We are all thoughtful of the quality of our breath and patients have expressed all kinds of concerns to me: “I am afraid to speak.’ ‘Co-workers shy away from me when I talk to them.’ ‘Why is it that my child’s breath smells?’ Often times we ourselves cannot truly tell how our own mouths smell, and I find that personal paranoia is usually greater than an existing condition. So I tell my patients to ask someone close to them. perhaps a spouse, a parent, a sibling, whether or not a case of bad breath exists. If it is then confirmed that halitosis exists, we have an issue. So let’s explore the underlying conditions that may cause this phenomenon.
Poor oral hygiene would be culprit number one. Improper brushing or flossing that leaves food on or in between the teeth will cause odor. As we chew, digestion begins and food particles breakdown in our mouths. If they are not properly removed with either subsequent brushing/flossing and rinsing they will accumulate on your teeth as plaque, collect bacteria, and release Hydrogen Sulfide vapors, or bad breath.
Bleeding gums or lose shifting teeth are a sign of gingivitis or periodontal disease which will also cause halitosis. Don’t forget to clean your tongue, especially the posterior 1/3, every time you brush. Most bad smells come from the back of your tongue. Take a soft bristle brush and scrub your tongue well twice a day to clean off accumulated dead epithelium. Even if it gags you, scrub well.
Poor fitting dental work like open crown margins, leaky root canals, decaying old fillings, or poorly cleaned dentures all cause bacteria to grow which emits a bad odor. If you have had any teeth extracted and are now developing a pain radiating through your jaw coupled with a bad smell, you may have an alveolar osteitis or dry socket. This is a painful condition when a blood clot is lost prematurely. You need to visit your dentist ASAP for treatment because this condition will not resolve on its own.
Dry mouth can also cause bad breath. This condition is caused by either poorly functioning salivary glands or may be a side effect from certain medications. Saliva washes out dead epithelial cells and bacteria which are usually swallowed. However, people afflicted with dry mouth have low saliva production and so these dead cells accumulate on the teeth, tongue, and tissue, and like in morning mouth, cause odor. Chewing sugar-free gum, parsley, mints, and mouth rinses are good ways to temporarily combat this. Also it is imperative that your dentist make you fluoride trays which will strengthen your tooth enamel and slow down root surface decay.
If your dentist has reviewed all of the above conditions with you and they are within normal limits yet you still maintain chronic bad breath, then a visit to your internist is warranted. Allergies or chronic sinusitis can cause a postnasal drip into the back of your throat resulting in an odor. Blood work should be taken and evaluated to rule out certain systemic diseases as well. Metabolic disorders of the kidneys can cause urine-like breath. Problems with the pancrease like noncontrolled diabetes can create a fruity-like odor. The lungs need to be evaluated to rule out infection as does your gastrointestinal tract for disorders like gastroesophageal reflux disease or GERD.
Certain diets particularly those high in protein can cause ketosis which makes your breath small acidic.
Most cases of bad breath can be treated with proper oral hygiene techniques, i.e. brushing twice a day, flossing at least once, rinsing your mouth with appropriate rinses or even warm water after you eat, and certainly cleaning your tongue. One mouth rinse that I recommend to my patients is the all natural Tooth and Gum Tonic. It is excellent for your gums and really makes your mouth feel fresh.
Visit your hygienist at least twice per year for cleanings, polishings, and your dentist for check-ups. Your dentist will help to determine if a case of bad breath can be managed in house, or if perhaps there is an underlying condition that needs to be addressed. Remember that prevention is key and dental problems are like a can of worms. Once they start and if left to progress, your mouth will deteriorate quickly, and mouth infection, be it soft tissue, bone, or tooth related, usually goes unnoticed until it becomes advanced. Early detection by your dentist will save you money, energy, and time and if arrested quickly can be maintained for a lifetime.