BAD BREATH

     Halitosis, bad breath, malodor—we’ve all experienced a situation where you slowly lean back when you get a whiff of someone’s breath.  Why aren’t they aware of it?  The body becomes accustomed to its own odors—an adaptation which is a dulling of the senses through continual exposure.  But this adaptation can have serious, embarrassing consequences—both professionally and personally.

Causes of Chronic Bad Breath

Bacteria are almost always the cause of chronic bad breath.  Hundreds of different types of bacteria live in your mouth and feed on the food you’ve eaten. By hiding in crevices in the mouth (tongue, tonsils, under the gums), oxygen cannot kill the bacteria.  Volatile sulfur compounds (VSC) are then released and give breath its bad odor.

The deep crevices found on the tongue can host 50% of all the bacteria and are a perfect escape from the toothbrush and floss. Post nasal drip creates a discharge that lingers on the back of the tongue and provides a blanket under which bacteria can hide. Drinking water can help thin the nasal mucous.  A tongue scraper (used for many years in other countries) is used to gently scrape a layer of bacteria, plaque and food debris. By incorporating a daily routine of tongue cleaning, your breath will be much fresher by simply using your toothbrush or purchasing a dental tongue scraper. 

Sinus drainage can also get lodged in the tonsils and a foul smelling exudate can form and harden.  These tonsilloliths or stones are white or yellow and rough.  These stones have a bad odor but some studies show they may not be a significant source of chronic bad breath.

Patients with periodontal disease can often have a particularly bad odor since large amounts of bacteria related to this gum disease are trapped in deeper pockets.  Since cleaning is extremely difficult, VSC are continually produced.  Once the periodontal disease has been treated, the problem of breath odor improves. Decay, cracked fillings or leaky margins of old restorations can also harbor bacteria and food particles that lead to a foul smell.

Causes of Temporary Bad Breath

Certain foods (i.e. cabbage, garlic, onions) contain sulfur compounds which are absorbed into the bloodstream and then carried to the lungs.  The VSC forms for several hours after ingestion and then is exhaled when you breathe.  New products are available that neutralizes the sulfur compounds while they are in the blood stream.

Saliva—The Perfect Mouthwash 

Saliva washes away bacteria, keeps the mouth moist and dissolves VSC. Decreased salivary function and the resulting dry mouth is a haven for bacterial growth.  Microbial activity increases and bad breath occurs.  Some commercial mouthwashes contain alcohol which then dries the mouth thereby contributing to malodor.  However, mouth rinses containing chlorine dioxide directly attacks VSC.  Breath mints are not formulated to mask the odor but to actually stimulate salivary flow.  Also, some medical conditions or prescription drugs result in a dry mouth and several dental products are available to help moisten the oral cavity.

Low Carb Diets and Bad Breath

Low carb diets can cause not only weight loss but can also cause bad breath! By increasing protein, the body turns to stored fat instead of carbohydrates for fuel.  Ketones are developed which is then expelled through the mouth leading to an offensive odor.  Also the low carb craze results in initial rapid weight reduction which can be mostly water loss. The resulting dry mouth can be responsible for malodor.

Eliminating Bad Breath

There are many ways to remedy temporary and persistent, chronic bad breath.  Avoid those foods which contain sulfur compounds.  Schedule regular dental visits for professional cleanings and checkups.   Detecting decay, failing restorations or periodontal disease in its early stages is important.  Dry mouth can be alleviated by increasing fluid uptake or using artificial saliva products. Also available are commercial toothpastes and mouthwashes (i.e. CloSysII, BreathRx, Oxyfresh) that neutralize VCS compounds (contains chlorine dioxide).  However, flossing, brushing and tongue scraping on a daily basis are the most important ways to prevent halitosis. 

Systemic Factors

If your mouth is in healthy condition, malodor can be a sign of a medical disorder such as a gastrointestinal ailment, diabetes, liver or kidney problems, chronic bronchitis, chronic sinusitis, or a chronic infection in the respiratory tract (throat, nose, lungs).  Tobacco users are at greater risk for developing oral, laryngeal or nasopharyngeal cancer.  Alcohol use can increase the risk of oral cancer and laryngeal cancer as well.  Contact your family doctor or specialist to determine the cause of bad breath for appropriate treatment.