The BIG Issue: Let’s Talk Bad Breath

In fact, it is estimated to be the third most frequent reason for seeking dental aid following tooth decay and periodontal disease (2). Despite this, halitosis continues to be a taboo subject. A survey once revealed that only one in 10 people are willing to tell friends and family that they have bad breath (3). No matter how close we are to someone we just can’t find it in ourselves to tell that person they have bad breath for fear of hurting their feelings. But for those who suffer from bad breath, it can have a significant impact on their personal and social life and can even be a sign of underlying health problems.

As a dental professional your advice and recommendation carries considerable weight and by educating patients on how to deal with bad breath you can help eliminate bad odour from their lives and save them from further embarrassment.

Approaching the subject of bad breath
As a dental professional, you are trained to deliver a positive oral health message to your patient in a professional and tactful manner.

Often the patient may not even be aware they have bad breath so its important to be considerate of their feelings and talk to them in a conversational and informal manner. Set the tone by asking a few common questions about their oral health. If it’s apparent the patient is embarrassed and does not wish to discuss the subject further, talk to them in general about halitosis and good oral care or wait until another time; they may even approach you at their next appointment. However, it is important to inform patients that bad breath can be a sign of underlying health problems and should not be ignored.

In many cases, the patient will be relieved that you instigated the conversation and “reveal all” to you. In these situations you should explore the subject some more as described below.

Explaining the causes and symptoms of bad breath
Many people are confused about the causes of their bad breath so it’s essential to make them aware of all the common factors and put them at ease. Generally a result of a build-up of bacteria in the mouth brought on by leftover food, the causes and symptoms will differ for every patient so it’s ideal to start by informing them that bad breath is relatively common and not usually a health concern.

• Ask about their oral hygiene routine - infrequent brushing or flossing causes food particles to become stuck between the teeth and decay inside the mouth.
• What type of foods and drinks do they consume? Garlic, onions, coffee, cigarettes and alcohol are just some foods and drinks that affect the breath.
• Do they suffer from gum disease; have they got red or swollen gums or are their teeth loose?
• Do they suffer from dry mouth (xerostomia) and find it difficult swallowing or speaking?
• Have they suffered from any respiratory or bacterial activity recently i.e. nasal discharge, catarrh, coughing, sore throat or sinusitis?
• Do they smoke?

Helping patients combat bad breath
Openly discussing bad breath with patients will enable you to identify how much of a concern it is for them and recommend a solution to help eliminate the bad odour. Put their mind at rest by confirming that bad breath can be easily addressed by following some simple oral care procedures:

• Brush teeth and gums for two minutes, twice a day. Recommend a toothpaste specifically developed to combat bad breath, leaving a fresh “minty” flavour after brushing and containing anti-bacterial agents and anti-bad breath ingredients; activated charcoal (as in Beverly Hills Formula Perfect White Black toothpaste) is a great agent helping to eliminate bacteria causing bad breath and neutralise remaining odours, leaving your patients’ breath feeling fresh all day long.
• Floss between teeth using dental floss or interdental brushes.
• Mouthwash (such as Beverly Hills Formula Total Breath Whitening mouthwash) will rinse away the bacteria that cause bad breath and offer anti-plaque properties.
• Tongue cleaners to brush the back of the tongue will remove food or odour causing bacteria.
• Chew gum to stimulate saliva and stop the mouth drying out.
• Consume foods and drinks that assist in preventing bad breath; baking soda, peppermint oil, fennel seeds, mastic gum, non-concentrated cranberry juice, natural yoghurt, and fruit. A handful of parsley will prevent bad breath from the stomach. Advise they keep a diary of foods and drinks; you may be able to identify a common factor.
• Quitting smoking is one of the best recommendations you could give, not just for eliminating bad breath but for reducing the risk of mouth cancer.
• Drink plenty of water and green tea but avoid coffee. Fizzy drinks provide short term relief but the sugar creates problems in the long-term.

Promoting Bad Breath Awareness
By helping your patients combat bad breath you will be making a dramatic improvement to their personal, professional and social life, boosting their confidence to eat, speak and laugh with friends and family again.

Nominate a “fresh breath” expert in the practice or hold a “fresh breath” day/week/month; you’ll be surprised at how many patients will come forward to end their fight against bad breath. Leave flyers/brochures on halitosis around the practice, in reception or in the waiting room, and patients will feel more inclined to tackle the subject.

References
(1) http://www.netdoctor.co.uk/diseases/facts/badbreath.htm
(2) Loesche, WJ; Kazor, C (2002). “Microbiology and treatment of halitosis”. Periodontology 2000 28: 256–79. doi:10.1034/j.1600-0757.2002.280111
(3) http://www.dentistry.co.uk/news/2197-Dentist-discovers-‘bad-breath’-secrets