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Why people have bad breath in the morning -Study

Written by Tunde Ajaja- Nigeria. 

When it comes to personal hygiene, apart from body odour, there are a few other things that can be as repulsive as having a bad breath, or simply put, mouth odour. Even the sound of it is distasteful, and not only does the smell nauseates, it goes ahead to present such a person in bad light, giving a vivid impression of a dirty human being. It could sometimes make the individual a lone ranger as people try to avoid such persons.

But as disgusting as bad breath is, it is amazing to find that most people experience it every time they wake up; mostly in the morning. It is also known as halitosis. In fact, it could be as repulsive to the owner of the mouth, not to even talk of others. Noteworthy is the fact that this case is independent of the chronic mouth odour, the product of which could make the listener (victim) puke.

Therefore, it is not uncommon to find that when people wake up in the morning, they tend to avoid close contact discussion, or better still maintain some distance or even cover their mouth while talking to others. The simplest cure would be to have a toothbrush. It could cure it all, only if done properly.

An expert in dental matters and periodontist, Sally Cram, said, "Everyone has morning breath to some degree. Here is the simple reason why: When you sleep, your mouth dries out and your normal flow of saliva decreases. When your mouth dries out, odour-producing bacteria multiply. That is why your breath can be worse in the morning."

However, for those who do not have mouth odour but wake up to find that they have bad breath, studies have shown that the trend is basically traceable to the fact that when a person is asleep, the mouth also goes into rest mode, leading to a drop in the rate of metabolic activities. And this form of bad breath is not limited to aftermath of waking up, it also happens when people close their mouth for too long without opening it.

Scientists also explained that saliva, which helps to flush out bacteria from the mouth and restrains some microorganisms, is less secreted while asleep, making it possible for bacteria to roam about in the mouth. According to a post on, the scientists explained that due to the dryness of the mouth at night occasioned by the reduced metabolism rate, microorganism compounds, especially a bacterium causing disease or fermentation, like lysozyme, tend to flourish more.

The report noted that the mouth may contain about 100 different species of bacteria, part of which can process some sulphuric compounds into chemicals like hydrogen sulphide, hence, the smell of such a compound tends to ooze out of the person's mouth.
A cosmetic dentist, Dr. Hugh Flax, once told Medical Daily that there is a strong link between bad breath and the absence of saliva, which is a watery liquid secreted into the mouth by glands, providing lubrication for chewing and swallowing, and aiding digestion.
He added, "During the day, your mouth produces a significant amount of saliva, but while you sleep, saliva production goes down and it is critical for sweeping away the food particles that would otherwise stay within the teeth. When those items are stuck there, bacteria feast on them and turn them to compounds that could make the mouth smell.
"Anytime you reduce saliva in the mouth, you reduce the mouth's ability to fight the bacteria that cause the bad breath."

Given that poor oral hygiene and some food items, such as beef, locust and vegetable, are more likely to leave some bad taste in the mouth, studies reviewed by Medical Daily, have shown that these bacteria tend to grow more when there are particles left in the jaws of the mouth.
Apart from these, a report published on showed that sleeping with the mouth open could also lead to bad breath because the inflow of air would make the mouth to dry, thereby giving room for such bad breath-inducing bacteria to thrive.
There are also indications that smokers are likely to have bad breath, because according to a study posted smoking increases the temperature of the mouth, which creates a thriving atmosphere for the kind of bacteria that cause bad breath.
Beyond smoking, it has also been found that taking certain drugs or being on medication can also cause bad breath.

Having established the various ways by which people develop bad breath in the morning, it is however worthy of note that there are simple and possible ways to avoid the seemingly unavoidable bad breath in the morning.
Tongue has been found to be a major source of bad breath, especially the back of the tongue, such that anyone who takes time to brush the tongue very well would be assured of a fresh and pleasant breath in the morning.

"Eighty-five per cent of bad breath comes from the tongue. It really helps tremendously to use a tongue cleanser before you go to sleep, or anytime during the day," says New York dentist, Irwin Smigel.
Apart from maintaining a good dental hygiene, one of the most advocated solutions to bad breath in the morning is brushing one's teeth before going to bed at night. By so doing, it was found that there would be less food items hanging in between the teeth and on the tongue.

