How to clean your tongue (using a scraper, brush or even just a spoon).

- For people with bad breath, the single most important step in curing it is just cleaning their tongue more effectively. This page explains why that's needed and how to do it. | Which method is best? (scraping vs brushing) | How to know when you're done.

What tongue
cleaning
does.

Link to why you need to clean your tongue.

Tongue
scraping
technique.

Link to how to clean your tongue.

Tongue cleaning - This should be the first cure you try.

Any person interested in successfully curing their bad breath should always start off by establishing a routine focused on improved tongue cleaning (either brushing or scraping).

Why is this needed?

The debris (white coating) that builds up on the top surface of the tongue is usually so chocked full of odor-causing bacteria that it's not realistic to think that anyone could possibly rid themselves of mouth odor without regularly removing it.

What level of results can you expect?

For the vast majority of people, this single change in their oral home care will lead to such a significant improvement in the quality of their breath that it may be the only halitosis cure that they need.

Here's what we cover on this page:


Evidence about the importance of tongue cleaning from research.

There's no shortage of published dental research that has demonstrated the importance of tongue cleaning in the treatment of halitosis. For example:

Study: Delanghe (1998)

This study evaluated subjects with oral malodor, and determined that for 87% of them the underlying cause of their problem stemmed from conditions in their mouth.

Background.

That's a common finding. Studies have shown that 80 to 90% of halitosis cases have an oral origin. That's why improved mouth cleaning is the basic underlying solution that's needed.

Study findings.

Of the test subject's cases, 51% were found to be primarily associated with tongue coating/buildup, 32% due to gum disease and 17% from a combination of both factors.

That means in roughly 68% of these cases, just the addition of thorough tongue cleaning should either cure, or at least have a significant impact towards resolving, the person's bad breath.

And in fact, that's precisely what a historic study by Tonzetich (1976) found. The average reduction in oral malodor after tongue cleaning (brushing in this case) was 59 to 88%.

Section references - Delanghe, Tonzetich, Danser

Study: Pham (2011)

This more recent study demonstrates that current research findings are essentially unchanged about the role tongue cleaning plays in curing halitosis.

Background.

The single case where tongue cleaning alone can't be expected to be the substantive solution to a person's breath problems is when gum disease is present. (Because with this situation, the bacteria causing the breath odors are located in between your teeth, not just on your tongue.)

But it still plays a very important role. And one that is needed before a full resolution is possible.

Study findings.

Pham evaluated subjects that had halitosis, some of whom had periodontitis (advanced gum disease) versus those with more minor gum-health issues (gingivitis).

  • Improved tongue cleaning alone was found to reduce oral malodor levels in gingivitis patients to below non-offensive levels.

    (This implies that tongue cleaning alone is all that's required for patients with healthy gums too.)

  • With the periodontitis group, tongue cleaning alone reduced odor levels in a statistically significant way but they still remained above "offensive" levels. It took a combination of both gum treatments and tongue cleaning to lower subjects' mouth odors to non-offensive levels.

    (These are the findings you would expect. Tongue cleaning alone, which doesn't clean in between teeth, was unable to cure the patient's gum disease-related halitosis. But neither did just gum treatments alone. Both were needed before full resolution took place.)

Section references - Pham


Illustration showing the Winkel Tongue Coating Index grid superimposed on a picture of a tongue.

Dentists use the Winkel Tongue Coating Index to document the amount of debris that's present.

What you accomplish when you clean your tongue.

When scraping or scrubbing the dorsal surface of your tongue (meaning its top side, the side you can see), especially its rear-most portion, ...
  • You're ridding your mouth of what's likely its largest refuge of odor-producing bacteria.
  • Along with the nutrients they feed on. (Some researchers think that it's this issue that's the more important one.)
Issues to know.

Remember the breath tests we outlined at the beginning of this topic?

