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Paging Dr. Frischer - Bad Breath

Do you have bad breath? It’s certainly embarrassing. Where does it come from?
Halitosis describes noticeably unpleasant odors exhaled while breathing. It actually has just as large an impact – personally and socially – on those who think that they suffer from it (halitophobia) as it does on those who actually do. Clearly, it can have a negative impact on one’s personal, social and business relationships, and can lead to poor self-esteem and increased stress. It is a major reason for seeking dental care. Chronic halitosis affects up to 25 percent of us, and occasionally a more serious condition can be responsible.
Most often, bad breath originates in the mouth itself. Its intensity varies during the day, depending on oral dryness, which may be due to stress, fasting, or poor fluid intake, as well as consumption of certain foods such as garlic, onions, meat, fish and cheese. Other factors include obesity, smoking and alcohol consumption. Because the mouth is dry and inactive during the night, the odor is usually at its worst upon awakening (morning breath). This bad breath may be transient, often disappearing after eating, brushing teeth, flossing, and rinsing.
The most unpleasant odors come from proteins trapped in the mouth, which are processed by oral bacteria. There are over 600 types of bacteria found in the average mouth. Many of these can produce high levels of foul odors when incubated in the laboratory. Common regions of the mouth contributing to odor include the back of the tongue, between teeth, beneath the gums, abscesses, and unclean dentures.
The tongue is the most common location for mouth-related halitosis. Here, bacteria are undisturbed by normal swallowing activities, it is relatively dry and poorly cleansed, and bacteria can thrive on remnants of food deposits, dead epithelial cells and postnasal drip. The odors are mainly due to the anaerobic breakdown of proteins into amino acids and then into foul-smelling gasses.
The second major source of bad breath is the nose. Nostrils can emit a pungent odor, which differs from oral odor. Nasal odor may be due to sinus infections or foreign bodies.
The tonsils can contribute to halitosis. Perhaps 7 percent of us suffer from small bits of calcified matter in tonsilar crypts called tonsilloliths. This hardened matter has an extremely foul odor and when released can cause bad breath.
Belching, of course, can bring up unpleasant odors from the stomach to the mouth. While reflux disease does cause stomach contents to rise to the mouth, the esophagus is an alternating open/closed tube, so there is no continuous flow or opening to the mouth. Therefore, reflux disease doesn’t tend to cause chronic halitosis.
There are some general systemic conditions that can cause bad breath, including chronic liver disease, lung and kidney infections, kidney failure, diabetes and certain cancers.
The best way to make the diagnosis…believe it or not…is to simply ask a close friend or family member whether or not your breath smells bad. Relying on oneself to make the diagnosis is unreliable due to habituation (we’re used to the way we smell!).
There are commercial breath clinics that claim to diagnose and treat bad breath. They use a “Halimeter”, a portable monitor used to test for levels of hydrogen sulfide and other emissions. Results are confused by the presence of garlic and onions, which produce sulfur for up to 48 hours and lead to false positive readings. Tests are also run to measure different enzymes in the saliva. My personal recommendation is to stick with the admittedly old-fashioned, but effective, “sniff” test.
See your doctor or dentist to rule out any treatable diagnosis. These suggestions should make a difference:
Go to the dentist regularly and maintain good oral hygiene. This includes brushing, flossing, and hygienist visits. Dentures should be properly cleaned and soaked overnight in antibacterial solutions
Maintain proper hydration by drinking several glasses of water per day
Chew gum to keep the mouth moist and to help prevent bad breath from dryness. Some gums contain special anti-odor ingredients. Folk remedies include chewing on fennel seed, cinnamon sticks, mastic gum or fresh parsley
Eat a healthy breakfast that includes roughage to help clean the back of the tongue
Gently clean the tongue surface twice daily with a tongue brush to scrape off bacterial biofilm, debris and mucous. Some people use an inverted teaspoon, but be gentle so as not to damage the taste buds
Gargle at bedtime with a mouthwash. Mouthwashes often contain antibacterial agents, which can be effective. Avoid those that contain alcohol, since this is a drying agent and may worsen the problem. Do not use a mouthwash just after tooth brushing, as many toothpastes will counteract the active ingredients of mouthwash
As always, seek the help of your primary care physician when necessary I wish you good health and pleasant breath.
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Published: January 9, 2009 – Volume 7 – Issue 38



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