Bad Breath

BAD BREATH

Bad breath, also called HALITOSIS, can be embarrassing and in some cases may even cause anxiety. Store shelves are overflowing with gum, mints, mouthwashes and other products designed to fight bad breath. But many of these products are only temporary measures because they don’t address the cause of the problem.

Symptoms

Bad breath odors vary, depending on the source or the underlying cause. Some people worry too much about their breath even though they have little or no mouth odor, while others have bad breath and don’t know it. Because it’s difficult to assess how your own breath smells, ask a close friend or relative to confirm your bad-breath questions.

Causes

Most bad breath starts in your mouth, and there are many possible causes. They include:

• Food. The breakdown of food particles in and around your teeth can increase bacteria and cause a foul odor. Eating certain foods, such as onions, garlic and spices, also can cause bad breath. After you digest these foods, they enter your bloodstream, are carried to your lungs and affect your breath.

• Tobacco products. Smoking causes its own unpleasant mouth odor. Smokers and oral tobacco users are also more likely to have gum disease, another source of bad breath.

• Poor dental hygiene. If you don’t brush and floss daily, food particles remain in your mouth, causing bad breath. A colorless, sticky film of bacteria (plaque) forms on your teeth. If not brushed away, plaque can irritate your gums and eventually form plaque-filled pockets between your teeth and gums (periodontitis). Your tongue also can trap bacteria that produce odors.

• Dry mouth. Saliva helps cleanse your mouth, removing particles that cause bad odors. A condition called dry mouth or xerostomia (zeer–o-STOE-me-uh) can contribute to bad breath because production of saliva is decreased. Dry mouth naturally occurs during sleep, leading to “morning breath,” and it worsens if you sleep with your mouth open. Chronic dry mouth can be caused by a problem with your salivary glands and some diseases.

• Medications. Some medications can indirectly produce bad breath by contributing to dry mouth. Others can be broken down in the body to release chemicals that can be carried on your breath.

• Infections in your mouth. Bad breath can be caused by surgical wounds after oral surgery, such as tooth removal, or as a result of tooth decay, gum disease or mouth sores.

• Other mouth, nose and throat conditions. Bad breath can occasionally stem from small stones that form in the tonsils and are covered with bacteria that produce odor. Infections or chronic inflammation in the nose, sinuses or throat, which can contribute to postnasal drip, also can cause bad breath.

• Diseases, such as some cancers, and conditions such as metabolic disorders, can cause a distinctive breath odor as a result of chemicals they produce.

• Chronic reflux of stomach acids (gastroesophageal reflux disease, or GERD) can be associated with bad breath. Bad breath in young children can be caused by a foreign body, such as a piece of food, lodged in a nostril.

Diagnosis

• Your dentist will likely smell both the breath from your mouth and the breath from your nose and rate the odor on a scale. Because the back of the tongue is most often the source of the smell, your dentist may also scrape it and rate its odor.

• There are sophisticated detectors that can identify the chemicals responsible for bad breath, though these aren’t always available.

Prevention

What Can I Do to Prevent Bad Breath?

• Practice good oral hygiene. Brush twice a day with fluoride toothpaste to remove food debris and plaque.

• Brush teeth after you eat (keep a toothbrush at work or school to brush after lunch). Don’t forget to brush the tongue, too.

• Replace your toothbrush every 2 to 3 months or after an illness.

• Use floss or an interdental cleaner to remove food particles and plaque between teeth once a day. Rinse with an antibacterial mouthwash twice a day.

• Dentures should be removed at night and cleaned thoroughly before being placed in your mouth the next morning.

• Stop smoking and chewing tobacco-based products. Ask your dentist for tips on kicking the habit.

• Keep a log of the foods you eat. If you think they may be causing bad breath, bring the log to your dentist to review. Similarly, make a list of the medications you take. Some drugs may play a role in creating mouth odors.

• Drink lots of water. This will keep your mouth moist. Chewing gum (preferably sugarless) or sucking on candy (preferably sugarless) also stimulates the production of saliva, which helps wash away food particles and bacteria. Gums and mints containing xylitol are best.

Treatment

In most cases, your dentist can treat the cause of bad breath. If your dentist determines that your mouth is healthy and the odor is not of oral origin, you may be referred to your family doctor or to a specialist to determine the odor source and treatment plan. If the odor is due to gum disease, for example, your dentist can either treat the disease or refer you to a periodontist, a dentist who specializes in treating gum conditions.

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