Halitosis: Many Causes and Treatments of Bad Breath
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By Dr. David Leader
When Good Breath Goes Bad
Patients often ask dentists what to do for bad breath or halitosis. Various ailments, foods and hygiene practices affect mouth odor. There is not a single way to treat halitosis. Before the dentist is able to advise their patient, they must ask a battery of questions.
Diet is the most obvious cause of mouth odor. Everyone knows that garlic causes garlic breath. Long after eating a garlic-laden meal, the spicy smell lingers. That is because the odor causing sulfurous chemicals in garlic float in the blood for hours. When oxygen and carbon dioxide exchange places in the lungs, those garlic odors rise out of the lungs for all to notice. Mint mouthwash or breath mints only mask the odor for a short time.
High protein diets like the Atkin’s diet cause bad breath. When the lack of carbohydrates forces the body to create energy by breaking down fat, ketones are released. People who have ketoacidosis are likely to loose bone density and have a higher rate of kidney stones. Frequently, dentists diagnose the characteristic sweet odor of ketones when patients request treatment for oral malodor. This condition is easy for non-diabetics to reverse by balancing their diet.
Ketoacidosis is very serious for diabetics. Type 1 diabetics may suffer from ketoacidosis when their blood sugar level is low. If a diabetic or someone with them notices the characteristic fruity, sweet mouth odor, seek professional medical advice immediately.
Smoking and consumption of alcohol cause halitosis. As with food, these odors lodge in the lungs and blood. Breath mints, sprays and mouthwash only provide temporary freshening.
Many disorders will cause the level of oral bacteria and fungi to increase. Periodontitis is a bacterial infection of the gums. Severe periodontitis will release a characteristic odor. Dentists treat periodontitis by removing bacteria from around the teeth using surgical and nonsurgical techniques. Patients maintain their periodontal health with regular tooth brushing, flossing, and rinsing with an anti-microbial rinse such as Peridex or Crest Pro-Health rinse.
Sinus infection and other respiratory infections are another cause of halitosis. When patients have malodor due to a respiratory infection, they usually require treatment with antibiotics. It is important for a medical doctor to supervise that treatment.
Pharyngeal pouch is a pocket that may form next to the esophagus. This condition usually occurs in older men. The pouch fills with food causing an obstruction. Inability to swallow (dysphagia) and bad breath are characteristic. Surgical removal of the pouch cures both the dysphagia and halitosis.
Some commercial treatments such as BreathRX oversimplify the cause of breath odor. Dr. Bill Dorfman, founder of BreathRx, pegs the cause of bed breath on bacteria that create volatile sulfur compounds (VSCs). “Can gum disease or other health conditions cause bad breath?” is a “frequently asked question” on his web site: www.breathrx.com. Dr. Dorfman’s answers, “In some cases, gum disease may be the cause of bad breath.” He writes that your dentist will help with treatment and advice, and “All BreathRx products are designed to fight bad breath and promote overall oral health.”
Are there treatments that really work? If you, your dentist, and your physician rule out systemic disease and disorder, then consider diet as a source of malodor. Use sugar free mints, gum, sprays and mouth rinses as short-term cover-ups. Practice careful oral hygiene including brushing three times a day, flossing once or twice a day, and rinsing after brushing with an American Dental Association approved anti-plaque rinse. See your dentist two or more times per year for professional cleaning and thorough exams.
Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.