Do you suspect you suffer from halitosis (bad breath)? Then here are some helpful ways to check for the problem, and a range of treatment options which will hopefully eradicate this social scourge. If your best friend won't tell you...
1 - Keep gum disease in check
One of the most common causes of bad breath is periodontal disease, according to registered dental hygienist Juliet Gwasira from the Portobello Dental Clinic in Dublin. "The bacteria involved in causing periodontal disease can actually produce some compounds or gases which will then result in someone having bad breath," she says, explaining that the two conditions often go hand-in-hand.
Gum disease needs to be treated by a professional, who may carry out a scale and polish of your teeth or prescribe a treatment regimen.
"Your dentist or hygienist can then go through oral hygiene instructions on how to control the bacterial growth in your mouth and maintain a healthy oral environment, using interdental brushes, flossing, and brushing twice a day," Gwasira says. They can show you the best techniques using an electric or a manual toothbrush, and highlight areas you might be missing where you would be getting more plaque accumulation. If the problem is not going away when you've tried to target or treat it at home then you would definitely need to see a professional," she says.
2 - See your doctor
Although in 80 to 90pc of cases the source of halitosis is the mouth, "certain systemic diseases, namely diabetes mellitus, chronic renal failure and cirrhosis of the liver can give rise to particular bad odours in the breath," according to Ireland's Dental Health Foundation. When these illnesses cause changes to the breath, it can indicate a serious medical problem which requires prompt attention from a doctor.
Other more common and less sinister medical causes of halitosis include tonsillitis, sinusitis, post-nasal drip and gastroesophageal reflux disease. In each of these cases, appropriate treatment of the underlying infection or condition should resolve the problem.
3 - Manage the microbes
"Halitosis is mainly caused by excessive amounts of volatile sulphur compounds (VSCs) being produced by bacteria in the mouth," according to Ireland's Dental Health Foundation. "The amount of VSCs in a person's breath can vary greatly during the day and is influenced by factors such as eating, drinking, oral hygiene, sleeping and the effect these activities have on saliva flow."
The latest research around halitosis has focused on how an individual's oral ecology - or the particular balance of different types of bacterial colonies in the mouth - affects breath odour. We all have between 100 and 200 different types of bacteria living in our mouth. Some species of bacteria have been found to help reduce volatile sulphur compounds, while others produce them.
Probiotics have been proposed as a possible weapon in the fight against bad breath, particularly those containing a bacterial strain called Streptococcus salivarius K12, which has been proven to keep bad bacteria in check. One small study carried out at the University of Otago, New Zealand demonstrated that participants taking a week-long course of a probiotic streptococcus salivarius experienced a significant reduction in types of bacteria which are known to be associated with bad breath.
4 - Ask a friend to check
It can be difficult for someone to determine whether they really have bad breath or not. Blowing into your hand is unreliable. Licking your forearm, letting it dry for about 10 seconds and then smelling the skin can provide a guide as to whether your breath is sweet or not, according to Dr Harold Katz, founder of the California Breath Clinics, but the most reliable indicator is to ask a trusted friend or family member, whom you can count on for their honesty, to check.
Transient bad breath, like morning breath or a temporary unpleasant odour caused by eating strong smelling food such as garlic or onion affects everyone from time to time. But for up to 25pc of the population, having foul breath is a chronic problem.
A significant number of people, however, believe they suffer from bad breath when they don't. Dr Katz estimates that up to 25pc of people seeking help for halitosis do not actually have the condition but are instead suffering from a psychological condition called halitophobia, or delusional halitosis.
Delusional Halitosis is related to hypochondria and obsessive compulsive disorder. Sufferers become paranoid that they have unpleasant smelling breath, and become fixated with repetitive behaviours such as using mouthwash, brushing their teeth or chewing gum. The appropriate treatment for this is a psychological one, such as cognitive behavioural therapy.
5 - Eat yoghurt
Parsley used to be the food of choice for those hoping that they could eat their way to fresh breath. But research into its effectiveness has found little evidence that guzzling the herb is of any benefit.
You'd be better off giving yogurt a go. In a small study conducted by microbiologists at Tsurumi University in Japan, the researchers found that volunteers who ate 6oz of unsweetened live yogurt daily for six weeks experienced a reduction in the levels of "bad breath" bacteria and their by-product, hydrogen sulphide, in most cases by more than half.
6 - Use a tongue scrape
"The tongue has a lot of follicles, it's a rough surface in your mouth and it does tend to trap food and bacteria," says registered dental hygienist Juliet Gwasira. "It is a big source of halitosis for some people. Tongue scraping does help to get rid of the food debris and the bacteria from the tongue surface. You can get tongue scrapers from the pharmacy. Or otherwise you can just use your toothbrush."
7 - Get prompt treatment for cavities
Cavities provide the ideal environment for bad breath to fester. "If you've got a hole in your tooth that hole can pack food and bacteria, which can go bad if it's not removed from the cavity, and then that can produce an odour," explains Gwasira.
8 - Keep your dentures sparkling
"We advise our patients who wear dentures to remove them every night before they go to sleep, and to clean them properly," says hygienist Juliet Gwasira. "If they don't carry out good hygiene and maintenance on the dentures then they can develop a foul odour," she says.
"Pharmacists can be very good with advice on what cleaning products to use," she adds. "You can get a toothbrush specifically for dentures as well to remove all food debris around the dentures and keep them clean."
9 - Quit smoking
Smoking, according to Gwasira, along with eating strong flavoured food, is a common cause of transient halitosis. Smoking is also known to be an important cause of gum disease.
Her first recommendation is to give up the cigs. Failing that, she recommends following a cigarette with a good brush of the teeth or chewing on sugar-free gum "to increase the saliva flow in your mouth".
"That can help to get rid of the odour."
10 - Cut out the crash diet
Certain types of weight-loss regimes are known to cause halitosis, especially those that involve extreme limitation of carbohydrates. Those who embark on juice fasts or intermittent fasting are also at increased risk of bad breath. These regimes are based on triggering a metabolic state known as ketosis, when the body begins to burn its own fat stores. This prompts the release of ketones into the bloodstream which in turn can cause an acetone, or an unpleasant ammonia-type smell on the breath.