Increased public awareness and demand for bad breath remedies

have resulted in a substantial growth of the breath freshening industry

and the saturation of the market with breath-improving products

such as mints, chewing gum, breath sprays, and pills,

the majority of which have only a short-term 'masking' effect

on bad breath and are essentially ineffective.

Well, what can we do? Could it be as simple as swishing with some water?

Take morning breath.

Malodorous breath upon awakening after a night's sleep

is a common condition known as "morning bad breath.”

The most common cause of bad breath in general is

the degradation of protein and protein fragments by

microorganisms residing on the tongue and teeth, particularly

the sulfur-containing amino acids cysteine and methionine

that are broken down into volatile sulfur compounds

like the rotten eggs gas hydrogen sulfide.

Approximately 50 per cent of the adult population

has early morning concentrations of these compounds in mouth air

that “exceed the threshold of objectionability”

established by the “organoleptic panel.”

What does that mean?

The organoleptic method is considered the gold standard

in the examination of breath malodor.

Basically, all this means is some examiner sniffs the air

exhaled from the mouth and nose and subjectively defines

the presence or absence of odor.

And when people's morning breaths are sniffed

about half exceed the threshold of objectionability.

Why? What causes it? A dry mouth.

Low salivary flow, particularly during the night,

creates like a stagnant pond effect,

favorable for bacterial proliferation and putrefaction,

and so to reduce morning bad breath,

you may read suggestions that rinsing with or drinking water

upon awakening is effective, but you don't know...

until you put it to the test.

“The effect of water on morning bad breath:

a randomized clinical trial.

One group was randomized to rinse their mouths

with a tablespoon of water, and the other to drink about a cup.

And... they both worked, significantly improving bad breath,

with no apparent difference between them,

though they didn't have a control group,

and it would have been interesting to see how much their breath improved

just being awake with their normal salivary flow.

After drinking and eating in the morning,

morning breath tends to disappear.

People brush their teeth in the morning thinking that's going to help,

but that may only reduce rotten egg gas levels 30 percent,

whereas eating breakfast works twice as well,

a 60% drop in hydrogen sulfide levels.

The mechanical action of chewing stimulates the flow of saliva

and the passage of food over the surface of the tongue

removes the putrefied surface film,

thus simulating the action of tongue brushing.

Well, if it's a matter of the amount of tongue coating there is,

how about actively brushing your tongue, like you would your teeth,

and you get closer to a 70% drop, suggesting the tongue

is the major source of the stinky gasses.

Other studies, though, show no benefit to tongue brushing

on oral odor in both adults and children.

The researchers suggest maybe the gag reflex

kept people from doing a better job?

What about tongue scraping?

In this study they compared tooth brushing, brushing plus flossing,

brushing plus scraping, or all three, and they found that

adding flossing didn't really seem to affect morning breath,

and that tongue scraping won the day against tooth brushing,

suggesting that tongue cleaning may be the most important

hygienic procedure to reduce morning bad breath.

This is not to suggest toothbrushing doesn't help with bad breath.

Here, they had people stop brushing their teeth for 5 days

but continue to floss and tongue scrape,

all while doing their fancy organoleptic technique

where they blew through a straw in some poor examiner's nose,

and despite all that scraping and flossing,

their breath got worse when they stopped brushing.

What about tongue brushing versus tongue scraping?

Researchers compiled all the randomized controlled trials

comparing different methods of tongue cleaning to reduce mouth odor

in adults with halitosis and…

the tongue scraping was found to be

slightly more effective than tongue brushing.

Perhaps the fact that the width of a toothbrush is smaller

than the width of a regular tongue scraper might make it

less effective in removing loosened debris from the tongue.