The alternative is to scrape your tongue with a special tongue cleaner. This method is also under assessment in the newest Cochrane review. Their last report found just two small trials looking at this method. They showed it can work, but that the effect is short-lived. They also highlight the risk of damaging the tongue by pressing too hard and to ensure that if you want to use a toothbrush to clean your tongue, you make sure that it’s a soft one.
Poor dental hygiene, chronic sinus issues, inflamed tonsillitis, and large tonsils may contribute to a build-up of this hardened material.

The most common cause of chronic severe bad breath is a dental infection. We do not mean a simple overgrowth of oral bacteria due to a buildup of plaque. That is what we discussed in the previous section. We mean an active dental disease, like decay (cavities) or gum disease.
The medical condition dry mouth (also called xerostomia) also can cause bad breath. Saliva is necessary to moisten the mouth, neutralize acids produced by plaque, and wash away dead cells that build up on the tongue, gums, and cheeks. If not removed, these cells decompose and can cause bad breath. Dry mouth may be a side effect of various medications, salivary gland problems, or continuous breathing through the mouth. In fact, morning breath is worse for people who sleep with their mouths open.