If you did them, you probably found out that the tip portion (anterior part) of your tongue smelled a whole lot better than the back (posterior region). There's a simple explanation for this.

a) The anterior portion of your tongue is fairly self-cleansing.

The tip part of your tongue is relatively self-cleaning and therefore unlikely to harbor large numbers of odor-producing bacteria.

Many tongue functions (swallowing, speaking) place it in firm contact with your hard palate. This friction creates a cleansing action that prevents any significant build-up of bacteria and debris on it.

Picture showing bacterial accumulation on the back part of the tongue.

Debris accumulation on the back part of the dorsum of the tongue is usually what causes bad breath.

b) The posterior portion is not.

In comparison, the back part of your tongue only touches (at most) your soft palate. And any contact that does take place is relatively passive.
As a result, your tongue movements don't create enough friction to result in any significant cleansing. Debris, including the bacteria that cause bad breath, will tend to build up in this region.
This is why cleaning your tongue in general, and the back part specifically, can be so effective in curing bad breath.

Look for yourself.

This accumulation is easy enough to see. Just stick your tongue out and look for the white, or even brownish, film on its surface.

Like we show in our illustrations, it's usually triangular in shape with its broadest aspect covering across the back part of your tongue.

Takeaways from this section.

It can't be said enough. For most of us, bad breath is caused by the debris that builds up on the back part of our tongue. And if you're not cleaning it off, you won't cure your breath odor problems.

How to clean your tongue - Getting started.

When cleaning your tongue, you have two options. You can either brush it or scrape it. (Use either link for specific instructions.)

Whichever method you choose, the goals and needed results of the process are exactly the same. And in general terms, here are some of the things you need to know.

a) You need to clean where the coating is.

Most people should direct the bulk of their efforts toward cleaning the back portion of their tongue. That's because that's where the majority of the film that causes bad breath lies.

But don't reach too far back. You just need to clean the smooth top surface of your tongue (back to about where its main groove in the middle ends). Don't scrape or brush your tongue's mounds of tonsillar tissue located even further back and off to the sides.

Graphic stating that halitosis is usually caused by plaque accumulation on the back part of the tongue.

The most common cause of bad breath is debris accumulation on the tongue.

Tips and pointers.
  • Don't be surprised if you find that you have an active gag reflex. If you do, over time, and as you refine your technique, it should diminish.
  • If gagging is a problem, just do the best you can. If having a mishap seems likely, consider cleaning your tongue at times when your stomach is relatively empty.
  • Scraping, as opposed to brushing, may be less likely to trigger your gag reflex. (Danser)

Section references - Danser

b) Be gentle.

It's possible for you to be too rough when you clean. You may even cause irritation or bleeding. Doing so should always be avoided.

As a plan, be deliberate but gentle. Focus primarily on cleaning the center region of your tongue (where the bulk of its buildup lies). In comparison, the lateral borders (sides) of your tongue are relatively self-cleansing, and the risk of causing injury to them is greater.

(Reports suggest that tongue cleaning may cause bacteremia, an issue of concern for people who have certain medical conditions.)

Section references - Redmond

c) How do you know when you've cleaned enough?

Generally, your efforts should be continued, gently, until that point when no more debris is removed.

  • With tongue scraping, this is easy enough to determine by examining your scraping device.
  • With brushing, you won't get a chance to see the debris you've cleaned off. But when you look at your tongue, you should be able to determine the point when no more improvement seems to be made.

Section references - Danser

d) How often do you need to clean your tongue?

  • If you're not having much of a problem with breath odors, once a day will probably suffice.
  • In cases where a cure is needed, several studies have suggested that twice-daily cleaning is indicated. (Bartold)
  • Considering how little time it takes, it's not a bad idea to just go ahead and do it every time you brush your teeth. The hope is that the habit will take hold and your mouth won't feel clean unless you've cleaned your tongue too.

Section references - Bartold

e) Tongue brushing vs. scraping - Which is more effective?

