What causes bad morning breath, and what can you do about it?
Tongue Scraping vs. Tongue Brushing for Treating Halitosis (Bad Breath)
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
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, such as cysteine and methionine, that are broken down into volatile sulfur compounds like the rotten-egg 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.
One study: “The effect of water on morning bad breath: a randomized clinical trial.” One group was randomized to rinse their mouths with tablespoon of water, and the other to drink about a cup. And…they both worked, significantly improving bad breath, with no apparent differences 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 percent 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 percent 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. They found that adding flossing didn’t really seem to affect morning breath, and that tongue scraping won the day against tooth brushing. This suggests 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 five days, but continue to floss and tongue scrape––all while doing the fancy organoleptic technique where they blew through a straw into some poor examiner’s nose. 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.
Please consider volunteering to help out on the site.
- Van der Sluijs E, Slot DE, Bakker EWP, Van der Weijden GA. The effect of water on morning bad breath: a randomized clinical trial. Int J Dent Hyg. 2016;14(2):124-34.
- Faveri M, Hayacibara MF, Pupio GC, Cury JA, Tsuzuki CO, Hayacibara RM. A cross-over study on the effect of various therapeutic approaches to morning breath odour. J Clin Periodontol. 2006;33(8):555-60.
- Danser MM, Gómez SM, Van der Weijden GA. Tongue coating and tongue brushing: a literature review. Int J Dent Hyg. 2003;1(3):151-8.
- Seerangaiyan K, Jüch F, Winkel EG. Tongue coating: its characteristics and role in intra-oral halitosis and general health-a review. J Breath Res. 2018;12(3):034001.
- Tonzetich J, Ng SK. Reduction of malodor by oral cleansing procedures. Oral Surg Oral Med Oral Pathol. 1976;42(2):172-81.
- Renvert S, Noack MJ, Lequart C, Roldán S, Laine ML. The underestimated problem of intra-oral halitosis in dental practice: an expert consensus review. Clin Cosmet Investig Dent. 2020;12:251-62.
- Silva MF, Leite FRM, Ferreira LB, et al. Estimated prevalence of halitosis: a systematic review and meta-regression analysis. Clin Oral Investig. 2018;22(1):47-55.
- Van der Sleen MI, Slot DE, Van Trijffel E, Winkel EG, Van der Weijden GA. Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review. Int J Dent Hyg. 2010;8(4):258-68.
- Gonçalves AC de S, Martins MCN, Paula BL de, Weckwerth PH, Franzolin S de OB, Silveira EMV. A new technique for tongue brushing and halitosis reduction: the X technique. J Appl Oral Sci. 2019;27:e20180331.
- Ileri Keceli T, Gulmez D, Dolgun A, Tekcicek M. The relationship between tongue brushing and halitosis in children: a randomized controlled trial. Oral Dis. 2015;21(1):66-73.
- Matarazzo F, Reino DM, Hayacibara RM, de Faveri M, Fujimaki M. Effect of toothbrushing discontinuation on morning volatile sulfur compounds in periodontally healthy subjects. Oral Health Prev Dent. 2013;11(4):309-13.
- Outhouse TL, Al-Alawi R, Fedorowicz Z, Keenan JV. Tongue scraping for treating halitosis. Cochrane Database Syst Rev. 2006;(2):CD005519.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
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, such as cysteine and methionine, that are broken down into volatile sulfur compounds like the rotten-egg 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.
One study: “The effect of water on morning bad breath: a randomized clinical trial.” One group was randomized to rinse their mouths with tablespoon of water, and the other to drink about a cup. And…they both worked, significantly improving bad breath, with no apparent differences 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 percent 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 percent 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. They found that adding flossing didn’t really seem to affect morning breath, and that tongue scraping won the day against tooth brushing. This suggests 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 five days, but continue to floss and tongue scrape––all while doing the fancy organoleptic technique where they blew through a straw into some poor examiner’s nose. 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.
Please consider volunteering to help out on the site.
- Van der Sluijs E, Slot DE, Bakker EWP, Van der Weijden GA. The effect of water on morning bad breath: a randomized clinical trial. Int J Dent Hyg. 2016;14(2):124-34.
