Helping patients manage halitosis

What are the potential causes?

Halitosis is a very common condition, affecting around 31.8% of people.[i] It produces an unpleasant odour which may cause people to feel very self-conscious about speaking to or being around other people. It is characterised by bad breath which doesn’t go away, with its most common cause being poor oral hygiene. If sufficient oral hygiene routines are not carried out every day, and patients do not attend regular dental check-ups, the risk of developing halitosis increases as bacteria is allowed to colonise.ⁱ These bacteria produce volatile sulphur compounds (VSC) when they break down proteins in the mouth, and sulphur is the malodour that we detect.[ii]

Other causes of halitosis may include xerostomia as reduction in saliva flow reduces its ability to cleanse the oral cavity; tonsil stones; and gingivitis/periodontitis which presents as oedema, erythema, and bleeding, in addition to a number of other conditions such as acid reflux, diabetes, and infections.ⁱ While using mints, for example, may briefly mask the problem, it is essential to manage the cause. This may be as simple as improving oral hygiene.

Cleaning the teeth and tongue

Twice daily brushing, once before bed and once at another time during the day, helps to manage the levels of plaque and bacteria in the mouth. Removing any plaque and using a toothpaste containing fluoride to deliver enamel strengthening properties helps to maintain oral health and protect the teeth from bacteria. However, a good oral hygiene routine should not stop here. Patients may think that, because they brush their teeth twice a day, their teeth are clean and they are not likely to have bad breath, but this may not be the case.

Another excellent way of reducing levels of bacteria in the mouth is by regularly cleaning the tongue. By not cleaning the tongue, patients may be allowing bacteria to thrive and transfer to the teeth and gums.[iii] For many patients, it may be appropriate to recommend that, as part of their oral hygiene routine, they gently clean their tongue using a toothbrush or a specially designed tongue scraper to remove any bacteria which may be building up. If allowed to accumulate over a long period of time, neglecting tongue cleaning may lead to bad breath.ⁱⁱⁱ Studies[iv] have shown that the most effective way to reduce halitosis is a combination of plaque removal from teeth and tongue and the introduction of a mouthwash containing zinc. Zinc binds to the VSC produced by bacteria and neutralises them.[v]

Interdental cleaning

Cleaning interdentally is essential for removing sufficient plaque from all surfaces of the teeth. It is crucial that patients clean in between their teeth every day, to remove any plaque and debris not reached by regular toothbrushing. Many patients will be aware of tools such as dental floss, with some finding it difficult to use, and experiencing bleeding or tender gums. Because of this, many patients give up. It’s important that they understand bleeding often happens when people first start cleaning interdentally, as the gums are already irritated by plaque build-up, and more sensitive. However, when carried out regularly, interdental cleaning reduces plaque build-up and therefore inflammation.[vi]

It may be helpful to recommend that patients try using interdental brushes instead of dental floss. They are usually far easier to use, and deliver a much more comfortable experience. Work with your patients during their appointment to select the right size interdental brushes for them, ensuring that they fit comfortably. Patients should not need to use any force to fit them in the gaps, and this might mean using different sizes in different areas of the mouth. Be sure to show patients how to use them properly to ensure that they are able to remove any food debris and plaque effectively.^vi

The FLEXI range of interdental brushes from TANDEX is ideal for your patients. Available in 11 different sizes, you can help patients find the perfect interdental brushes for them. FLEXI brushes are ideal for reducing plaque between the teeth, and should be used daily for the best results. For patients who need an extra boost, recommend PREVENT GEL from TANDEX. It contains 0.12% chlorhexidine and 900 ppm fluoride to strengthen the enamel and provide an antibacterial effect. Tandex also offers WASH&PREVENT mouthwash, which not only contains chlorhexidine for an antibacterial effect, but comes in a zinc containing variant to help minimise malodours.

Nothing to be ashamed of

If your patient is experiencing halitosis and is feeling embarrassed, make sure you reassure them that it is nothing to be ashamed of. Discuss the potential causes, and how improved oral hygiene, regular dental visits, and treating any underlying conditions can improve their situation.ⁱ

For more information on Tandex’s range of products,
visit https://tandex.dk/ or visit the Facebook page: https://www.facebook.com/TandexUKOur products are also available from CTS Dental Supplies https://www.cts-dental.com/ and DHB Oral Healthcare https://dhb.co.uk/

Author Kimberley Lloyd- Rees on behalf of Tandex

Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering

[i] https://my.clevelandclinic.org/health/symptoms/17771-bad-breath-halitosis

[ii] Aung, E.E., Ueno, M., Zaitsu, T. et al. Effectiveness of three oral hygiene regimens on oral malodor reduction: a randomized clinical trial. Trials 16, 31 (2015). https://doi.org/10.1186/s13063-015-0549-9

[iii] https://www.huffingtonpost.co.uk/entry/tongue-scraping-risks-and-benefits_uk_65043dbee4b045a142a4a705

[iv] Dudzik A, Sozkes S, Michalak E, Olszewska-Czyz I. Efficacy of a Zinc Lactate Mouthwash and Tongue Scraping in the Reduction of Intra-Oral Halitosis: A Single-blind, Controlled, Crossover Clinical Trial-A Pilot Study. J Clin Med. 2021 Nov 26;10(23):5532. doi: 10.3390/jcm10235532. PMID: 34884234; PMCID: PMC8658071.

[v] Suzuki N, Nakano Y, Watanabe T, Yoneda M, Hirofuji T, Hanioka T. Two mechanisms of oral malodor inhibition by zinc ions. J Appl Oral Sci. 2018 Jan 18;26:e20170161. doi: 10.1590/1678-7757-2017-0161. PMID: 29364345; PMCID: PMC5777415.

[vi] https://www.nhs.uk/common-health-questions/dental-health/why-should-i-use-interdental-brushes/