Brushing Techniques To Combat Bad Breath

Halitosis, commonly known as bad breath, refers to any unpleasant odor coming from the mouth. It can lead to social and psychological challenges, causing embarrassment in interpersonal interactions. Halitosis is very common, with approximately half of the population experiencing bad breath at some point, especially with its causes being so diverse. However, over 90% of cases stem from oral issues, such as poor oral hygiene, poor tongue cleaning, dry mouth, periodontal disease, oral carcinomas, and throat infections.

The surface of the tongue, throat, and periodontal pockets harbor over 500 bacterial species that, when they break down, produce foul-smelling volatile sulfur compounds (VSCs). Inadequate oral hygiene leads to the buildup of food residue and dental bacterial plaque, providing an environment for VSCs to thrive and consequently cause halitosis. Therefore, maintaining good oral hygiene, including regular brushing and flossing, is crucial in combating bad breath.^1,2

Importance of brushing for oral hygiene

Proper brushing plays a crucial role in maintaining oral health by effectively removing dental bacterial plaque and white tongue coating, which are major contributors to bad breath. Research indicates that correct brushing techniques can lead to a significant reduction in plaque levels by up to 42% and VSC levels by up to 33%.^1,3 

What constitutes “proper” brushing? 

Many people fail to brush properly, with over 70% of participants in one study exhibiting improper brushing habits.⁴ To ensure you're reaping the benefits of proper brushing, here are some essential tips to follow:

Selecting the right tools

• Numerous studies have shown that high-frequency, sonic powered toothbrushes are more effective at plaque removal than manual toothbrushes 
• Further research emphasizes that the brushing technique matters more than the type of toothbrush
• Manual toothbrushes remain effective in removing plaque
• Remember to replace your toothbrush every 2-3 months or when the bristles become worn
• Opt for toothpaste containing fluoride and antibacterial agents like triclosan and zinc to safeguard against plaque buildup and tooth decay.^5,6,7 

Mastering the technique

The bass technique, or its modifications, are the most commonly recommended brushing method. The modified bass technique is proven to be superior to other brushing techniques for reducing plaque and gingivitis. This is because it pays special attention to cleaning the sulcus (the space between the tooth and gums) and inner tooth surfaces where food debris tends to accumulate.^4,8,9

Establishing frequency and duration

Make it a habit to brush your teeth at least twice a day for 2-3 minutes each session.⁴

Addressing the tongue

Often overlooked, the tongue harbors a significant amount of odor-causing bacteria within its coating. Pay close attention to cleaning the tongue surface by: 

• Gently brushing it in a wiping motion from the back to the front
• Follow up with a thorough rinse
• Use a tongue scraper for a more comprehensive cleaning, as it effectively removes the layer of biofilm 

The objective when cleaning the tongue is to eliminate the yellow or white coating on the tongue, which serves as a breeding ground for bacteria.^1,2,10

Additional tips for combating bad breath

In addition to proper brushing, incorporating other oral hygiene practices can significantly aid in preventing bad breath. Among these, two crucial techniques are using dental floss and mouth rinses as supplementary measures.

Dental flossing

Flossing is essential for interdental care, as it effectively removes food debris and plaque from areas that toothbrushes cannot reach, such as the spaces between teeth. Whether using traditional dental floss, a floss holder, water flosser, or tiny interdental brushes, the goal remains the same: to thoroughly clean between teeth. It's important to make flossing a daily habit to maintain optimal oral hygiene.¹¹

Mouth rinses

Mouth rinses, or mouthwashes, contain antimicrobial agents like chlorhexidine and triclosan, which play a vital role in inhibiting the growth of oral bacteria. Additionally, many mouthwashes contain essential oils such as tea tree or peppermint oil, known for their effectiveness in controlling bad breath. You should ideally aim to incorporate mouthwash into your oral care routine twice a day or as recommended by your dentist.²

Lifestyle changes for fresher breath

Implementing certain lifestyle changes can significantly contribute to fresher breath and combat the root causes of bad breath:

• Hydration is key to combating one of the main causes of bad breath; dry mouth. Saliva possesses natural antimicrobial properties, and so reduced salivation (dry mouth) is closely associated with halitosis. Ensure you drink enough water throughout the day to maintain proper hydration levels and promote saliva production¹² 
• Smoking not only poses various health risks but also contributes to dry mouth, exacerbating bad breath. Quitting smoking can lead to improved oral health and fresher breath²
• Foods high in sulfur content, such as onions, garlic, and alcohol, can emit foul odors when digested. While these odors may be short-lived for some, individuals struggling with halitosis may benefit from limiting consumption of these foods to help manage bad breath.
• Masking agents such as sugar-free chewing gum, breath mints, and mouth sprays can temporarily mask bad breath with pleasant scents. While these solutions offer short-term relief, they do not address the underlying cause of bad breath. Use them sparingly and focus on addressing the root issues causing halitosis^1,2
• Schedule regular visits to your dentist for checkups, clinical examinations, and professional cleanings as needed 

While poor oral hygiene is a primary cause of bad breath, there may also be underlying extraoral factors contributing to halitosis such as oral carcinomas or metabolic diseases which can only be identified through professional evaluation.^1,2

FAQs

Why do I still have bad breath even after brushing properly?

Although a majority of halitosis cases originate from the oral cavity or improper oral hygiene, around 8% of cases are from extraoral sources. Gastrointestinal disease, metabolic diseases and respiratory system disorders can all be plausible causes of bad breath. Hence, halitosis can only be treated if the underlying cause is identified through clinical examination.^1,2

How can I tell if I have bad breath?

Often, individuals suffering from bad breath may not be aware because they may have developed a tolerance and it may only be noticed by the people around them, which can be distressing. 

• However, there are a couple signs you can pay attention to that may be indicative of bad breath: Bad breath is often accompanied by a persistent sour, bitter, or metallic taste in your mouth
• Any plaque buildup around your teeth or a white coating at the back of your tongue could indicate that you may have bad breath¹ 

If you are still concerned following these self-evaluation tips, visit your dentist whocan use various diagnostic methods and tools to confirm the presence of bad breath.

Summary

The prevalence of halitosis, or bad breath, affects up to 50% of the population, with over 90% of cases stemming from oral issues such as poor hygiene and bacterial growth. Effective oral hygiene, particularly proper brushing techniques, plays a pivotal role in combating bad breath by reducing plaque and volatile sulfur compounds (VSCs). Choosing the right toothbrush and toothpaste, employing correct brushing techniques like the modified bass method, and incorporating tongue cleaning are crucial steps. 

Additionally, complementary practices such as flossing and mouth rinses, along with lifestyle changes like staying hydrated and avoiding certain foods, contribute to fresher breath. While temporary solutions like chewing gum may provide relief, addressing underlying causes through regular dental checkups is essential for good long-term oral health.

Molly Bassey

BSc Biomedical Science, University of Birmingham

Molly holds a BSc in Biomedical Science and is a driven professional deeply committed to advancing healthcare and medical research. Throughout her undergraduate studies, she polished her writing skills which she now applies to her years of experience in the medical/healthcare communications industry. She possesses in-depth knowledge across various therapeutic areas, particularly in neurology and oncology, as well as expertise in drug development and clinical research. Notably, her research background includes exploration into smooth muscle and muscarinic antagonists.

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