- Faveri M, Hayacibara MF, Pupio GC, Cury JA, Tsuzuki CO, Hayacibara RM. A cross-over study on the effect of various therapeutic approaches to morning breath odour. J Clin Periodontol. 2006;33(8):555-60.
- Danser MM, Gómez SM, Van der Weijden GA. Tongue coating and tongue brushing: a literature review. Int J Dent Hyg. 2003;1(3):151-8.
- Seerangaiyan K, Jüch F, Winkel EG. Tongue coating: its characteristics and role in intra-oral halitosis and general health-a review. J Breath Res. 2018;12(3):034001.
- Tonzetich J, Ng SK. Reduction of malodor by oral cleansing procedures. Oral Surg Oral Med Oral Pathol. 1976;42(2):172-81.
- Renvert S, Noack MJ, Lequart C, Roldán S, Laine ML. The underestimated problem of intra-oral halitosis in dental practice: an expert consensus review. Clin Cosmet Investig Dent. 2020;12:251-62.
- Silva MF, Leite FRM, Ferreira LB, et al. Estimated prevalence of halitosis: a systematic review and meta-regression analysis. Clin Oral Investig. 2018;22(1):47-55.
- Van der Sleen MI, Slot DE, Van Trijffel E, Winkel EG, Van der Weijden GA. Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review. Int J Dent Hyg. 2010;8(4):258-68.
- Gonçalves AC de S, Martins MCN, Paula BL de, Weckwerth PH, Franzolin S de OB, Silveira EMV. A new technique for tongue brushing and halitosis reduction: the X technique. J Appl Oral Sci. 2019;27:e20180331.
- Ileri Keceli T, Gulmez D, Dolgun A, Tekcicek M. The relationship between tongue brushing and halitosis in children: a randomized controlled trial. Oral Dis. 2015;21(1):66-73.
- Matarazzo F, Reino DM, Hayacibara RM, de Faveri M, Fujimaki M. Effect of toothbrushing discontinuation on morning volatile sulfur compounds in periodontally healthy subjects. Oral Health Prev Dent. 2013;11(4):309-13.
- Outhouse TL, Al-Alawi R, Fedorowicz Z, Keenan JV. Tongue scraping for treating halitosis. Cochrane Database Syst Rev. 2006;(2):CD005519.
Motion graphics by Avo Media
Republishing "Tongue Scraping vs. Tongue Brushing for Treating Halitosis (Bad Breath)"
You may republish this material online or in print under our Creative Commons licence. You must attribute the article to NutritionFacts.org with a link back to our website in your republication.
If any changes are made to the original text or video, you must indicate, reasonably, what has changed about the article or video.
You may not use our material for commercial purposes.
You may not apply legal terms or technological measures that restrict others from doing anything permitted here.
If you have any questions, please Contact Us
Tongue Scraping vs. Tongue Brushing for Treating Halitosis (Bad Breath)
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
When you think about waking up next to the love of your life, I’m sure you’re not thinking about phrases like “putrefied surface film” or “stagnant pond effect.” But, don’t fret: All you have to do, it seems, is sip some water to help get the juices flowing again. Tooth brushing and tongue scraping can also help with morning breath. Tongue brushing, too, but tongue scraping beats it. Before you rush to buy a tongue scraper, though (not that anyone really runs out and buys anything anymore…before you go online and click to buy one), the title of the next video sounds pretty ominous, so you may want to check it out before pulling out your credit card. Stay tuned.
This is the second in a five-video series on tongue scraping. The first video was Effects of Tongue Scraping on Plaque, Gingivitis, and Cavities. The next three are:
- Does Tongue Scraping Cause Cancer?
- How Tongue Scraping Can Affect Heart Health
- How to Clean Your Tongue
Can Stress Cause Halitosis? Watch the video to find out.
Check out my newer videos on this topic: How to Get Rid of Garlic Breath and Green Tea as a Mouthwash for Halitosis (Bad Breath)
If you haven't yet, you can subscribe to our free newsletter. With your subscription, you'll also get notifications for just-released blogs and videos. Check out our information page about our translated resources.