For all practical purposes, it probably doesn't make a whole lot of difference in which technique you use. However, some researchers have stated a preference. Here's what they've reported.

  • In an overview of the topic of halitosis, Zurcher makes mention that scrapers tend to just clean the surface of the tongue, and therefore brushing has a more lasting effect.

    [We assume the thought is that the bristles of a brush have a greater ability to work themselves down into tongue grooves and furrows.]

  • Another literature review (Outhouse) concluded that tongue scrapers and "cleaners" showed a marginal but statistically significant advantage in effectiveness over the use of a regular toothbrush.

    [FYI: Tongue "cleaners" are tools whose design combines aspects of a brush (having either bristles or nubs) and a scraper (as seen in this picture below).]

  • As discussed below, brushing does offer the advantage that a chemical agent (mouthwash or toothpaste) can be used as you perform your routine.

Section references - Zurcher, Outhouse

What method should you use?

From reading these papers, it would be our conjecture that:

  • Scraping your tongue using a "cleaner" probably makes the best choice.
  • Next in line would be using a specially designed tongue brush, scraper or even just a spoon (see below).
  • Using an everyday toothbrush probably makes the least effective option.

We think that it's important to state that we wouldn't be unduly swayed by the above information.

If there's a technique that you find preferable (more convenient to do, makes you gag less, just seems the right method to you, etc...), and thus using that device will make it more likely that you will take the extra step of cleaning your tongue, then it probably makes the best choice.

Being thorough yet gentle is the key.

We should state that a paper by Yaegaki that described the treatment of halitosis did not recommend the use of tongue scrapers, or even "adult" toothbrushes. This opinion was based on two papers (Kameyama 1969 and Odajima 1979) that reported that mechanical stimulation (such as that created by these types of devices) enhanced the chances of tongue cancer in laboratory animals.

We are unaware of more recent findings on this subject. We'd expect that the level of risk would be greatest for those who are overzealous in their cleaning activities. When you brush or scrape, just keep in mind that it doesn't take a lot of pressure to break up your tongue's coating of film.

Section references - Yaegaki


Instructions for tongue cleaning -

Option #1: Tongue brushing.

To experiment with brushing your tongue, you don't have to buy anything special to get started. You can just use your regular toothbrush.

Then, if you decide that this does make the right choice for you, shop around and take a look at the specialty brushes that are available. Generally speaking, you can expect them to do a more effective job.

Instructions- How to brush your tongue.

  • Moisten your brush with tap water. Doing so will soften up its bristles.
  • Stick your tongue out as far as you can and inspect it. Make a note of where the coating has formed. (Usually this is the rear-most area of the tongue.)
  • Starting in back, and as you work forward, make brush strokes across your tongue that break up and dislodge the debris that's there.

    You'll need to use some pressure but of course not enough to irritate your tongue's surface.

  • Stick your tongue out again and evaluate your results. If you notice that some of the film remains (which you quite likely may), repeat the process.
  • Rinse your mouth out when you're finished. Rinse your brush off by holding it under a stream of running water, and then set it somewhere where it can air dry.

You can use something on your brush if you want.

You may be able to improve the effectiveness of your efforts by using toothpaste, or dipping your brush in mouthwash. However, just brushing is the really important step, the use of a product on it much less so.

Different product ingredients are included to perform different functions, so choosing one that contains multiple agents offers advantages.

  • a) Compounds that neutralize volatile sulfur compounds.

    It's the stinky volatile sulfur compounds (VSC's) produced by anaerobic bacteria that actually cause bad breath. Some products contain VSC-neutralizing agents, such as chlorine dioxide or zinc.

  • b) Compounds that have antibacterial properties.

    Look for products that contain antibacterial agents such as chlorine dioxide or cetylpyridinium chloride.


Option #2: Tongue scraping.

