Dentalnews (en)

It goes from being unpleasant to downright disgusting and keeps you from making friends or finding a partner.

Strangely though, estimates say that every fourth adult in Europe has bad breath every once in a while. One in fifteen has it all the time.
It might not be a bad idea to let the affected know, but most find this embarassing. But why? Well, it’s like foot or underarm odor: lots of people have it, but nobody likes to talk about it.
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If you have this problem, you should see a doctor.
Treating bad breath has has never really been a priority in dentistry. Only in the last four or five years have younger generations begun looking at the issue. This is definitely a good idea, because nine times out of ten, bad breath begins in the oral cavity.
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What causes bad breath?
Aside from poor oral hygiene and inflammation of the gums, the most common cause of bad breath is scum forming on the tongue. Bacteria that cause bad smells settle on the tongue, but if you clean your tongue using a scraper or simply your toothbrush, you get rid of them and your breath once again smells good.  Stress can also be a factor, as it slows the flow of saliva. And smelly bacteria like inhabiting this dry environment. Many business-people have great oral hygiene, but their breath still smells bad. This is the result of stress and too much coffee, which dries out the mouth. The solution is simple: drink more water and eat fruit.
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Can you test yourself for bad breath?
Yes and no, the airbag-method is the best: simply take a clean plastic bag and breathe into it. Be sure to breathe in through the nose and out through the mouth. Then seal up the bag. To improve your sense of smell, go out into the fresh air, or smell some fresh-ground coffee or espresso. Then squeeze the bag out in front of your nose. What also works is the «wrist-licking method», in which you give the back of your wrist a few strong licks and then sniff at it. This may be a sign that your bad breath is coming from your tongue. One thing that definitely does not work is breathing into your cupped hands. And the one really sure-fire way to find out is simply ask sombody who’s opinion you trust: «Hey, do I have bad breath?»
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What about lozenges and mouthwash?
Products abound: sprays, mouthwash, chlorophyl tablets, peppermint leaves that you put on your tongue. They do cover up the smell for a while, but they only treat the symptom, not the cause. If you suffer from dry mouth, you can take sugar-free gum or candy, but all those do is speed up saliva production.

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A placebo is a substance which a patient is told is medicine, but which actually contains no medicinal properties and thus has no real pharmacological effect!

Even surgical procedures can be placebos, for example ‘pretend’ operations.
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Researchers have discovered that the sensation of pain is blocked on the way from the skin to the spinal cord if the patient expects little or no pain.
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There are many different ways in which psychological factors can affect the way we perceive pain: drawing attention away from it, hypnosis and of course the placebo effect. But what neuro-biological mechanisms are involved in reducing the feeling of pain?
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Researchers have found that the placebo effect is associated with reduced nerve cell activity in the spinal cord.
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Neuro-scientist explain the placebo effect as follows: believing that pain medication will work leads to an rise in the level of endogenic opiates released in the brain – also known as endorphins. This is the case both in the frontal cerebral cortex, which is more highly developed in humans, and parts of the brain stem, which are older in evolutionary terms. The release of these endogenic opiates leads to reduced pain perception and thus a reduced response on the part of the nerve cells in the parts of the brain responsible for processing sensations of pain.

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How exactly this release of opiates and the reduction of nerve-cell activity responsible for pain perception are related used to be unclear. Earlier studies have shown that placebo effects – reduced pain perception despite physical stimulation – are accompanied by increased endorphin activity between the frontal areas of the cerebral cortex and the brain stem. The latest technical developments now enable the use of high-resolution magnetic resonance tomography pictures of the human spinal cord to show that during a placebo effect there is reduced nerve cell activity in the spinal cord, the gateway to  the central nervous system. This shows that the psychological factors affecting pain modulation are rooted deep in the brain.
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The fact that these factors can be measured in the human spinal cord is also important for clinical studies on testing new medicines, as it is possible to measure both their efficacy and examine the areas they affect.

Source:  Science Vol. 326. no. 5951, p. 404

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