It was also pointed out that anyone who chooses to brush at night before going to bed must not eat any other thing afterwards. "After you brush, go directly to bed. Don't eat or drink anything so you're not leaving food in your mouth," Cram said.
Also on dental hygiene, people are advised to spend more time scrubbing their teeth rather than doing some brief job, and that beyond brushing, flossing with the aid of dental floss, which is a material used to clean between the teeth could be of help.
The use of mouthwash might also help, even if temporarily, as it helps to kill the germs that could cause bad breath. "A quick swish won't do it. If the directions say rinse for 30 seconds, then rinse for 30 seconds. The mouth rinse has to be in there long enough to kill the bacteria. Rinse for five to ten seconds, you're not getting the full effect. The trick is you have to follow directions," Harms advises.

To a large extent, for overall good health, having a pleasant breath may not be negotiable, as it has been found that the bacteria that cause bad breath may possibly have some health implications, including cardiovascular disease, oral cancer and Alzheimer's, which is a progressive mental deterioration that can occur in middle or old age, due to generalised degeneration of the brain, and it is the commonest cause of premature senility. "When the toxins from oral bacterial are released into your blood stream, it can possibly inflict mayhem on other parts of the body," Flax said.

Commenting on the study, a medical practitioner, Dr. Rotimi Adesanya, said apart from the medical condition that makes people have mouth odour, food particles in the mouth and the cessation of saliva during sleep are other reasons why people have bad breath.
He said, "Saliva is a cleansing agent that cleanses the bacteria from the mouth, but in the night or while sleeping, its operation is reduced. Also, the bacteria in the mouth would act on the food particles that are left in the mouth and the waste product of that process gives an offensive odour. That is why dentists advise that we brush our teeth in the morning and before going to bed, so that any food particle that is left over will be removed.
"Bad breath is a major problem in the society, but it is avoidable. However, there are people who have medical condition, such as tonsillitis, which is the swelling up of the tonsils as a result of bacteria infection, sinusitis and adenoid enlargement."

Adesanya advised that even if people are too tired or reluctant to brush their teeth before going to bed, rinsing the mouth with water before sleeping could help. He added that there are some food that people eat before going to bed that could also give them bad breath, such as garlic, legumes and groundnut. "When they are broken down, there is a gas that is normally released, which is offensive and gives bad breath," he added.

Deal with bad breath before it embarrasses you

Written by Bukola Adebayo - Punch, Nigeria

Seun Akintayo was a fine, tall and handsome gentleman by many ladies' standards. He was not just good looking; he was also doing well in his career. At the age of 35, he was already a senior partner at the accounting firm where he worked.

As dashing as he looked, it was difficult to get a lady that would stay in a relationship with him for more than a year. They usually opted without giving him a reason. But one of them did him a favour before she dumped him. She said she could no longer withstand his breath.
According to her, his breath smelt as if like a rotten organism Harsh isn't?
Akintayo decided to ask his best friend if his ex-girlfriend was just being nasty or truthful. He got the home truth from his bosom friend. He had bad breath, a medical condition known as halitosis.

Halitosis can be embarrassing and downright offensive. It is also sad that most people who suffer this condition do not know until occurrences such as Akintayo's happen.

Consultant Dentist, Dr. Yemi Adelaja, says that halitosis, a common condition caused by sulphur-producing bacteria that live on the surface of the tongue and in the throat, can be a symptom of some dental infections or the result of poor oral hygiene over the years.
Adelaja explains that when bacteria build up in the cavities of the mouth and gums, they form plaque that can irritate the gums. He adds that these germs eventually become plaque-filled pockets between the teeth and gums and start emitting odour.
He notes that uneven surface of the tongue also can trap bacteria that produce odour, while dentures (teeth) that aren't cleaned regularly or don't fit properly can harbour food particles and odour-causing bacteria.

Simply put, poor oral hygiene such as not brushing your kid's mouth twice daily, not cleaning the tongue with a soft bristle brush or not flossing to remove food particles from the cavities around the teeth before they become plaque over the years can predispose you to halitosis.

Dental surgeon, Dr. Temilola Banjo, states that not all people with bad breath have poor oral hygiene. According to the specialist, having a dry mouth – that is, not enough saliva in the mouth, can also cause halitosis.
She says, "Saliva helps cleanse your mouth, removing particles that may cause bad odour. A condition called dry mouth can contribute to bad breath because production of saliva is decreased.

"The reason many people experience bad breath in the morning is because the saliva production at night decreases, leading to "morning breath," and is made worse if you sleep with your mouth open. It is people who suffer from chronic dry mouth that have bad breath, even after cleaning their mouth in the morning.
"Since you may not even know that you have bad breath, this is a symptom to watch for and if you have it, ask people to sincerely tell you if your breath smells, so you can quickly treat it. There are medications that will boost your salivary glands if that is the reason for your bad breath."

