In a world where texts and videos gone viral can embarrass and humiliate the unsuspecting victim, ratting out bad breath is still considered taboo.
"Telling a friend that he or she has bad breath is a tough thing," said Dr. Todd Marshall, a dentist at the Facial Pain Center in Edina. "That's why it goes untreated."
Marshall is one of only a few Twin Cities dentists who treat chronic oral malodor, aka bad breath. He performs tests to determine that the sinuses or the lungs aren't the source of the problem. His system, which costs about $200 for each of three visits and is not covered by insurance, involves a high-powered spray wash of the tongue, which he compares to deep-cleaning a shag carpet.
He describes his system as 95 percent effective but only when patients are willing to follow a strict regimen that involves brushing, flossing, rinsing with ProFresh, scraping the tongue thoroughly, rinsing again and gargling twice a day. As part of the treatment, Marshall requires patients to ask a friend or family member to smell their breath.
"I warn them that the friend won't say the breath is minty-fresh," he said. "Normal breath is not offensive, but it doesn't smell minty-fresh."
But what might be a cure for years of chronic halitosis for some is overkill for most of us. While 25 percent of the population has bad breath regularly despite good health and oral hygiene, nearly everyone has bad breath at some point, Marshall said.
Still, the frequent advertisements of mints, gum, pastes and mouthwashes to combat mouth odor have convinced a significant number of patients that they have bad breath when they really don't, said Dr. Bashar Bakdash, professor of periodontology at the University of Minnesota School of Dentistry.
"It's a cultural thing. Some people take it to the extreme," he said.
In 2007, Americans spent nearly $6.7 billion on mouth-freshening products, according to Euromonitor International, a market research firm.
Product claims 12-hour fix
Recently, a product called SmartMouth hit the shelves claiming to offer breath protection for 12 hours. Most products are effective against bad breath for only an hour. That makes SmartMouth's two-bottle mouthwash system a good potential product for people who work face to face with the public or couples who want to banish morning breath.
The product's claims of 12-hour protection were determined to be reasonable by the Better Business Bureau after its own tests. SmartMouth uses a combination of sodium chlorite, a cleansing agent that blunts odors, and zinc chloride, a mineral that reduces the number of gas-releasing bacteria in the mouth. The two solutions are mixed in a small cup, and the user rinses and gargles with it for 30 to 60 seconds.
Jolene Taleen of Minneapolis, a customer-service agent often in front of clients, has used SmartMouth for six weeks and said it works better than other breath- freshening products.
"It works great for about six hours," she said, "but I didn't find it as effective overnight."
Last week, Amazon.com had 46 reviews of the product, getting a favorable 4.5 stars out of 5. A few reviewers complained about the taste, price, loss of effectiveness after eating or decreased taste sensitivity, but most said it works better and longer than other such products.
SmartMouth is about $12 for 16 ounces, but it's often on sale at discounters (Target, Wal-Mart) or drugstores (CVS or Walgreens). A $2 off coupon can be printed at www.smartmouth.com. One box lasts about 15 days, but some online reviewers say they have extended its longevity by using only two or three pumps from each bottle instead of four, with no noticeable loss of effectiveness.
But no one product works best for everyone, says Pat Lenton, a dental hygienist and research fellow at the University of Minneota School of Dentistry. She says SmartMouth might work well for someone who is already brushing and flossing regularly with no gingivitis but wants extra protection against bad breath.
Break it to them gently
How to break the taboo and tell someone with bad breath about his or her problem?
Passive-aggressive Minnesotans can always do the dirty deed at www.nooffenseor anything.com. The site will send an anonymous e-mail after you submit a first name and e-mail address. Senders can see a preview of the message, which begins, "No offense or anything, but a friend who cares would like you to know that you have bad breath."
The site also offers five tips to reduce bad breath but no advice on curing passive-aggressiveness.