Tuesday, 19 April 2016

bad breath while fasting

if there is one thing i hate about intermittent fasting, its the halitosis. I mean it really gets bad, i often mask it with lots of water.

i am really confused about how to reduce bad breath without breaking my fast. sweet and gum is full of sugar and might break my fast.

sometimes coffee helps but its more of a temporary fix. as i reasearch good ways to reduce this problem i found that some of the causes were

” Poor Oral Hygiene

The number one cause of bad breath is poor oral hygiene. If we do not maintain good oral health by brushing twice a day / flossing /using a mouth wash, we are less likely to wash away and reduce the number of these natural bacteria thus resulting in bad breath. Not removing and disturbing the bacteria in the mouth (plaque) will also lead to dental diseases such as periodontal disease (gum disease) which, along with bad breath, will cause other dental problems. Maintaining good oral health is discussed in further detail later in this article.

Dry Mouth

The intensity of bad breath however can differ depending on diet and dryness of the mouth etc. As a result of the mouth being drier whilst fasting (where drinking any form of liquid is impermissible), there is more of a potent smell.

During fasting bad breath seems to be worse. Why would this be? Saliva is the natural mouthwash we were born with. It contains antibacterial agents, and competes with bacteria for scarce resources such as iron. Saliva helps wash bacteria and food from the mouth, and the saliva layer helps the oral odours from escaping. Bad breath is worst when there is little or no saliva flow, for example during a long fast. This is because whilst we are fasting we abstain from all food and drink during day light hours thus lowering our salivary stimulary flow causing us to have a dry mouth. If the mouth is dry, dead cells and bacteria can build up on the tongue, gums and the insides of our cheeks. These cells then start to rot and give off an unpleasant smell thus intensifying our breath. As soon as one begins to eat and drink the Parotid salivary gland is stimulated and starts to salivate causing the dead cells and bacteria to be washed away reducing the unpleasant smell.
A dry mouth is also the reason why we have bad breath first thing in the morning compared to later in the day. Our salivary flow drastically decreases whilst we are sleeping causing dry mouth and thus leading to bad breath for the reasons explained above. This is worse in people who tend to sleep with their mouth open. It is therefore imperative to ensure we clean our mouths properly before going to bed to limit the number of bacteria in the mouth.

The examples of dry mouth above are all temporary e.g. whilst fasting or sleeping, however if you suffer from dry mouth persistently it is important you consult your GP or Dentist as there is usually an underlying problem. The medical term for persistent dry mouth is known as Xerostomia and has a number of causes ranging from side effects from medication, diabetes and post cancer treatments.

Other causes of Bad breath[6][7]

Smoking – can cause bad breath directly and indirectly. The most immediate and direct way that cigarettes cause bad breath is by leaving smoke particles in the throat and lungs. This effect is typical of nearly any tobacco product that involves inhaling smoke or rolling it around in the mouth. The smell of a freshly smoked cigarette can linger in the lungs for hours, hence the stale scent associated with smoker’s breath.

However, this is just the beginning. The chemicals in tobacco smoke can remain in the mouth, leading to a host of secondary indirect causes of bad breath such as causing dry mouth. Smokers are more likely to suffer from gum disease and other dental problems which cause bad breath. Smokers tend to have a reduced salivary flow rate causing dry mouth and are more prone to gum disease as a result of a reduced immune response causing bad breath as a secondary symptom.

During Ramaḍān, Muslims who are smokers abstain from smoking cigarettes during fasting hours (daylight) which otherwise in other months they would find difficult to do. However most tend to smoke after the fast is broken which will contribute to worsening their breath. This is why Muslims should use the month of Ramaḍān to help them quit smoking and thus vastly improve their health and lower their risks of all the harmful diseases associated with smoking. Smokers should consult their GPs, Dentists or pharmacists who can provide information on smoking cessation – helping you to quit the habit of smoking once and for all!

