague or family member if you’ve got a smelly mouth, Richter said.

If you’re on the receiving end of the odorous particles, Beatty said, be nice but be direct. Try using humor to tell people they’re foul-mouthed offenders, she said.

Of course, not everyone with bad breath suffers from halitosis. For temporary cases like post-coffee odor and pre-date preparation, mints, gum, mouthwash or spray are a good fix, Beatty said.

“I think the Boy Scouts got it right with their motto — Be Prepared,” she said.

Oral malodor: philosophical and practical aspects.

Bosy A.

J Can Dent Assoc. 1997 Mar;63(3):196-201.

http://www.ncbi.nlm.nih.gov/entrez/PubMed&list_uids=9086681&dopt=Abstract

Although oral malodor or bad breath is an unpleasant condition experienced by most individuals, it typically results in transient discomfort. At least 50 per cent of the population suffer from chronic oral malodor, however, and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment. The mouth air of chronic malodor sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan and organic acids, which produce a stream of foul air that is gravely offensive to the people in their vicinity. Sufferers often make desperate attempts to mask their oral malodor with mints and chewing gum, compulsive brushing, and repeatedly rinsing with commercial mouthwashes. While dental diseases have been strongly associated with this condition, there is considerable evidence that dentally healthy individuals can exhibit significant levels of mouth odor. Proteolytic activity by microorganisms residing on the tongue and teeth results in foul-smelling compounds, and is the most common cause of oral malodor. A specialized device called the halimeter is available to measure the volatile sulphur compounds in mouth air. Many of the manufacturers of bad breath remedies claim that their products contain antibacterial mechanisms with sufficient strength to control oral malodor over long periods of time. None, however, effectively eliminate the problem. Interest in oral malodor research and clinical treatment has increased in the last few years, and this distressing problem is finally getting the attention it deserves.