Science of Breath Odor and Intervention
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Bad Breath Basics – A Deeper Dive
What is bad breath?
Simply put, it is a noticeably unpleasant odor in exhaled air. These odors can have two possible origins. The most common source is the mouth and throat area. Another source is air from the lungs. Most experts discount the stomach as a direct contributor to bad breath.
We are not offering relief from odors that come from the lungs, but will take a moment to explain a little about them. Some odors arise from fasting or keto-diet or poorly controlled diabetes. A small number of disease conditions or genetic circumstances can also be responsible for creating disagreeable breath. All of these odors are due to metabolic processes, which produce gas byproducts that are eliminated from the blood as it passes through the lungs causing it to be present in breath air just like carbon dioxide. Some of these odors can be managed by changes in dietary practices.
Consuming certain foods such as garlic or onions or alcohol can create breath odors of both oral and lung origin. The initial odors appear in the oral region and can actually be helped by our Pristine System. These oral odors typically disappear within 3 hours if no intervention is provided. The lung-derived odors may continue for as much as two or three days before being completely gone. We all understand the cause of these odors and the behaviors that bring them on.
Our focus is on breath odor that originates in the mouth and throat area and constitutes the majority of bad breath. It is the third most common complaint (behind decay and gum disease) of our dental patients. We are concerned with persistent, chronic, socially disruptive breath odor that effects about 25% of the population. We are also sympathetic to another 35% of the population that deal with troublesome, transient, occasional, milder issues such as morning breath or dry mouth breath. We find that our system works well in both circumstances.
The experts believe that 90% of bad breath is the result of bacterial activity in the mouth and throat regions. A simple description of the process is that certain bacteria eat particular foods that cause them to release gas, sulfur gases (3 types) and other gases (at least 10 others) that smell offensive. Basically you have farting bacteria in those regions. Scientists have studied to identify which species are the odor producers. So far thirteen different varieties have been acknowledged as being associated with offensive breath, with one type present 100% of the time according to one study.
So what do we know about oral bacteria? A good estimate is that the average person has 8 billion bacteria in his mouth, similar to the number of people living on our planet. Over 700 species have been detected. The normal human has about 70 different kinds at any one time. Many of these are beneficial or at least not harmful. Different bacteria have favorite places to live. Some favor teeth, others prefer gums; a few like to avoid oxygen. Similar to the way that we don’t find scorpions living in the same territory as polar bears, bacteria that are associated with bad breath don’t generally hang out with bacteria that like to chew on teeth. So how do we contend with these stink causing guys?
The Four Keys To Correcting Bad Breath
Key #1. EFFECTIVE PRODUCTS: Three Rinses
Use products with ingredients at concentrations that have been scientifically shown to improve breath quality.
Key #2. REACH THE SOURCE
Deliver these products directly to where the problem originates.
Key #3. Maintain Contact
Be certain those products remain in contact long enough to be successful.
Key #4. Order of Use
Administer the products in an optimal sequence.
Key #1. EFFECTIVE PRODUCTS: Three Rinses
Bottle #1 is zinc acetate. You may have noticed that several existing breath products show zinc in various forms as an ingredient. This is no coincidence as it is well recognized to have beneficial effects on malodor. We have chosen to not combine our selected form (zinc acetate), keeping it pure and simple. One scientific report found that: “It may be concluded that some commercial mouth rinses are markedly less effective than a simple solution of zinc acetate”.
Acta Odontol Scand. 2002 Jan;60(1): 10-2.
Comparative analysis of some mouthrinses on the production of volatile sulfur-containing compounds.
Rosing CK, Jonski G, Rolla G.
Bottle #2 is food grade hydrogen peroxide. This is similar to the hydrogen peroxide that you can buy at the local pharmacy except that it is less concentrated to make it safer for daily use and has no additives or stabilizers included. It is considered a cleansing agent. A journal article observed that: “Hydrogen peroxide significantly reduced the sulfur gas concentrations (a measure of bad breath) for eight hours”.
J Dent Res. 2000 Oct;79(10): 1773-7.
Morning breath odor: influence of treatments on sulfur gases.
Suarez FL, Furne JK, Springfield J, Levitt MD
Bottle #3 is a combination of ten essential oils. These were selected based on their ability to be effective against the most troublesome odor- producing microbes. Also taken into account were reported complementary activities among the different essential oils. Strong consideration was given to the user experience of taste, flavor and persisting freshness. An interesting study determined that “Cinnamon oil inhibited the ability of S. moorei to produce H2S”. S. moorei is a bacteria associated with producing bad breath and H2S is a foul-smelling component of bad breath.
Archives of Oral Biology. 2017 Nov;83:97-104.
Effect of cinnamon (Cinnamomum verum) bark essential oil on the halitosis-associated bacterium Solobacterium more and in vitro cytotoxicity
Genevieve LeBel, Bruno Hass, Andree-Ann Adam, Marie-Pier Veilleux, Amel Ben Agha, Daniel Grenier
Eur J Oral Sci. 2020 Dec;128(6):476-486
Effect of essential oils on oral halitosis treatment: a review.