Food and drink – certain foods, such as onions, garlic and some spices may cause the breath to smell after consuming them. Bad breath from garlic is not caused mainly from the bacteria, but from the garlic itself – many people would argue that garlic breath is not unpleasant, and therefore not an example of halitosis. The bacteria in our mouths tend to give off higher volumes of smelly gases when they decompose proteins, such as meat or fish. If bits of meat get stuck between your teeth and you do nott clean them properly, your risk of having bad breath is significantly increased.

Medications – any medication that causes a dry mouth or nose is more likely to cause bad breath, examples include antihistamines and drugs for treating systemic diseases such as Hypertension (high blood pressure) and Diabetes. Patients who are on a cocktail of medication treating systemic diseases should speak to their GP before commencing Ramaḍān to ensure their fast will not affect the efficacy and use of their medication.

Poor denture hygiene – people who use dentures and don’t clean them regularly have a higher risk of bad breath. If the dentures do not fit properly food is more likely to get stuck. Patients should ensure they clean their dentures on a daily basis using a brush and water or denture cleaning tablets.

Illnesses, conditions and situations – experts say that about one tenth of all cases of halitosis are caused by an illness or medical condition. Examples include: Diabetes, GORD (gastro oesophageal reflux disease) and renal disease. Patients who are fasting and suffer from such diseases should consult their GP first.”


the best ways to reduce bad breath were

Maintaining good oral hygiene

The things that we can do to reduce bad breath both during Ramaḍān and throughout the year should now be obvious and the reasoning should be easier to understand. We have established that the main cause of bad breath is poor oral hygiene. Therefore the main treatment for bad breath is to ensure we maintain good oral hygiene cleansing the mouth of bacteria and food remnants. Below are the current recommended evidence based guidelines in maintaining good oral hygiene as set out by the department of health toolkit “Delivering better oral health 2014”[8]

  • – Brushing using a fluoride (1350ppm) toothpaste should occur twice daily as a minimum – clean teeth last thing at night before bed and at least one other time each day
  • – Brushing should last for two minutes ensuring you brush all tooth surfaces including gum margins
  • – Patients who are not correctly brushing their teeth with a manual toothbrush should try to switch to an electric tooth brush where studies have shown electric toothbrushes can significantly improve their cleaning. (Discuss your brushing technique with your dentist before moving to an electric toothbrush).

Alongside brushing your teeth, studies have also shown using floss, interdental TePe brushes, tongue cleaners and anti-bacterial mouthwashes can disturb the plaque in your mouth and remove food remnants thus reducing bad breath.

During fasting, Muslims can brush their teeth with toothpaste as long as they do not intentionally ingest the toothpaste. It is also possible to use mouthwash as long as the mouthwash is not ingested. Brushing twice a day with the correct use of a mouthwash during Ramaḍān and throughout the year should significantly reduce bad breath from occurring.

Recommended mouth wash specifically for bad breath?

Studies have shown a mouthwash called CB12 has significantly reduced bad breath in patients.

The active ingredients in CB12 are zinc acetate and chlorhexidine (anti-bacterial). Zinc acetate is used to neutralise and prevent production of the VCSs (foul odour gases) from exhaled air. Small amounts of chlorhexidine are used to break down the sulphur gas molecules by interacting on their bond strength.[9]

Tongue Cleaning

Gently cleaning the tongue twice daily is another effective way to keep bad breath in control; that can be achieved using a tongue scraper or a separate tongue toothbrush to wipe off the bacterial biofilm, debris, and mucus. Ask your dentist to recommend a scraper for your tongue.[10] Brushing a small amount of saltwater onto the tongue surface will further inhibit bacterial action. Eating a healthy breakfast with rough foods helps clean the very back of the tongue too.[11]

Overcoming dry mouth during fasting – To minimise the effects of having a dry mouth during fasting which, as discussed earlier, can intensify bad breath, a person fasting must ensure they ;

  • – Drink plenty of water out of the hours of fasting, drinking small sips but in regular frequency.
  • – They can rinse out their mouth with water (as long as no water is swallowed intentionally), most Muslims will perform this act three times each time they perform wudu (ablution) before offering obligatory prayers.
  • – Use Miswāk to stimulate salivary flow.
  • – Speak to their GP /Pharmacist to check if any of their medication is causing dry mouth.”

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