Q. What is the cause of the dreaded “morning breath” and how can I eliminate it? -- B.G. in MA
A. Let me assume that overall, you are in good health and have no systemic issues.
You speak of an offensive odor in the morning only but in reality, if there is one, there must be malodor “bad breath” (BB) during the day as well. It is more noticeable in the morning because during the night, salivary flow decreases and this, plus possibly breathing through your mouth, will dry out the oral cavity. Moisture from salivary flow will tend to cleanse the oral cavity and keep odor less noticeable.
Let me first state without equivocation that mouthwashes of any type, chewing gum as well, if they have any affect on odor will be very short-lived. At best they will act as a cover-up. All of these proprietary, easy-to-use remedies are of such limited and transient value that they are not worth the effort and the cost.
Simply put, if your oral cavity is free of disease such as tooth decay and gum disease, then with proper daily hygiene, there is no reason for BB. To determine that there is no disease, you will need to see your dentist. With proper examination the dentist, in corroboration with the dental hygienist, need to make that finding. The dentist can eliminate the decay possibility with whatever means he or she deems necessary. The most important is a thorough clinical inspection of all teeth. By that I mean the dentist has looked very carefully at every tooth surface in your mouth to be sure that disease is not present. This takes time and it can not be cursory. A pop in after your teeth are cleaned without that careful inspection is not adequate.
You can be very helpful in alerting the dentist and hygienist that this odor is a problem. If you have gum irritation or bleeding of your gums with or without brushing, you need to make them aware. If you have a bad taste when you floss in a particular area, this is important to communicate. Things such as hot, cold or sweet sensitivity are very important to share with the clinician.
In order to have this morning or anytime BB, unrelated to other disease or ingestion of odor-producing foodstuffs such as garlic, there must be specific or even generalized areas that are not clean. Assuming the dentist has determined that decay is not a factor, then there has to be sites of material buildup that are not normally present on tooth surfaces. Hopefully you have heard of the substance called plaque, which is a material that normally builds up on tooth surfaces each and every day we are alive. Plaque contains byproducts of saliva and breakdown products of foodstuffs in addition to normally present bacteria. When this sticky substance is not removed each and every day, it may start to harden, calcify, and become adherent to the tooth surface. At that point it can only be removed by scraping it off the tooth surface, a procedure done by the dental professional.
Plaque will usually start to harden in 24 hours, with some faster and with others slower, but in general, you need to clean that sticky substance off every surface of your teeth a minimum of once every 24 hours. If you miss a surface, more and more material accumulates along with an increasing number of bacteria. In order to be sure you are not missing any surface, I recommend brushing and flossing using no flavoring agent such as toothpaste. All over-the-counter toothpastes do nothing to make it easier to remove plaque, no matter what is advertised.
You need the take your brush, moist or not, and start in one area of your mouth and brush carefully and thoroughly every surface facing your cheeks and lips, upper and lower as well as every surface facing or adjacent to your tongue. Once that is done, then you need to clean the sides of your teeth that are not accessible to the brush. This is every surface that touches an adjacent tooth. If you have spaces or missing teeth, you may only need the brush, but if not you will need floss, and again, do not use flavored floss at least this one time.
Be sure that your flossing is as thorough as your brushing and that you do not just “pop it through and pop or pull it out.” It can not be cursory. You need to feel that you are rubbing that surface as well as you brushed the others. When this is done properly, you will see no bleeding, feel no tenderness and have no unpleasant odors. If that is the case and you have performed this thorough cleansing at least once every 24 hours, you may brush and floss more casually for any number of other times per day that you desire. But at least once must be impeccable. If you have to thread floss then you must do it. The dentist or hygienist will point out those areas that need threading and demonstrate how it is done.
If your dental professional has removed all calcified material from your teeth and you have removed all the plaque that has built up each and every day, then there never should be any offensive odors from your mouth morning, noon and night.
I wish I could say there was an easier way but alas, there is none. Shame on those false advertisements.
Happy cleansing and look forward to waking free of the dreaded BB.
-- Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at email@example.com.