Stop blaming bad breath - at least the chronic kind - on smelly food or poor dental hygiene.
Bacteria on the tongue is the true culprit, say those who've studied halitosis, the proper name for seriously bad breath.
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"Everyone has some of this bacteria, but in some people it really takes over," says Cleveland dentist Dr Louis Malcmacher, who's treated more than 1 500 people for chronic bad breath.
Just why it affects some people more than others, though, remains unclear, he says.
The problem bacteria, which cannot survive in oxygenated areas, hide in the thick surface in the back of the tongue and emit a sulphur compound that causes the offending smell, Malcmacher says. It's different from the smelly breath that comes from eating certain foods, he says.
That's a more temporary version, says Dr Jon Richter, founder of the Pennsylvania Centre for the Treatment of Breath Disorders.
Onions, garlic and alcohol are absorbed rapidly in the bloodstream, Richter says, and then the blood is carried back to the lungs, where the food smells are released by the lungs and evaporate into the air, causing the food odours from the mouth.
"You let it run its course, and through evaporation, [the breath] eventually returns to normal," Richter says.
"The type of foul and pungent odour [that makes people worry] is almost invariably caused by bacteria in the back of the tongue," he says.
Bad breath's social toll
Bacteria-caused bad breath is chronic, the experts say, and can cause real problems for its sufferers.
"These people avoid social contacts, cover their mouths, are very aware of getting too close to people," Malcmacher says. One of his patients, a man in his early 30s, hadn't gone on a date for four or five years because of his bad breath, he says.
"There is a strong social taboo in Eastern cultures, which are particularly sensitive to bad breath," he says. And in Israel, "people have actually sued and won divorce decrees for bad breath," Richter says.
Getting rid of halitosis, however, can be fairly simple, the dental experts say. It all starts with brushing your tongue along with your teeth at least once a day.
"If you brush your teeth, it's about 10 to 20 percent effective in removing the odour," says Dr Israel Kleinberg, an oral biologist and dental school professor at the State University of New York. "But brushing the back of the tongue is about 70 percent effective."
A regular toothbrush works just fine, although it makes some people gag a little bit, he says, or you can buy a special tongue scraper or a tongue brush, which is thinner and easier to use.
"Everybody should be doing something to clean their tongue," Malcmacher says. "Nearly every dental professional brushes his or her tongue, but only 10 percent tell their patients to do so."
Taming the sulphur compounds
Combined with the daily brushing, Kleinberg recommends gargling with one of several products that affect the bacteria in your mouth. These range from anti-bacterial mouthwashes that kill bacteria - although he says they're least effective because the bacteria grow right back - to chemicals like chlorine dioxide that oxygenate the mouth, inhibiting bacteria growth. Zinc also is helpful, he says, affecting the enzymes of the sulphur compounds and making it harder for them to grow.
Many newer products on the market contain combinations of these elements, and their use should eliminate most of the mouth odour, Kleinberg says.
But as important as curing halitosis, the dentists say, is making sure you have it in the first place.
"A significant proportion of people have imaginary halitosis," Richter says. "They think they have it, but they don't."
Many people who think they have bad breath actually suffer from dry mouth, Kleinberg says.
"Dry mouth is very common because of all the medications. More than half that are on the market dry out the mouth," he says.
Most dentists today have instruments to measure both the sulphide level and the amount of moisture in a person's mouth, to get a definite diagnosis, Kleinberg says.
"Find a dentist who knows how to take the measurements and can then take care of your problem," he says.
What to do
Finding out if you have bad breath requires the help of someone you can trust to tell you. If that's difficult, Malcmacher suggests you floss your teeth with unscented floss and then smell the floss to see if there's an odour. But the surest way to confirm a diagnosis of halitosis, he says, is to go to the dentist.
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