Bad Breath Past, Present and Future

Bad breath is not new. It’s probably been around as long as humans. Bad breath was alluded to in the Ebers Papyrus, the Jewish Talmud and the Ayerveda. Folks have been chewing, tongue cleaning and gargling for hundreds and thousands of years.

Bad breath was a thing in Elizabethan times and not infrequently referred to in Shakespearean plays.

http://news.bbc.co.uk/2/hi/health/282425.stm

“And most dear actors, eat no onion, nor garlic, for we are to utter sweet breath.” (Midsummer Night’s Dream act 4, sc. 2)

In the late nineteenth century a book by Howe and a review by Hawxhurst reveal a clear undersanding of postnasal drip and tonsilloliths as potential causes, and the problems inherent in self diagnosis.

I’ve written several books about bad breath. Some are free.

Modern day bad breath research dates back to the 1930s with the seminal work of Fosdick and Sulser and colleagues who showed that oral malodor is chiefly of microbial origin and based on the anaerobic putrefaction of proteins.

Grapp’s study of 500 subjects revealed the importance of the tongue as the major locus of oral malodor, and further strengthened the case for deep tongue cleaning.

In the 1960s and 1970s the molecular contribution of VSC (volatile sulfur compounds) to oral malodor was established by the pioneering Gas Chromatography research pioneered by Joseph Tonzetich and his colleagues at UBC.

In the early 1980s, together with Jacob Gabbay and others, we proposed the use of portable sulfide monitors to measure VSC in clinical and laboratory environments where GC apparatus was not available. The use of such monitors popularized studies in oral malodor.

Studies by Kleinberg and colleagues studied the biochemistry of putrefaction based on saliva models. Loesche and his team suggested the BANA test as an adjunct measurement tool. Greenman, Saad and colleagues developed biofilm approaches and looked at odor judge assessment of bad breath-associated gases.

In 1991 William H. Bowen suggested that the IADR hold its first symposium on the subject of oral malodor. This was followed by a dedicated multidisciplinary meeting on the subject in Israel in 1993. Daniel van Steenberghe then proposed the establishment of a scientific association ISBOR, which published newsletters and sponsored subsequent international meetings. In 2007 I co-founded the Journal of Breath Research with Prof. Anton Amann.

Research during the past twenty years by Sterer and others has focused on understanding the specific biochemistry of malodor production and the microorganisms involved (e.g., collaboration between gram + and gram -).

Future research will make extended use of genomic studies to determine the genes involved in malodor production, and the microbial culprits.

We need more studies to (i) understand how tongue odor differs from gingival odor; (ii) determine the microbial basis of nasal odor; (iii) find better ways to deal with tonsilloliths; (iv) determine whether Helicobacter pylori is involved in malodor, and if so, in what manner; and (v) to help patients with exaggerated self-estimation of their malodor problem.