WebMD Feature By Leanna Skarnulis Reviewed By Michael Smith, MD
Dentists can tell you horror stories about the terrible social and professional consequences of chronic bad breath. A 6-year-old boy whose classmates called him "Stinky." A stockbroker whose co-workers told his boss they'd chip in to set him up with a home office so they wouldn't have to be around him. A dentist who knew his own breath was offensive to patients. Fortunately, these people found they didn't have to live with bad breath. In most cases there's no cure, but experts say managing the symptoms leaves breath kissing-fresh.
Wondering if your breath smells? Try this test at home, says Harold Katz, DDS, founder of the California Breath Clinics in Los Angeles and San Francisco. Lick the back of your hand and let the saliva evaporate. If odorous compounds are in your saliva, they'll remain on your hand. Sniffing it will tell you what your friends won't.
If you're not sure you have bad breath, ask your dentist. Katz uses a halimeter to measure the sulfur in your breath. Anything over 75 parts per billion is not quite fresh, and over 120 is a problem.
Sniffing the breath can help you determine where the bad breath is coming from, says American Dental Association (ADA) spokesman Richard Price, DDS, recently retired from private practice in Boston. "The patient takes a deep breath and holds it for three minutes, then slowly exhales through the mouth. Then they do the same thing, only exhale through the nose. If the bad breath is coming from the nose, I'd refer them to their physician because it could be a sinus infection."
Blame Bad Breath on Your Mouth
Experts say at least 90% of all bad breath originates in the mouth. "It used to be that physicians and dentists accepted as gospel that 90% of halitosis came from gastric reflux or hiatal hernia," says Ken Fieldston, DDS, who practices dentistry in Cresskill, N.J. "That idea came from a medical paper that we now know was based on speculation, not research. Less than 5% of bad breath is due to gastric reflux."
Basic dental hygiene that includes brushing and flossing is important, but the crud that collects between your teeth isn't the main source of odor. It comes from the back of your tongue, and the culprit is sulfur compounds, by-products that occur when anaerobic bacteria (they thrive in the absence of oxygen) break down food.
These bacteria play a role in digestion, and as long as your mouth has plenty of oxygen-rich saliva, they do their job without offending. "Think about drooling babies," says Katz. "They smell so sweet because of all that healthy saliva." It's when your mouth is dry that the bacteria brew up trouble. Dry mouth can result from a medical condition, such as diabetes or a cold, or as a side effect of a number of medications, such as antidepressants, antihistamines, and long-term use of antibiotics.
How to Combat Bad Breath
Brush and floss. "Getting rid of any body odor begins with good hygiene," says Price. The ADA recommends brushing twice a day with fluoride toothpaste, brushing your tongue, and flossing. Dentures should be removed at night and thoroughly cleaned. Katz says brushing the tongue with most brands of toothpaste dries the mouth because they contain sodium lauryl sulfate, a chemical also used in shampoos to create foaming action. Moisturize mouth and nasal passages. Chewing sugarless gum or snacking on an apple will promote saliva production. "Anytime you put food in your mouth, there's a reflex to produce saliva," says Price. In the winter, run a humidifier and use a saline solution, such as Ocean nasal spray, to keep nasal passages moist.
Use a tongue scraper. "Physically remove the bacteria and plaque," says Price. "I always had bad breath from allergies, postnasal drip, and mouth-breathing, which as a dentist was not cool. I scrape my tongue the first thing in the morning and the last thing at night, and my wife says I wake up fresh as a tulip." He adds there's a trick to scraping without gagging. "Force yourself to exhale as you scrape. You will overcome the problem. I did." Rinse with chlorine dioxide. Your dentist may recommend a mouthwash containing chlorine dioxide. "People grab an over-the-counter mouthwash, but they're just perfume, says Fieldston. "They accentuate the problem because they contain alcohol, which dries the mouth. Chlorine dioxide combines chemically with the sulfur compounds and makes them inert." Katz makes a complete line of products, including oral rinse, breath drops, and toothpaste, containing chlorine dioxide (which appears on labels as "Oxyd-8"). The products, available in drug stores, are sold under the brand name TheraBreath.
What to Do if the Problem Persists
If bad breath persists, see your dentist, who will do a dental exam and inquire about your general health, diet, and medications. The cause could be gum (periodontal) disease or some other condition that needs special treatment. "Some people have fissures and grooves in the tongue where food and plaque get trapped," says Fieldston. "We use an ultrasonic scaler to vibrate it off the tongue, and immediately the individual feels a cleaner mouth. They can maintain it by brushing or scraping the tongue and using a chlorine dioxide mouthwash."
Mouth breathing is another condition that may require special treatment. "Mouth breathers can wake up with horrible breath, and their gums can become inflamed," says Fieldston. Treatment involves wearing a plastic guard containing fluoride at night, scraping the tongue before bed, and using a chlorine dioxide rinse.
Your dentist will refer you to your doctor if the source of your bad breath is somewhere other than your mouth.
What About Onions and Garlic?
Eat onions and garlic, and you'll pay. Experts say there's not much you can do about the odor that comes from these sulfur-producing foods. Through digestion, the odor is absorbed into the bloodstream and delivered to the lungs, where it's pumped out as dragon breath.
Drinking Tea May Ward Off Bad Breath
Some beverages, especially alcoholic ones, can give you bad breath, but a cup of green or black tea may freshen it. Tea contains antioxidants called "polyphenols," which in a laboratory study inhibited growth of bacteria that causes bad breath and reduced sulfur compounds by 30%. The study was reported at the 2003 annual meeting of the American Society for Microbiology by Christine Wu, professor of periodontics and associate dean for research at the University of Illinois at Chicago College of Dentistry. She notes that the study, conducted in labs rather than in people's mouths, doesn't prove tea sweetens bad breath. But it's a promising line of research she says she hopes to continue.
Originally published July 21, 2003. Medically updated July 14, 2004.
WebMD Feature By Leanna Skarnulis Reviewed By Michael Smith, MD