There are two basic types of tools that you can use with this technique, either a "scraper" or a "cleaner."

a) Scrapers

In its simplest form, this type of tool might just be an inverted spoon (the "homemade" solution for tongue cleaning, see picture below). Or you might choose to use a specially-designed tongue scraper.

As advantages, with a scraping device you get the satisfaction of being able to see the gunk that's come off your tongue. And you may find that you have less of a tendency to gag when using one.

As for disadvantages, scrapers tend to just clean the surface of your tongue, as opposed to down in grooves and furrows like possibly brush bristles can. And you may be more likely to cause tissue trauma with a scraper, at least until you get the hang of using it.

A picture of a tongue 'Cleaner.'

A tongue "cleaner."

b) Cleaners
Tongue "cleaners" are the middle ground between scrapers and brushes. Their design typically includes:
  • An arrangement of rubber bristles or nubs that help to break up the tongue's coating and clean down in grooves and furrows.
  • A blade part that scrapes your tongue's surface.
Which type of device should you use?
By at least a small margin, tongue cleaners are probably the most effective type of tool.

But as we mentioned above, a decision about which to use (a cleaner, specially designed scraper or even just a spoon) should simply depend on which you prefer. All are valid implements.

If you end up shopping around for one of these devices, you'll find there's no shortage of designs to choose from. And there's no hard or fast rule about how to pick one out. Just go with the type that looks right to you. The one that looks like it would be most effective or easiest to use, and then go from there.

Instructions- How to scrape your tongue.

To experiment with tongue scraping, you don't have to buy anything special. You can just use a spoon out of your silverware drawer. When scraping, here's what to do.

Tongue scraping using a spoon.

A picture of using a spoon as a tongue scraper.

This simple "homemade" solution makes a pretty reasonable choice.

  • Pick out a spoon. Smaller is usually better than larger. An iced tea spoon or regular teaspoon can make a good choice.
  • Moisten the spoon. (So the gunk you scrape off will wash off it easier.)
  • Stick your tongue out as far as you can and look for evidence of the coating that's formed. This will give you an idea of what you are trying to remove and where it's located.
  • Turn the spoon upside down. Place it at the back of your tongue and draw it forward, using just enough pressure so it makes steady contact. (Be thorough but gentle. Don't scrape so hard that you irritate your tongue.)

    [You'll probably find that you've scraped off a lot of whitish, or even brown, goo. You might try smelling it. This is what your breath smells like to others.]

  • Rinse the gunk off your spoon by running it under your tap.
  • Repeat the process a few times until that point when no more debris seems to come off. (Different than with brushing, it's easy to tell when you're finished scraping.)
  • Once finished, rinse your mouth out with water. Stick your tongue out and admire your work.

Store-bought cleaners and scrapers are used the same way.

If you find scraping preferable to tongue brushing, you might decide to give up on your "homemade" spoon scraper in favor of a specialty device.

If you do decide to buy a specialty item, just use it in the same way. Pull the tool from back to front, repeatedly, until the bulk of the tongue's coating has been removed.


Our next page explains which mouthwashes do what, when it comes to curing bad breath.

 

 Page references sources: 

Bartold M. Update on Breath malodor.

Danser MM, et al. Tongue coating and tongue brushing: a literature review.

Delanghe G, et al. Halitosis, foetor ex ore.

Outhouse TL, et al.Tongue scraping for treating halitosis (Review).

Pham TAV, et al. Clinical trial of oral malodor treatment in patients with periodontal diseases.

Redmond AM, et al. Endocarditis after Use of Tongue Scraper.

Slot DE, et al. Treatment of oral malodour. Medium-term efficacy of mechanical and/or chemical agents: a systematic review.

Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis.

Yaegaki K, et al. Examination, Classification, and Treatment of Halitosis; Clinical Perspectives.

Zurcher A, et al. Diagnosis, Prevalence, and Treatment of Halitosis.

All reference sources for topic Bad Breath.

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