Dorota Dobler, Frank Runkel, Thomas Schmidts
Key #2. REACH THE SOURCE
(This is the big secret)
By finding the favorite location of bad breath causing bacteria we are able to target that area specifically. It turns out that these varieties of bacteria, when present, can consistently be found at the back and root of the tongue and into the tonsil/throat area. If gum disease is present they may congregate there also. How did we come to decide where bad breath bugs prefer living? Three studies make clear their preferred location.
One report on morning breath found that “Brushing the teeth had no apparent influence on the sulfur gases” (a measure of breath odor), but “Ingestion of breakfast resulted in strong trends toward decreased sulfur gases”. They determined that the activity of eating and swallowing had the effect of dislodging and washing away bacteria and odors on the back of the tongue and the throat. Tooth brushing didn’t reach that area and had little effect on breath odor.
Another study, of folks with significant bad breath, looked at the tongue. Six areas were sampled. 73% of odor-producing bacteria were found to be located at the extreme rear root of the tongue, which is not even visible. 17% were found on the far back of the tongue that can be seen and reached with a tongue scraper. So 90% were thriving on the rearmost part of the tongue. The other 10% were found in the four sample sites more towards the front. They concluded, “that the tongue surfaces not accessible to routine oral hygiene procedures can significantly contribute to oral malodor.”
A paper looking at tonsillectomy as a treatment of bad breath concluded that: “Tonsillectomy is a significantly effective procedure for the treatment of halitosis caused by chronic tonsillitis.” This supports the idea that the throat and tonsil area can be a major source of odor creating bacteria. Every time you swallow, the root of the tongue contacts with the throat and tonsil area. It should be no surprise that they would share a similar bacterial community. In a related review, 90% of children with bad breath and enlarged adenoids “showed significant improvement after removal of adenoids.”
When trying to test our own breath, most folks instinctively cup their hand and exhale deeply from the throat. We seem to naturally sense where the problem resides.
Below are images to allow you to view tongue and throat anatomy and be able to visualize places where bacteria might find a protective environment.
This image shows a front view of the tongue that most of us can see in the mirror. The row of large circular bumps on the back of the tongue (circumvallate papillae) is typically the limit that can be reached by a tongue scraper. Try to identify these on yourself.
This image is a view of the root of the tongue, looking forward from the back of the throat. You cannot see this in your mirror. Take note of the irregular surfaces and concavities, making this region a challenge to cleanse.
This image is a photo of the throat and tonsils. Notice all the nooks and crannies available to shelter bacteria. Tonsil stones (collections of bacteria and food debris) sometimes form in the craters of tonsil surfaces and when dislodged smell like the worst bad breath.
Video Of Throat In Action
This video demonstrates the tongue and throat in action. Can you see how there is no barrier between the mouth and throat and how it makes sense that odors created in the depths could easily come forward. Also note the contact of the rear of the tongue contacting with the throat/tonsil region when swallowing. This occurs at least once a minute during waking hours. Do you think bacteria from these areas are getting transferred back and forth?
To determine the best way to reach these challenging locations we consulted with a speech pathologist. She helped us to identify sounds, which if made during gargling, would cause the rinse to reach our target areas.
We discovered that reaching the far rear and root of the tongue could be done by sticking the tongue way out and making the “AAAHHHHH” sound. The throat was best contacted by retracting the tongue as deeply as possible and making a low “OOOOOOOO” sound.
The physical movement of the air and liquids during gargling, combined with the direct effect of the rinse ingredients, neutralized odors, disrupted bacterial attachment and washed away bacteria and debris while weakening the vitality of the remaining microbes.
Key #3. Maintain Contact
Don’t cut short the period spent gargling. Our products need adequate exposure time to be effective. We have run laboratory experiments with bacterial biofilms and done lots of personal testing to calibrate appropriate contact time of the rinses in order to optimize results. We also acknowledge that user convenience is essential. During the more intense 3-Day Cleansing Phase, longer contact times (three minutes total) and more frequent exposures (twice a day) are called for. Thereafter, during Maintenance, the system takes only 1 minute once a day total. A more detailed description is found in Pristine Breath Care Instructions >.
Key #4. Order of Use
We settled on three rinses, each with its own particular benefits. It was logical to select the refreshing and lingering essential oil rinse as the final application. The other two rinses are simple and have different modes of action so each contributes its own activity. One scientific article suggests that applying zinc prior to or in conjunction with hydrogen peroxide could enhance the beneficial effect of hydrogen peroxide, so we advise using the zinc acetate first or combined with the hydrogen peroxide. Our instructions for the Cleansing Phase are to use #1, #2, and #3 in sequence. The Maintenance Phase involves combining #1 and #2 prior to gargling, then gargling with #3. See Pristine Breath Care Instructions > for details. The gratifying results of our users reinforce the benefit of our recommended progression.
In summary, we know that some bacteria produce odors. We know who the offending bacteria are. We know where they like to live. We know how to disrupt their obnoxious activities.