Banjo, however, notes that eating certain foods can also cause bad breath. She says foods such as onion, garlic, and other vegetables and spices emit foul odour after they have been broken down or when some particles are stuck in-between the teeth and the gums.
Banjo states, "When you eat foods that have lots of onion and garlic, you can experience bad breath some hours after because once they are digested, they are carried into the bloodstream, then the lungs and you breathe them out. It's usually a foul odour that comes out. This is the mild one because it lasts for just few hours.
"You should also avoid sugary foods and acidic drinks. These are bad both for your breath and for the health of your teeth, as acidic drinks can hurt the enamel on your teeth. Avoid fizzy drinks as much as possible and if you have to drink them, make sure to drink them quickly without holding them in your mouth.

"Coffee and alcohol too may cause bad breath. Both of these drinks provide an environment in your mouth for bacteria growth, which causes bad breath. They also dry out your mouth, which causes the bacteria to linger. Smoking can cause bad breath because naturally, they leave unpleasant mouth odour."

Adelaja quickly adds that bad breath can be a symptom of an underlying illness. He explains that halitosis may be a sign that something has gone wrong with the kidneys and some metabolic processes in the body.
According to him, some cancers and chronic gastro-intestinal disorders can cause a distinctive breath odour as a result of chemicals they produce.
This is the reason why the experts advise that people who suffer from halitosis see a doctor who will either erase or confirm all doubts. One thing is sure, bad breath is a reason for any smoker to quit today!
NB: If your baby has bad breath, you may also need to see a doctor quickly. He or she may have swallowed a foreign object like coins, a key or toy.

How To Deal With Foul Breath

Dr. Sylvester Ikhisemojie
A smelly breath is known as halitosis. It bothers many people and is also often referred to as a bad breath.
This column has received many mails and text messages specifically complaining about halitosis. Many others seek information on ways to deal with it. Many individuals realise this has become a problem when they start to get attracted to the opposite sex. There does not appear to be any specific sexual predisposition but men might suffer from it more because they also tend to be less conscious of their health.  This piece would focus on the common factors which lead to the development of halitosis and proffer some common solutions.

The consumption of too much of the wrong type of food predisposes one to developing a bad breath. It includes eating too much of certain types of food such as carbohydrates. These are cited because most of our common food are carbohydrates and they are available in surplus amounts. Carbohydrates cause damage by acting as a fuel for the bacteria which inhabit the mouth and thus break down these foods to reproduce and also give rise to a by-product which is offensive. The offensive odour in the breath is often difficult to deal with or remove. Instead of consuming a carbohydrate-rich food all the time, it is wise to take food that are rich in fibre. These help to remove large amounts of bacteria from the mouth.

Another wrong food is garlic consumed in large amounts. This in particular causes the mouth, clothes and even the hair of those who take it, to smell. It produces such a pungent smell which is difficult to get rid of until after several days of trying hard to do so. For those who are used to taking it, perhaps people of their communities learn how to cope with the smell, almost as if it were not there. For example, an Indian will not be aware of the smell of garlic in the breath of a Chinese.

Another food substance that is unhealthy for a good breath is milk. Many people in sub-Saharan Africa do not take much of this food because of poverty. It is believed to thicken nasal mucus and lead to the development of a sulphurous smell in the breath as the protein component is denatured by bacteria. Singers know this flaw and usually avoid it when they are due for a performance. It is far more beneficial to take yoghurt, a partly fermented type of milk product, its load of bacteria acts as gut cleansers and helps to decontaminate the alimentary tract.

The eating of fish and groundnuts without rinsing the mouth or brushing it afterwards can often lead to the production of a very disagreeable smell soon after consuming those food substances. The breakdown of the protein component of the food produces an offensive smell rich in ammonia that tends to smell like spoilt fish. The awareness of this unique smell should warn consumers of such foods that it is beneficial to have the mouth adequately freshened before meeting with people.

Poor dental hygiene is a common problem that both the mighty and the lowly in the society are guilty of. It is wise to brush the mouth at least twice daily with a soft brush. A hard brush ultimately wears out the teeth rather quickly and therefore does not have an advantage over soft brushes. Many people hardly even bother to brush their mouth for two minutes. This is the minimum duration required to keep the mouth reasonably clean. The tongue should also be brushed, particularly its back portion, to ensure the removal of most of what produces a disagreeable smell. Also, this helps to reduce the probability of developing dental caries in which cavities of various sizes develop in the teeth and thus provide an avenue for the multiplication of bacteria and the production of various types of smell.

