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Daily Mail

Frankly my dear, you need a trip to the Fresh Breath Centre

By Jonny Beardsall
Daily Mail  (9 February 2008)

Clark Gable was a notorious sufferer, though it obviously didn’t put off all the ladies.

But for many couples, it’s a taboo subject that dare not breathe its name.

Some people with halitosis are so mortified that they have their sinuses flushed, undergo surgical explorations such as a gastroscopy or even have their tonsils removed.

They may become depressed and get agoraphobia as a result. “We take the problem very seriously,” says Dr Phil Stemmer of the Fresh Breath Centre in London.

“Patients regularly tell me their bad breath affects their every waking moment,” says the dentist, who has seen up to 50,000 patients since the centre opened 12 years ago.

“I’d been a dentist for 20 years and have always had a special interest in trying to cure and prevent gum disease. Often, patients with gum problems also have bad breath and I wanted to find out why, so I spent more than 4,000 hours with a team researching bad breath before opening the centre.”

“Huge strides in diagnosis—such as studying bacteria under a microscope, in the mouth, on the tongue, between the teeth—have been made and, happily, we now know how to treat what has become one of the last taboos.”

And at my first one-hour session, Dr Stemmer, 55, expresses confidence that he can cure the problem in more than 95 per cent of cases.

Bad breath is almost always due to poor dental hygiene which causes a build-up of bacteria in the mouth. There are two types—one uses oxygen, the other can grow only without it.

Too much of the latter is generally believed to be responsible for smelly breath as it leads to a fierce combination of volatile sulphur compounds such as hydrogen sulphide, dimethyl sulphide and methyl mercaptan with others including nitrogen containing gases such as cadaverine (smell of corpses) and putrescine (smell of decaying meat).

If you have bad breath these gases can overwhelm others when you speak or exhale.

But while the condition may be linked to poor oral hygiene, Dr Stemmer has seen patients who clean their teeth as many as 20 times a day and still suffer, in which case their technique may be wrong.

“They may be cleaning their teeth incorrectly and missing the buildup of core bacteria that is causing problems,” Dr Stemmer says.

“Those with gum disease will, for example, have four times more bacteria in the mouth than those with healthy gums. Excessive bacteria may also occur due to illness—such as colds, flu or diabetes, which can lower your immune system—or because of low fluid intake, stress and lack of salivary flow. Anything that dries the mouth will make it worse, particularly alcohol. Coffee does, too.”

If you think you have a problem, Dr Stemmer says your first port of call should be the dentist and not the doctor.

“Very rarely is it a problem with the stomach, although many people think it must be,” he says.

And diet has precious little to do with the problem either, he adds. “If you eat garlic, onion or pizza, you’ll smell of garlic, onion or pizza, and if you stop eating it you won’t. But with bad breath, whatever you do you’ll smell of it.”

During my visit—which comes as Valentine’s Day approaches—he asks if I brush properly, how often I floss, if my gums bleed and whether I sleep with my mouth open.

His first diagnostic tool is a Halimeter—a white unassuming rectangular box that measures two of the smelliest sulphur gases contained in exhaled air. He attaches a red and white drinking straw to one end of a clear plastic tube and vacuums air from my mouth. I watch nervously as the numbers in the display fluctuate to as high as 27 before they settle on 22.

“You’re fine. You haven’t got bad breath,” he reassures me. “Under 50 is nothing to worry about, anything over 150 would be noticed socially but we’ve had people in here registering as high as 2,000.”

But with 50 to 60 other ghastly oral gases to check for, he cannot take one test in isolation. So a trained odour judge evaluates my breath on a scale of zero to five.

“This can range from ‘slightly unpleasant’ at the lower end, to ‘dog’s breath’ in the middle, to ‘dragon’s breath,’ way off the scale,” Dr Stemmer says.

Even though I haven’t brushed or flossed this morning I am assured I can kiss with confidence. But any smugness fades as he removes some dubious plaque from a molar, places it on a glass slide and projects it on to a widescreen monitor.

Ugh. It makes gripping viewing as he identifies the wriggling, squirming bacteria. “Look, there’s a spirochete—they appear only on plaque that is eight to ten days old,” Dr Stemmer says, excitedly.

He reaches for a tiny intra-oral camera and takes appalling pictures of the inside of my mouth and reproduces them on the monitor. This illustrated guided tour highlights potential problem areas. Scenes of oral plague and pestilence can make unpleasant viewing. I need to see a hygienist.

Dr Stemmer’s most remarkable revelation is that some people think they have a problem when they don’t. “Someone will register zero on the Halimeter yet can’t accept it. It’s all in their minds, but a low reading does go some way to convincing them otherwise.”