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That is why the corona pandemic has led to more bad breath

The corona pandemic has taught us that there are more pleasant things than wearing a mask over your mouth and nose.

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That is why the corona pandemic has led to more bad breath

The corona pandemic has taught us that there are more pleasant things than wearing a mask over your mouth and nose. But does it also lead to bad breath? In some countries, such as India and the USA, the term “mask mouth syndrome” has recently been circulating. "According to dentists, more than 20 percent of the population is affected," claims Sudip Bhattacharya of the All India Institute of Medical Sciences in Madurai.

In a current contribution to the discussion, he suspects that the main cause of the problem is that the constant wearing of a mask means that breathing is mainly done through the mouth, so that it dries out. As a result, fewer germs and their metabolites are flushed away with the saliva, and more volatile and foul-smelling sulfur compounds accumulate. In the end, according to the Indian preventive physician, "mask breathing" occurs, which is often perceived as unpleasant by those affected and by their fellow human beings.

His tips on the other hand: Take frequent breaks when wearing a mask and use them to drink a lot. And you should eat less sugary foods and pay more attention to oral and dental hygiene. Of course, changing the masks regularly also helps.

In Germany, doctors rarely talk about Mask Mouth Syndrome, but the halitosis associated with wearing a mask, as permanent bad breath is called medically, is also an issue here. One of the researchers working on this is Philipp Kanzow from the Polyclinic for Preventive Dentistry, Periodontology and Cariology at the University Medical Center Göttingen. Together with research colleagues, he surveyed a total of 3,750 men and women, with an average age of 50, about their bad breath experiences during the pandemic. They apparently increased significantly, by around 20 percent with an average mask-wearing time of 4.7 hours per day.

But surveys and answers from people are one thing, the measurement data of objective parameters something else. So Kanzow and colleagues examined 40 orally healthy volunteers to see how their saliva parameters and the concentration of volatile sulfur compounds in the air they breathed changed when they wore different masks for four hours. The result of the analysis was recently published - and no particular changes emerged.

"The amount of volatile sulfur compounds, for example, was largely the same before and after wearing the masks," emphasizes Kanzow. The subjective experiences of halitosis when wearing a mask are therefore not necessarily covered by objective measurements in the oral cavity. However, according to the dentist, we know from other studies that breathing behavior changes when wearing a mask: "You breathe more through your mouth as a result, and that is considered a risk factor for bad breath."

Halitosis is widespread in the population even without masks. The number of those affected is estimated at 22 to 32 percent, depending on the type of survey. The suffering is considerable. It is not for nothing that the brochures of the health insurance companies say: “Halitosis makes you lonely.” Because persistent bad breath pushes those affected into social marginalization. 15 million Germans regularly use mouthwash, and Americans spend more than 1.5 billion dollars on respiratory care products every year. Halitosis causes grief, even if there is usually nothing worse behind it.

Rather, in about 90 percent of cases, their causes come from the mouth, and as Mel Rosenberg of Tel Aviv University points out, the main culprits are often located on the back of the tongue. "It is rarely cleaned by saliva," explains the microbiologist and dentist, "and bacteria can easily settle in its numerous small wrinkles."

From a nutritional point of view, it is also good for microbes to live there. On the back of the tongue, not only food scraps fall off for them, but also secretions that drip down from the nasal passages. An inexhaustible reservoir of food that the microbes convert into foul-smelling hydrogen sulfide, for example. Or in isovaleric acid, which is reminiscent of sweaty feet, or even in cadaverine, which is otherwise found in decomposing animals. "It's no wonder," says Rosenberg, "that the human breath sometimes offends the other person's nose."

In view of the undesired bacterial glut, it seems obvious to rely on antibiotics in the treatment of halitosis. But they only drive the coating off the tongue for a short time, and with their radical effect they also rob the natural bacterial opponents of the fungi that live there, with the result that the tongue is covered with a dense fungal coating. "And then it gets really serious," warns Rosenberg.

Better to stabilize the oral environment, for example by using probiotic cultures to suppress the odor-causing bacteria in the mouth. A current evaluation by the Chinese Sichuan University, which analyzed seven studies on a total of 278 people, shows that this approach is promising. The administration methods of the probiotic cultures ranged from chewing gum to lozenges to mouthwashes containing Lactobacillus reuteri, Streptococcus salivarius or Weissella cibaria in different concentrations. The severity of bad breath was assessed either subjectively by a doctor or using a breath analyzer that measured volatile sulfur compounds in the breath.

It turned out that the probiotic cultures reduced the sulfur compounds by around 25 percent and bad breath by more than 50 percent. At least for a period of four weeks. For longer durations of action, however, the data situation does not look so good. According to Kanzow, this is a clear indication "that the probiotic cultures have reduced the volatile sulfur compounds in the mouth in the short term, but have not eliminated the causes of the microbial degradation processes".

In halitosis therapy, microbiologist Rosenberg advocates cleaning not only the teeth but also the back of the tongue with a brush - as has been done in the Far East for many centuries. Clinical studies prove the effects. As a result, a large part of the coating disappears after the first cleaning. One to two minutes once a day is sufficient, the pressure with the brush should not be so strong that it causes injuries on the back of the tongue. Alternatively, you can also use the tongue scrapers that are available everywhere.

In a current analysis of eight clinical studies, Polish researchers come to the conclusion that antibacterial photodynamic therapy (aPDT), which has been used for periodontitis for several years, can help against bad breath. Gums and the back of the tongue are coated with a so-called photosensitizer, which is then irradiated with laser light. That not only sounds complex, but is actually also relatively complex from a technical point of view. And, as with probiotic cultures, the long-term effects are by no means certain.

In any case, Philipp Kanzow recommends considering possible causes beyond the oral cavity in the case of stubborn bad breath: "Because if bad breath is caused in 90 percent of cases in the mouth, this means, conversely, that 10 percent of it is caused somewhere else." For example in ENT area or from metabolic diseases such as diabetes, and if a smell of clay or ammonia wafts from the mouth, this may indicate a serious liver disease or kidney failure.

Long-term medication such as antidepressants, antihypertensives and Parkinson's medication can also have an odor in the breath. And anyone planning a fasting cure in the spring must also reckon with it. This not only reduces the flow of saliva, but also promotes the production of ketone bodies, which are broken down into strong-smelling acetone. In this trap, breath smells like nail polish.

"Aha! Ten minutes of everyday knowledge" is WELT's knowledge podcast. Every Tuesday and Thursday we answer everyday questions from the field of science. Subscribe to the podcast on Spotify, Apple Podcasts, Deezer, Amazon Music, among others, or directly via RSS feed.

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