If you do not drink enough water, your mouth is likely to smell because bacteria multiply when the mouth becomes dry. Also the saliva that ought to wash away the break-down products of the bacteria is not available or sufficient to do so. The accumulation of such products in the mouth therefore encourages the formation of those smelly substances. That is why even in conferences where certain people are expected to make long speeches, water is provided for them to sip intermittently and thus keep their breath fresh.

When there are untreated allergies, especially those which cause nasal congestion, the mucus accumulates in the sinuses around the nose and can get infected with bacteria, thus producing a very disagreeable smell while speaking or even breathing. The smell resembles that of an almost rotten egg and may often be nearly as pungent. It is therefore of the utmost importance to seek expert help in such a situation and have proper treatment by an ear/nose & throat surgeon.
Infections such as sinusitis, resulting from complication in the above scenario or a purulent form of sinusitis can also lead to bad breath. The infection needs to be diagnosed quickly and proper treatment started.  It is then a combination of remedies to decongest the nose, ensure the early restoration of normal breathing and eradication of the bacteria using antibiotics.

Sometimes, various types of intestinal reflux diseases lead to belching, which releases gases of various types that also smell in different ways. These odours are detectable in the breath and thus evident during normal conversations with people around us or while singing.

Finally, there is also the terrible smell perceived in the breath of those who are suffering from serious, life-threatening diseases. Thus, people suffering from cancer of the stomach and those who have chronic liver disease usually have a peculiar smell in their breath. Occasionally, like in the end-stage of liver disease, there is a mixed alcohol/fishy smell in the breath that often heralds death. The detection of that aromatic tell-tale sign is often a signal to the attending physician that all hope of providing a cure is perhaps gone.

Smokers also have a peculiar kind of bad breath which is irritating to many and perhaps pleasant to some, depending on their orientation. At the beginning of the habit, the smell is possible to conceal but as time goes on, this becomes progressively more difficult until it leaves a nearly permanent odour in the person’s breath.

Ask the doctor

Good day, doctor. May God bless you for your selfless service to humanity. Sir, please what is pseudomonas? Due to constant stomach pain, I was sent for a stool test and it was discovered to have a heavy growth of pseudomonas. After treatment, I went to check again and the same heavy growth was discovered.  I am worried. Please help. God bless.    
Pseudomonas is a gram negative bacteria found living naturally in the alimentary tract. In most situations, it lives in a status of equilibrium with its human or animal host. When it causes disease, however, it is often serious and difficult to deal with. You cannot afford to get tired of repeating the required tests. This cycle of testing and treatment should be continued until a level is reached where the number of the bacteria per gram of stool is not considered harmful. Then treatment can be stopped for it is not possible to eliminate all the pseudomonas in the stool nor is it wise to even try.

Doctor, please I need your help and medical advice urgently. I am 42 years old and used to be a chronic alcoholic. I have been having body itches since June 2013 and have gone for treatment several times without success. Could this be psoriasis and if yes, is it treatable? Please, help.    

If you have been taking a lot of alcohol in the past, you are certainly at risk of developing psoriasis. However, several other mechanisms are involved in the development of this disease and generalised pruritus is only one of the more common symptoms. Unfortunately, there is no cure for this condition, although there are various medications that are designed to help you cope with its more notable symptoms. However, the way you asked your question suggests that you have simply been scouring the Internet for clues. You ought to see a dermatologist for diagnosis and treatment.

Hello doctor. I am 24 years old. I have observed that a white substance comes out when I am urinating. Please, what can I do?    

The whitish substance, as you explained, could be due to an infection. In this case, there would also be pain when voiding. Or, it could be semen, which is a common accompaniment of urination at your age. The only way to be truly certain about which one it is, is to do a urine microscopy, culture and sensitivity. The cause would then be obvious.

Good day, doctor. Thank you so much for bringing solutions for health issues. Well done! I am 34 years old. Can Staphylococcus prevent one from getting pregnant even after treatment? What causes this infection? Can English medicine cure it completely or should I resort to traditional medicine? Thank you.      

Staphyloccus cannot prevent pregnancy after it has been treated. Traditional medicine is not the solution to the problem because you are dealing with a problem first identified by English scientists. If you have had proper clearance of these bacteria from the reproductive system and pregnancy is not forthcoming, something else must be responsible for that situation. You must see a gynaecologist for proper examination and for more serious tests. The cause of this challenge would be found.

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