 Increased public awareness and demand for bad breath remedies has 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 wakening 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 acid cysteine and methionine that are broken down into volatile sulfur compounds like the rotten egg gas, hydrogen sulfide. Approximately 50% 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 malodour. 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 breath 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 wakening is effective, but you don't know until you put it to the test. The effect of water on morning bad breath a randomized clinical trial. One group was randomized to rinse their mouths with a 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%, whereas eating breakfast works twice as well, a 60% 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 close to a 70% drop, suggesting the tongue is the major source of the stinky gases. Other studies, though, show no benefit to tongue brushing on oral odor on 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, suggesting that tongue cleaning may be the most important hygienic procedure to reduce morning bad breath. This is not to suggest tooth brushing 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 their fancy organoleptic technique, where they blew through a straw into some poor examiner's nose, and 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 control trials comparing different methods of tongue cleaning to reduce mouth odor in adults with holotosis, 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.